Anatomy
What part of the ankle is involved?
Ligaments are tough bands of tissue that help connect bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle.
They are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The common inversion injury to the ankle usually involves two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keeps the ankle from rolling inward on its side.
Causes of Ankle Sprains
Why do I have this problem?
A ligament is made up of multiple strands of connective tissue, similar to a nylon rope.
- A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain. The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury, the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.
- A severe form of an ankle sprain called an ankle syndesmosis injury involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called a high ankle sprain because it involves the ligaments above the ankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting the tibia and fibula bones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.
Symptoms of Ankle Sprains
What does an ankle sprain feel like?
- Initially, the ankle is swollen, painful, and maybe bruised. The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.
- People who have sprained an ankle often end up spraining the ankle again. If the ankle keeps turning in with activity, the condition is called ankle instability. Patients who have ankle instability lose confidence in their ankle to support them, especially on uneven ground. They often have to swell around the ankle that doesn’t go away. Pain and swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels like it is going to give way, meaning it may have a tendency to twist again very easily. People who have had several mild ankle sprains or one severe sprain are prone to impingement problems in the ankle. The ligaments that were sprained may become irritated and thickened, causing them to get pinched near the edge of the ankle joint.
Diagnosis
How do we diagnose the condition?
The diagnosis of an ankle sprain is usually made by examination of the ankle. An X-ray or MRI may be required to make sure that the ankle is not fractured or ankle ligaments are torn. A physical examination is used to determine which ligament has been injured. The doctor will move your ankle in different positions in order to check the ligaments and other soft tissues around the ankle. If a complete rupture of the ligaments is suspected, your doctor may order stress X-rays as well. These X-rays are taken while the ligaments are placed in a stretched position. The X-ray will show a slight tilt in the ankle bone if the ligaments have been torn.
Treatment
What can be done for the problem?
Treatment options depend on whether your problem is an ankle sprain or ankle instability.
Ankle Sprain Treatment
The best results after an ankle sprain come when treatment is started right away. Consult us immediately. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle.
- Swelling and pain are treated with specialised Platelet Rich Plasma, electrical stimulation, and Prolotherapy.
- We also apply specialized hands-on treatment called joint mobilization to improve normal joint motion. These treatments restore the gliding motion within the ankle joint where the lower leg meets the talus bone. This form of treatment speeds healing after an ankle sprain, and it helps return people and players more quickly to their activity or sport.
Ankle Instability
If the ankle ligaments do not heal adequately, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain. If your ankle ligaments do not heal adequately following an ankle sprain, your osteopath may suggest several things.
- Platelet Rich Plasma helps heal the disrupted ankle ligaments and joint. The growth factors in the plasma stimulate the healing and reduce inflammation.
- Prolotherapy stimulates healing by laying down healthy collagen tissue of the ankle ligaments to restore proper ankle function.
- Clinical Pilates will likely be initiated to help restore joint range of motion, strength, and joint stability. Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation called position sense. For example, nerve sensors in your arm and hand give you the ability to touch your nose when your eyes are closed. The ligaments in the ankle work the same way. They send information to your nervous system to alert you about the position of your ankle joint. We will help you retrain this sensation as a way to steady the ankle joint and protect you from spraining your ankle again.
- Many people who have ankle instability have weakness in the muscles along the outside
of the leg and ankle. These are called the peroneal muscles. Strengthening these muscles may help control the ankle joint and improve joint stability.
Rehabilitation
What will it take to make my ankle healthy again?
As part of treatment, you may need to follow a program of Clinical Pilates over 2 to 4 weeks. We can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle.
Effective treatment for ankle sprains is disc training, which uses a circular platform with a small sphere under it. Patients place their feet on it while they sit or stand and work the ankle by tilting the disc in various positions. This form of exercise strengthens the muscles around the ankle, and it improves joint sense.
When you get full ankle movement, your ankle isn’t swelling, and your strength is improving, you’ll be able to gradually get back to your work and sports activities. An ankle brace may be issued for athletes who intend to return quickly to their sport.
