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ANKLE
INJURIES
INTRODUCTION
Ankle sprains are caused by direct or indirect trauma to the ankle ligaments. In a sprain, the ankle ligaments that normally support the ankle are either stretched beyond their normal limits or torn outright as a result of this trauma.
The sprain can occur when the ankle is forced beyond its normal range of motion, such as when people twist their ankle when making a sudden stop on an athletic field or track, walking or running on an uneven surface, or when tripping over an obstacle. If not treated, or with repeated sprains of the same tissues, pain and dysfunction from acute ankle sprains can become chronic.
The complex design of an ankle makes it a relatively stable joint compared to other joints in the body, and this stability is essential to its function.
The ankle sustains 1.5 times of the body's weight in impact with every walking step, and up to 8 times the body's weight with each step when running or jumping. In high-impact activities, the normally stable ankle is subject to increased injury risk, especially when it turns or twists too far out of its normal range of motion.
ANKLE INJURIES COMMONLY OCCUR DURING
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Acute injury that forces the ankle joint beyond its normal range of motion, such as in a sports injury or falling off.
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Overuse injury caused by repetitive forces, such as repeated hard landings involved in sports such as long distance running and basketball.
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LIGAMENTS OF THE ANKLE
3 ligaments on the outside of the ankle make up the lateral ligament complex.
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Anterior talofibular ligament (ATFL)
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Calcaneofibular ligament (CFL)
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Posterior talofibular ligament (PTFL
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Deltoid ligament - a thick ligament which supports the entire medial, or inner side of the ankle
The anterior inferior Tibiofibular ligament (AITFL), which connects the tibia to the fibula
Two posterior fibular ligaments, which crisscross the back of the tibia and fibula:
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Posterior inferior Tibiofibular ligament (PITFL)
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Transverse ligament
ANKLE SPRAIN SEVERITY GRADING
GRADE 1 INJURY
Minimal tearing of the affected ligaments.
Cause of injury
Signs & symptoms
Minimal tearing of the affected ligaments.
Tenderness, pain, and swelling of the injury site is minimal, but still enough to be noticed upon viewing or palpating (touching).
Slight bruising or discoloration of the skin may be present, and standing/walking impairment is also minimal.
GRADE 2 INJURY
Moderate tearing of the affected ligaments.
Cause of injury
Signs & symptoms
Overstretch or landing on imbalance surface.
Swelling, pain, and tenderness at the injury site are moderate, some loss of range of motion, ankle instability, ankle partially give way with standing or walking. Moderate bruising or skin discoloration may be present, trouble walking or standing.
GRADE 3 INJURY
Complete tearing or rupturing of the Ligament, with no individual fibres remaining intact.
Cause of injury
Signs & symptoms
Overstretch over landing on imbalance surface.
Swelling and tenderness at the injury site is significant, severe discoloration of the skin (black-and-blue, purplish-black). The ankle cannot support any weight, completely affect range of motion.
Standing, walking, or turning of the foot is impossible.
TREATMENT
GRADE 1 & 2 INJURY
Calls for RICE protocol.
R
I
C
E
Rest
Ice
Compression
Elevation
GRADE 3 INJURY
Sprains and strains are usually unstable and require longer healing.
A. Casting
B. Rehabilitation
Initially used to support the affected ankle from further injury.
Patients may need to undergo a series of rehabilitation treatments, such as electrical stimulation and ultrasound, as well as strengthening exercises to help decrease pain and support the development of new tissue.
REHABILITATION
Physiotherapy is the primary part in ankle rehabilitation to regain optimal ankle strength and performance. Ankle rehab programs begin with non-weight bearing ankle motion exercises.
Increase reps as you get stronger for progression.
Resisted strengthening exercises should be performed with a Theraband. Moving only your ankle, point your foot back toward your nose (while keeping knees straight). Continue until you feel discomfort or can't tilt it back any further. Hold this position for two seconds and slowly release. Return to the neutral position, and then repeat the exercise.
Resisted strengthening exercises should be performed with a Theraband. Moving only your ankle, point your foot forward (while keeping knees straight). You may feel tightness in your calf muscle behind your lower leg. Continue until you feel discomfort or can't move it any further. Hold this position for two seconds. Return to neutral position.
Stand on the injured foot while lifting the uninjured foot off the ground. Raise up, standing only on the ball of the injured foot and lifting your heel off the ground. Hold the position for 15 seconds. Relax and put your weight back onto your uninjured foot.
Resisted strengthening exercises should be performed with a Theraband. Moving only your ankle, point your foot back toward your nose (while keeping knees straight). Continue until you feel discomfort or can't tilt it back any further. Hold this position for two seconds and slowly release. Return to the neutral position, and then repeat the exercise.