Ankle Ligament Sprain (tear)
What is an ankle ligament sprain?
Ankle injuries are one of the most common injuries seen by physiotherapists. This joint acts to provide stability and support in weight bearing while allowing for propulsion, deceleration and change of direction. Injuries to the ankle are extremely common in normal activities. The most frequent ankle injuries occur while playing high intensity sports such as football, soccer, netball and tennis.
What causes an ankle ligament sprain?
The most commonly injured ligament of the ankle is the anterior talo-fibular ligament. This ligament attaches from the fibular(outside bone) to the talus(top of foot). It is one of three ligament bands positioned laterally. It limits the amount of abnormal movement in a frontal direction and the foot turning inwards(inversion). Very often this occurs when the ankle lands on an unexpected object, e.g. uneven ground/hole or opponents foot. Here, the ankle rolls over on the outside. An ankle sprain is the stretching or tearing of ligaments. The extent of damage is classified into grades:
Grade 1 ankle sprain
- Stretching or mild tearing of the ligament
- Little or no functional loss – the joint can still function and bear some weight
- Mild pain, swelling and joint stiffness
Grade 2 ankle sprain
- Severe tearing of the ligaments
- Moderate instability of the joint
- Moderate to severe pain with painful weightbearing
- Swelling and stiffness
Grade 3 ankle sprain
- Total rupture of a ligament
- Instability of the joint
- Severe pain initially followed by no pain
- Severe swelling
How does an ankle ligament sprain feel?
The initial sensation is acute pain on the outside of the ankle. Quite often a snap or crack is heard. This is the ligament tearing. Swelling will develop and the ankle may feel weak and often unstable. Within days bruising may develop.
Management of an ankle ligament sprain and how to fix it
Stop your activity immediately and start initial treatment. Treatment of this injury is best in the first 24-48 hours. The RICE regime should be commenced (Rest, Ice, Compression and Elevation) as this will reduce blood flow, swelling and pain. You should continue the RICE regime until you consult a sports medicine professional, preferably within 2 days of the initial injury. Physiotherapists can accurately assess and diagnose the injury to determine the best method of treatment. Specialised treatment techniques to assist in reducing pain and swelling and enhance the healing of the injured ligaments will be commenced. This will include an appropriate progression of exercises aimed at increasing range of motion, strength and proprioception (balance control). These exercises will speed up your return to sport or work participation and by identifying the cause of the injury, will help prevent re-injury. Preventative measures such as taping or bracing may also be discussed.
Posterior impingement syndrome
What is posterior impingement syndrome?
This refers to the impingement or compression of structures in the back of the ankle. It is commonly seen with activities or sports that involve repeated pointing of the foot or ankle e.g. soccer and ballet.
What causes posterior impingement syndrome?
Repeated or excessive plantarflexion(pointing of foot) compresses structures which can cause inflammation and swelling. Some people are pre-disposed to this condion as they have an enlarged prominence on the back of the talus called an ‘os trigonum.’ Occasionally when the ankle is involved in an inversion ankle injury, the posterior structures are also traumatised, initiating posterior impingement.
How does posterior impingement syndrome feel?
A sharp pain is felt at the back of the ankle when the foot is pointed forward such as during kicking or lifting up onto the toes. Pain is sometimes also experienced when twisting and turning during running.
Management of posterior impingement syndrome and how to fix it
Initially, the ankle should be treated as you would an acute ankle sprain. Adopt the RICE regime and avoid activities and positions reproducing pain. Physiotherapy can be of great assistance by mobilising the talo-crural (ankle) joint and subtalar joint (the joint between the heel and ankle) and guiding you through a progressive exercise program to restore normal function. Biomechanical analysis of the ankle is necessary as this abnormal loads may contribute to aggravation of symptoms. Footwear should also be assessed by your physiotherapist.
In cases of posterior impingement which don’t settle with conservative management, an injection of cortisone may be of great assistance.