Ankle Sprains and Ligament Injuries

A sprained ankle is a very common injury that can happen to anyone from children up to adults and athletes to non athletes and can happen when simply stepping on an uneven surface or incline to actual high impact sporting/physical activities.

Ligaments are connections between bones that hold the bones and joints in the correct position and they protect the joint from excessive motion during a variety of twisting, turning and rolling motions of the foot and ankle.
When a ligament is pushed beyond its normal range a sprain occurs.

If the sprain is severe then actual tearing of the ligament can ensue.

Sprains therefore usually happen when the foot and ankle gets twisted beyond its normal range of motion. A heavy load is normally transmitted on the joint in this vulnerable position causing the ligament to stretch beyond its normal range in an abnormal position resulting in either ligament tears or fractures of the bone that the ligaments are attached to.

It is common for people to experience hearing a pop and most commonly there is immediate pain, swelling with difficulty taking weight on the leg and ankle.

Ligament sprains are divided into three grades.

• Grade I is a mild stretching with minor damage to the ligament fibres
• Grade II is a partial tear of the ligament
• Grade III is a complete tear of the ligament with increased looseness or laxity across the ankle joint itself.

With Grade I injuries there is usually mild swelling, tenderness and with the ability to bear weight reasonably quickly over the next few days. With Grade II injuries there is marked swelling and bruising, some ongoing difficulty weight bearing and Grade III injuries have significant swelling, are very tender and feel as if the ankle bone itself is broken.

Grade I mild sprains are treated by rest, ice, compression bandaging, elevation , walking as tolerated, isometric exercises and range of movement/stretching strengthening exercises as tolerated. There is no evidence for use of splints or casts.

Grade II and Grade III ligament injuries usually require some form of immobilisation in the initial phase followed by physiotherapy with range of motion stretching strengthening exercises.

Grade III ligaments will take a longer period to recover from than Grade II. If there is associated bruising of the bones as they collide when the ankle was initially sprained this can often slow down recovery.
It is therefore important to seek appropriate medical advice and initial an appropriate treatment pathway reasonably urgently for Grade II and Grade III injuries.

All ligament injuries recover through 3 phases, phase 1 normally includes resting, protecting the ankle and reducing the swelling which usually lasts 5-7 days, phase 2 involves restoring range of motion, strength and flexibility which can vary from 1 – 6 weeks and phase 3 involves a gradual return to activities that do not require turning/pivoting but do involve maintenance exercises to be followed later by cutting/twisting/pivotal activities and return to contact and racket sports such as tennis, basketball and football which takes weeks to months.

If the ankle sprain is not appropriately recognised and treated with the necessary treatment programme and care chronic problems of instability and pain may result.

Ligament injuries can be associated with small avulsion chip fractures, cartilage damage within the joint or bruising of the bones all of which may require additional evaluation, investigation and treatment.