Lateral Ankle Sprains
What are they and why are they so common?
Lateral ankle sprains are the most common acute injuries in sports. The three common ligaments that are affected by lateral ankle sprains are the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament. They typically occur when the athlete is forced into plantarflexion and inversion, resulting in ligament sprains when excessive pressure is applied. If not properly rehabilitated, lateral ankle sprains can result in ligament laxity, predisposing the athlete to similar injuries in the future.
Some sports/activities where lateral ankle sprains occur:
Softball
Baseball
basketball
Lacrosse
Swimming
Track and field
cheerleaders/ dancers
What are some common symptoms of lateral ankle sprains?
Pain during weight-bearing
Tenderness
Swelling
Bruising
Restricted range of motion (ROM)
Instability in the ankle
A popping sensation or sound at the time of the injury
When to see a doctor:
Call your doctor or go to your certified athletic trainer (ATC) at your school if you have any pain or swelling in your ankle. Self-care measures might be appropriate for most cases but it is better to receive a professional evaluation. If symptoms (i.e. pain) are severe, you may have a severe sprain and in extreme cases, an avulsion fracture of the lower leg.
Causes:
Lateral ankle sprains are caused by a combination of inversion and plantarflexion (Toes toward the ground). Some ways this mechanism can be achieved are:
Landing awkwardly on the lateral aspect of foot while walking or exercising on an uneven surface
Another person stepping or landing on your foot during a sports activity
Prevention:
Properly warming up before exercise
Being careful when walking, running, or working on an uneven surface
Using an ankle support brace or tape on a weak or previously injured ankle
Wearing appropriate shoes designed for the specific activity
Being properly conditioned for the activity
Maintaining good muscle strength and flexibility
Practice stability training, including balancing exercises
How do you diagnose a lateral ankle sprain:
Lateral ankle sprains can be classified into 3 main categories: Grade 1, 2, and 3.
Grade 1: slight damage or stretching to the ligament fibers
Grade 2: Partial tearing of the ligament, you may notice abnormal looseness known as laxity in the ankle joint
Grade 3: complete tear of the ligament, resulting in gross instability of the ankle sprain
A proper diagnosis can be made via special tests or if necessary an MRI. The special tests that would be used are the anterior drawer test and the inversion talar tilt test.
Anterior Drawer Test
Bring the patient's hip to 45 degrees and your patient's knee to 90 degrees flexion. After, while being in the position gently palpate the joint line of the patient with your thumbs and try to move the tibia anteriorly in an explosive movement
Inversion Talar Tilt Test
Patient must be seated with the foot and ankle unsupported and the foot should be positioned 10-20 degrees plantarflexed. The distal lower leg of the foot should be stabilized with one hand that is proximal to the malleoli and the hind part of the foot should be inverted using the other hand. The lateral aspect of the talus is palpated to determine if a tilting motion occurs.
Treatment:
RICE (Rest, Ice, Compression, and Elevation)- Ice the affected ankle for 15 to 20 minutes every hour or so (Preferably wait longer between icing sessions), wrap the ankle with something similar to an ACE Wrap to apply compression, and elevate the ankle
Joint Mobilization - Special manual therapy techniques that help treat joint dysfunctions and regulate the pain
Strength training - Exercises designed to help the injured area to strengthen the weak ankle which include ankle circles (rotating your ankle), ankle pumps ( bend and straighten your ankles briskly), deep calf stretch, calf stretch, heel raises, heel dips and raises, and balancing exercises. (This is to be done after the athlete is cleared to begin the rehab process)
Taping - When the athlete returns to play, the previously injured ankle should be taped to help maintain its stability and prevent re-injury.
Balance or proprioceptive training - These specific exercises aid your body in developing better spatial awareness, balance, and coordination.
Soft tissue work - Kneading and gently manipulating the muscles around the ankle can help alleviate pain
Electrical therapy - Neuromuscular electrical stimulation can be used to reduce swelling
Gait training - Your gait is the way your body walks and the motions it goes through. By doing specific exercises to improve gait, you can end up building endurance, improving posture and balance, developing muscle memory, training your legs for repetitive motions/movements, and improving your ability to walk and stand.
Return to activity plan of the athlete - Your healthcare provider will work with you to develop a plan to return to full activities after examining your lateral ankle sprain. An ankle sprain can result in long-term adverse effects, such as decreased range of motion (ROM) or increased instability without proper treatment
Sources:
Acute Ankle Sprain - Statpearls - NCBI Bookshelf, www.ncbi.nlm.nih.gov/books/NBK459212/. Accessed 26 Dec. 2023.
Hertel, Jay. “Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability.” Journal of Athletic Training, U.S. National Library of Medicine, Dec. 2002, www.ncbi.nlm.nih.gov/pmc/articles/PMC164367/#:~:text=Lateral%20ankle%20sprains%20typically%20occur,suffered%20a%20previous%20ankle%20sprain.
DrSchoene. “What Sports Are Ankle Sprains Most Common In?” Dr. Schoene, 26 Jan. 2023, drschoene.com/press/doc-blog/what-sports-are-ankle-sprains-most-common-in/#:~:text=While%20these%20five%20sports%20are,feet%2C%20causing%20an%20ankle%20sprain.
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NHS Choices, NHS, www.cuh.nhs.uk/patient-information/exercises-for-patients-following-an-acute-ankle-injury-or-operation/. Accessed 26 Dec. 2023.
Lindsey Barton Straus, JD. “Ankle Sprains Most Common High School Sports Injury, Study Finds.” MomsTeam, www.momsteam.com/health-safety/muscles-joints-bones/ankle-foot/ankle-sprains-are-most-common-injury-high-school-sports. Accessed 26 Dec. 2023.
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