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Ouch! My ankle really hurts

By Greg Hearn
Physiotherapist at Life Ready Physio Baldivis

What is an ankle sprain?

Ankle sprains are one of the most common musculoskeletal injuries, accounting for 15-20% of all sporting injuries. The vast majority of ankle sprains involve the ligaments on the outside of the ankle (lateral ligament complex). This consists of the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament.

Together, these ligaments connect bones together on the outside of the foot, prevent excessive movement occurring, and provide stability to the ankle.

How do ankle sprains occur?

Ankle sprains most commonly occur when the foot is internally rotated while the toes are on the ground, and the heel up.
Injury typically occurs to the anterior talofibular ligament first, followed to a varying degree by injury to the calcaneofibular ligament.
The posterior talofibular ligament is usually spared from injury unless the ankle is dislocated.

How is an ankle sprain graded?

Ankle ligament sprains are usually graded on the basis of severity. Grade one is mild stretching of the ligaments without rupture or joint instability.

Grade two is partial rupture of the ligament with moderate pain and swelling. There may be functional limitations and slight to moderate instability that generally affects the ability to bear weight through the ankle.

Grade three is a complete ligament rupture with marked pain, swelling, and bruising. In grade three injuries there is a marked impairment of function with instability.
What treatment is involved in ankle sprains?

Initially treatment involves applying the rest, ice, compression, and elevation principle to control the acute inflammatory process and prevent further damage.

Taping and bracing may be used in the short term to provide stability to the ankle and assist in return to normal activities.

Treatment may then be progressed to functional rehabilitation which is aimed at restoring and improving strength, proprioception, and protective balance reactions at the ankle to prevent recurrent sprains occurring.

In severe cases, surgical intervention may be recommended. This primarily involves repairing the ruptured ligaments with internal sutures. However, there is currently very little evidence to suggest that surgical intervention is any more effective than functional rehabilitation.

  1. Peterson et al (2013): Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg. 133: 1129-1141
  2. Brukner P & Khan K (2012): Clinical Sports Medicine (4th ed). McGraw Hill Co., Sydney
  3. Kerkhoffs et al (2010): Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database of Systematic Reviews. 2: 1 -79
  4. Chaudhry et al (2015): Cochrane in CORR: Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults (Review). Clinical Orthopaedics and Related Research. 473: 17-22
  5. Pihlajamaki et al (2010). Surgical versus functional treatment for acute ruptures of the lateral ligament complex of the ankle in young men: A randomized controlled trial. The Journal of Bone and Joint Surgery. 92: 2367-2374
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  8. Prado et al (2014): A comparative, prospective, and randomized study of two conservative treatment protocols for first episode lateral ankle ligament injuries. American Orthopaedic Foot and Ankle Society. 35(3): 201-206
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  11. Holme et al (1999): The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scandinavian Journal of Medicine & Science in Sports. 9(2): 104-9

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