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Ankle Sprains

David Fitzgerald

Ankle sprains are an exceedingly common injury and unfortunately are often not well rehabilitated. At www.Dublinphysio.ie we see alot of ankle sprains and have years of experience treating these conditions.

Ankle Sprains – injury mechanism

Usually the mechanism of injury is a so called “inversion” strain, also know as “rolling the ankle”. This can occur on unevern surfaces, unexpected changes in direction or trips/falls. There are a number of different structures that can be injured and professional assessment is required to determine this accurately.

Ankle Sprain- Assessment

It is important to rule out the possibility of fractures and in this area they sometimes not as obvious as you might think.  Clinicians use a number of tests and the “Ottowa ankle rules” protocol is the most widely adopted. If the bones have not been injured then we are usually dealing with varying combinations of ligaments and muscles strain which can be either localized to the outside of the ankle or in more severe cases involve the side of the foot or extend the to the side of the leg.

More clinical detail on ankle assessment can be found here.

A simple ankle sprain which just involves a few ligament fibers can settle within a week and allow return to normal function ( even sport) and not require any treatment.

A more modest ankle sprain will be uncomfortable to walk on, will be obviously swollen usually with some bruising or discoloration and typically require 3 to 4 weeks off sporting activities but should allow normal walking within a week or two.

Complicated Ankle Sprains

If  pain levels are more severe than this and daily activities are compromised for longer periods then we are suspicious of more serious ligament damage which does not just involve the Lateral ankle ligaments (outside of foot) but may also involve the ligaments of the mid-foot, medial ankle (inner ankle) or the joint above the ankle socket known as the Syndesmosis.

There are a number of different clinical tests required to determine the extent of damage and of course plan the most specific type of treatment required. There is another complicating factor of severe ankle sprains which involves joint surface bruising or worse , joint surface Cartilage Damage.

These cases must be recognized and managed differently from normal ankle sprains, can sometimes require a surgical intervention and are certainly more long-term and challenging to treat.

From a physiotherapy perspective to key is recognizing the extent of damage and planning the rehabilitation program to achieve the fastest possible recovery.

Recurrant Ankle Sprain risk factors

Recurrent ankle sprains are a major problem and a huge amount of research has been undertaken internationally to try to solve this issue. Despite all this research the most striking conclusion is that the biggest risk factor for recurrent ankle sprain is a history of previous ankle sprains.

This is confounded by the fact that frequently management strategy is to rest, take it easy, use of anti-inflammatories and “see how it goes”. What we see commonly clinically is that pain and swelling may settle for activities of daily living but the ankle just doesn’t feel right or is unstable on rough ground, with sudden movement, impact or reduced attention. We see this so frequently clinically and it is because there are residual problems of hidden flexibility deficits, reduced muscle strength, poor coordination and compensatory movements which shift the point of pressure.

The objective of skilled physiotherapy assessment is to identify all of these components and restore normal function and load tolerance to ensure return to pre-injury status.

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