Ankle Sprain

Original Editor - Dale Boren, Michael Kauffmann, Pieter Jacobs

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description

An ankle sprain is where one or more of the ligaments of the ankle are partially or completely torn.  

Clinically Relevant Anatomy

An ankle sprain is a common injury in which one or more of the ankle ligaments is torn or partially torn. Inversion ankle sprains are the most common, making up 85% of all ankle sprains.  The most commonly torn ankle ligament is the anterior talofibular ligament (ATFL) which is on the lateral aspect of the ankle.  

Ankle Complex

Epidemiology /Etiology

The most common mechanism of injury for an ankle sprain involving the lateral aspect of the ankle (commonly called a lateral or inversion ankle sprain) is when the foot is forced into a combined movement of plantarflexion and inversion. In this situation the ankle would roll into an outward direction with the foot and toes moving inward toward the midline of the body.  

A less common mechanism of injury involves a forceful eversion movement at the ankle, resulting in injury to the strong deltoid ligament complex.  

File:Inversion of ankle.jpg Ankle Inversion

File:Eversion of ankle.jpg Ankle Eversion

Characteristics/Clinical Presentation

add text here relating to the clinical presentation of the condition

Differential Diagnosis

The Ottawa ankle rules constitute an accurate tool to exclude fractures within the first week after an ankle injury.

Diagnostic Procedures

add text here related to medical diagnostic procedures

Outcome Measures

add links to outcome measures here (also see Outcome Measures Database)

Lower Extremity Functional Scale (LEFS) - www.manualphysicaltherapy.net/Downloads/Lower_Extremity.doc

Examination

add text here related to physical examination and assessment

Medical Management

add text here

Physical Therapy Management

CASE1: Mild ankle sprain (natural full recovery within 14 days)
Taping and making an appointment for a check-up to evaluate the healing of the ankle sprain

CASE2: Severe ankle sprain
In this case physiotherapy is required. Functional therapy of the ankle is shown to be more efficient than immobilisation. Functional therapy treatment will be divided in four steps, related to the four steps in the tissue recovery after an acute ankle sprain, Inflammatory phase, Proliferative phase,  Early Remodelling, Late Maturation and Remodelling.

Step 1: Inflammatory Phase (0-3 days)

Reduction of pain and swelling and improve circulation and partial foot support
Actions
The most common approach to manage ankle sprain consists of rest, ice, compression, and elevation (RICE)
1. Recommendations for the patient:
o REST: advise to rest for the first 24 hours after injury, possibly with crutches to offload the injured ankle and altering work and sport/exercise requirements as needed
o ICE: Apply a cold application (15 to 20 minutes, one to three times per day)
o Apply a compression bandageto control the swelling caused by the ankle sprain
o ELEVATION: ideally elevate the ankle above the level of the heart but minimally avoid positions where the ankle is in a dependent position relative to the body
2. Practice foot and ankle functions:
Ask your patient to move toes and anke within pain-free limits to improve the local circulation.

Step 2: Proliferative Phase (4-10 days)

Goals: Recovery of foot and ankle function and improved load-carrying capacity.
Actions:
1. Patient eduation regarding gradual increase in activity level, guided by symptoms.

2. Practise foot and ankle functions - range of motion, active stability, motor coordination

3. Tape/Brace :
Apply tape as soon as the swelling is decreased. Whether you use a tape or a brace depends on the preferences of the patient. Boyce et al (2005) found that the use of an Aircast ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function compared with standard management with an elastic support bandage.

Still it remains uncertain which treatment (brace, bandage, tape) is most beneficial.

Step 3: Early Remodelling (11 -21 days)

Goals: Improve muscle strength, active (functional) stability, foot/ankle motion, mobility (walking, walking stairs, running).
Actions:
1. Education:

• Provide information about possible preventive measures (tape or brace)
• Advise regarding appropriate shoes to wear during sport activities - judge the quality of the shoes in relation to the type of sport and surface

2. Practise foot and ankle functions

• Practice balance, muscle strength, ankle/foot motion and mobility (walking, stairs, running). Look for a symmetric walk pattern.
• Work on dynamic stability as soon as the load-bearing capacity allows, focusing on balance and coordination exercises. Gradually progress the loading, from statical to dynamic exercises, from partially loaded to fully loaded exercises and from simple to functional multi-tasking exercises. Alternate cycled with non-cycled exercises (abrupt, irregular exercises). Use different types of surfaces to increase the level of difficulty.
  
• Encourage the patient to continue practicing the functional activities at home with precise instructions regarding the expectations for each exercise.

3. Bandage

• Advise to wear tape or brace during physical activities. These procedures are needed until the patient is able to execute correctly the static and dynamic exercises of balance and motor coordination.

Step 4: Late Remodelling and Maturation

Goals: Improve the regional load-carrying capacity, walking skills and improve the skills needed during activities of daily living as well as work and sports.
Actions:
1. Practise and adjust foot abilities (functions and activities)

• Practise motor coordination skills while practising mobility exercises
• Continue to progress the load-bearing capacity as described above until the pre-injury load-carrying capacity is reached
• Increase the compexity of motor coordination exercises in varied situations until the pre-injury level is reached
• Encourage the patient to continue practicing at home
  

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

J Whitman, et al. Predicting short term response to thrust and non-thrust manipulation and exercise in patients post inversion ankle sprain. J Orthop Phys Ther, 2009; 39(3):188-200. 

Clinical Bottom Line

add text here

Recent Related Research (from Pubmed)

Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=10AkQ1Iw49RNj1Cqs_4wNakMkqbX7LuY-6-rVEFqFMH3xQJMDP|charset=UTF-8|short|max=10: Error parsing XML for RSS