The most common injury we see of the ankle complex is the sprained ankle. An ankle sprain is defined as a stretching and/or tearing of the strong ligaments that connect the lower leg bones to the ankle bones and help increase ankle joint stability.
Ankles have a lateral ligament complex consisting of the anterior talofibular (at the front), the calcaneofibular (at the side) and the posterior talofibular (at the back) and the deltoid ligament on the medial aspect. Approximately 80% of ankle sprains occur with injury to the lateral aspect, specifically the anterior talofibular ligament. An ankle injury can occur while playing sport, landing on an uneven surface or just plain walking and occurs across all ages.
Dependent on the degree of tearing, the injury to the ligament/s can vary from a slight sprain to a complete tear.
Injured ankles are graded on a scale of 1-mild, 2-moderate and 3-severe.
A grade 1 ankle sprain presents with:
- Small tear
- Very little pain
- Little or no ankle joint instability
- Some pain with weight bearing activities
- Some loss of balance
A grade 2 ankle sprain presents with:
- Some tearing of the affected ligament/s
- Moderate to severe pain and swelling
- Moderate joint instability
- Moderate joint stiffness
- Pain with weight bearing activities
- Poor balance
A grade 3 ankle sprain presents with:
- Completely torn ligament
- Severe pain at the time of injury followed by very little pain
- Gross joint instability
- Severe joint swelling
- Possible pain with weight bearing
- Poor balance
We will assess the extent of your injury using the above grading scale and commence management. Immediate management follows the RICER - rest, ice, compression, elevation and referral protocol for the first 48 - 72 hours post injury. Applying ice should continue for 20 min every 2 hours in the first 48 - 72 hours. This is to reduce bleeding, swelling and further damage within the joint. Dependent on the grade of sprain, pain relief may also be required. Crutches will be recommended if putting weight on the injured ankle may worsen symptoms. Orthopaedic referral for further medical advice will be issued, if a broken bone is suspected.
Once the acute phase of injury has passed, treatment aims at restoring normal range of motion as quickly as possible and improving muscle strength. One important factor in the recovery of sprained ankles is to restore proprioception or balance. Proprioception and balance need to be retrained to minimise the likelihood of re-injury and long term joint instability.