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Ankle Sprains

Ankle sprains are very common injuries. They occur when the foot is rolled inward when stepping on an unlevel surface, or when an athlete lands on another player's foot. When the sprain occurs, damage can be done to the ligaments on the outside of the ankle. Ligament injuries are graded as type I to III.

Grade I injuries microscopically tear the ligament tissue but do not cause any significant laxity (or looseness). Grade II injuries partially tear the ligaments and produce moderate laxity. Grade III injuries are complete tears of the ligaments and result in significant laxity. Each of these injuries produce swelling and bruising with increasing severity as the injury grade increases from I to III.

Initial Treatment

Immediately after an ankle sprain the ankle should be Rested, Iced, Compressed and Elevated (RICE).

Ice should be applied by placing ice cubes into a plastic, sealable freezer bag and wrapping the bag around the ankle. You should ice on the ankle for 30 minutes, then remove the ice for 30 minutes. Blue ice should never be used as it can freeze the skin and result in "freezer burn," which can be serious.

Compression can be applied through the use of an Ace bandage.

The ankle should be elevated above the heart. If you have significant difficulty walking, then a physician should evaluate the injury and take X-rays to rule out a fracture.

ankle 1
Figure 1: Lateral Ankle Ligaments
(Safran et al, 2003.)

Follow-Up Treatment

Follow-up treatment of ankle sprains involves range-of-motion exercises, strengthening exercises, balancing exercises and progression of activities. You should be able to perform these without pain at least three times a day.

Anti-inflammatory medications (Advil, Aleve or a prescription anti-inflammatory) can be used to reduce pain with inflammation. Check with your physician to make sure it is OK for you to take anti-inflammatory medications.

You can put weight on the ankle as the pain allows. Sometimes a walking boot or crutches may help. Often, an air-cast is used after the walking boot is discontinued. Next, you can use a functional ankle brace to transition back to sports.

Performing pain-free exercises, including range of motion movements and strength training, will accelerate recovery.

Figure 2 dorsiflexion
Figure 2: Dorsiflexion and
Plantarflexion range of motion
(Safran et al, 2003.)

figure 3, alphabet range of motion
Figure 3: Alphabet Range of Motion
Using the big toe to draw the
alphabet. (Safran et al, 2003.)

figure 4 plantarflexors
Figure 4: Plantarflexors. Using a
towel or rubber tubing for resistance
push against or away from your body.
(Safran et al, 2003.)

figure 5 towel curls
Figure 5: Towel Curls.
Place your foot on a
towel and curls your toes
and foot to grip the towel.
(Safran et al, 2003.)

Figure 6: Dorsiflexors. Using rubber
tubing for resistance pull the foot
towards you. (Safran et al, 2003.)

fugyre 7 - walk on heel
Figure 7: Walk on heel and
toes, then inner and outer foot.
(Safran et al, 2003.)

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