Sprained ankle

Ankle sprains are among the most common of all sports-related injuries. The ankle joint is designed to adapt to uneven terrain, but a sudden or forceful twisting motion can result in damage to the ankle ligaments. In severe sprains, the ligaments may be torn and the ankle dislocated. In some cases, the bones around the ankle may also be fractured. Tearing or stretching of the ligaments can occur when the foot is rolled or twisted forcefully. High-impact sports involving jumping, sprinting or running on changing or uneven surfaces often, cross country and hockey are a few of the sports commonly associated with ankle sprains.

Lateral ankle or inversion sprains commonly occur when stress is applied to the ankle during plantar flexion. The anterior ligament is most commonly injured. The medial malleolus may act as a fulcrum to further injure the ligament if the strain continues. The peroneal tendons may absorb some of this strain. Medial ankle sprains are less common because of the strong deltoid ligament and bony structure of the ankle. When ligaments are stretched beyond their normal range some tearing of the fibres may occur.

Cause of injury

Sudden twisting of the foot. Rolling or force to the foot, most commonly laterally.

Signs and symptoms

First-degree sprains: Little or no swelling: mild pain and stiffness in the joint.

Second-degree sprains: Moderate swelling and stiffness: moderate to severe pain: difficulty weight bearing and some instability in the joint.

Third-degree sprains:  Severe  swelling and pain: inability to weight bear: instability and loss of function in the joint

Complications if left unattended

Chronic pain and instability in the ankle joint may result if left unattended. Loss of strength and flexibility and possible loss of function may also result. Increased risk of re-injury.

Immediate treatment

RICER. Second- and third-degree sprains may require immobilization and immediate medical attention should be sought.

Rehabilitation and prevention

Strengthening the muscles of the lower leg is important to prevent future sprains. Balance training will help to improve proprioception (the body’s awareness of movement and joint position sense) and strengthen the weakened ligaments. Flexibility exercises to reduce stiffness and improve mobility are needed as well. Bracing during the initial return to activity may be needed but should not replace strengthening and flexibility development.

Long-term prognosis

With proper rehabilitation and strengthening the athlete should not experience any limitations. A slight increase in the probability of injuring that ankle may occur. Athletes who continue to experience difficulty with the ankle may need additional medical interventions including, in rare cases, possible surgery to tighten the ligaments.



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