The ankle is a very important joint in the body and ankle sprains are very common. The ankle represents the joint between the tibia and fibula (leg bones) with the talus bone (in the foot). This joint is critical for providing stability while walking on level ground, as well as maneuvering on irregular terrain or performing athletics. Although there is a moderate amount of stability to the bones of the ankle, there are important tendons and ligaments that also help stabilize the ankle joint. These include the anterior and posterior tibio-fibular ligament, the deltoid ligament, and the anterior talofibular ligament (ATFL). The ATFL is the lateral (outside) of the ankle and most commonly injured with an ankle sprain.
The supporting ligaments of the ankle are thick bands of tissue that connect bones to other bones and stabilize the joint during twisting and turning maneuvers. However, during a forceful “roll” of the ankle, ligaments can be stretched and torn. Tearing of these ligaments is called a “sprain” and most commonly occurs in the ATFL ligament while “rolling” an ankle. This pain is classically over the lateral (outside) of the foot, just below the lateral malleolus (the bony bump over the outside of the ankle).
Sprains are graded by severity. A grade 1 injury includes stretching of the ligament and a grade 2 strain usually consists of a partial tear. A grade 3 injury describes a complete tear of the ligament with instability of the joint.
The initial treatment for any sprain, including ankle sprains, is the RICE protocol. This consists of Rest, Ice, Compression, and Elevation. For grades 1 and 2 injuries, this is typically all that is required. Often patients are more comfortable using a stabilizing elastic brace, an air-cast, or wearing high-top sneakers for support.
Grade 3 sprains are more severe and typically require supportive devices, such as a short leg brace or sometimes a cast. Rarely, chronic instability may result and the best option may include surgery for stabilization.
Rehabilitation and physical therapy play a critical part in your recovery. In the early recovery period, physical therapy exercises are prescribed to decrease pain and swelling and to maintain ankle range of motion. In addition, therapy is important for proprioception, which is the body’s ability to sense its location in space, which can help prevent future injuries. As you progress with your therapy, strengthening and special training exercises can help your reduce your risk for repeating the same injury. Exercises should be performed in a supervised setting, as well as at home on your own time. Your commitment to rehabilitation is key to a successful outcome.