Lateral Ankle Sprain

A lateral ankle sprain is one of the most common injuries that individuals experience, whether they are athletes, just walking or engaging in everyday activities/hobbies. Understanding the anatomy of the ankle, how the injury occurs, and how to treat it properly is crucial for recovery and preventing future injuries.

The ankle joint is made up of three bones:

1. Tibia (shin bone)

2. Fibula (the smaller bone on the outside of the lower leg)

3. Talus (the bone that connects the leg to the foot)

   
   

These bones are held together by ligaments, tendons, and muscles. The lateral aspect (outer side) of the ankle is primarily supported by three important ligaments:

1. Anterior Talofibular Ligament (ATFL) – This is the most commonly injured ligament in lateral sprains.

2. Calcaneofibular Ligament (CFL)

3. Posterior Talofibular Ligament (PTFL)

When a lateral ankle sprain occurs, the ligaments on the outside of the ankle are stretched or torn due to an inversion (rolling the foot inward) or a sudden twisting movement. It occurs most often by directional changes or uneven surfaces. Common symptoms you might experience are: pain on the outside of the ankle, swelling and bruising, difficulty bearing weight, and instability. You might be very familiar with these if you have sprained your ankle before. This leads us to the various degrees of ankle sprains. The degree of the sprain will determine treatment and recovery. 

Ankle sprains are classified into three grades based on their severity:

• Grade 1 (Mild): Stretching or minor tearing of the ligaments. Symptoms typically include mild swelling and pain.

• Grade 2 (Moderate): Partial tearing of the ligaments with moderate swelling, bruising, and difficulty walking.

• Grade 3 (Severe): Complete rupture of the ligaments with severe swelling, bruising, and the inability to bear weight on the affected leg.

Treatment for a lateral ankle sprain depends on the severity of the injury. The more severe the longer the recovery time. You want to ice, elevate and move it. You heard it right, move it, do not just rest it. Only stabilize if it is a grade II or more. Getting imaging done will confirm the severity and to ensure nothing else is injured in that area. 

The overall goal is to reduce pain, swelling, inflammation, and to restore mobility, function and strength. Building strength not just at the ankle but the muscles and joints above and below the area of injury is essential. Research shows that injury to the ankle also inhibits and affects the ability of the glutes to activate. Looking at the whole picture is a game changer in regards to rehab and return to sport/activity. Understanding the stages of tissue healing will be vital for a successful recovery. 

 Tissue healing occurs in phases: inflammatory, proliferation and maturation.

• Inflammatory (acute) phase:  Days 1-5, focus on protecting the injured tissue, pain and swelling management.

• Proliferation phase: days 5-21, focus on ROM, controlled loading, strength, and proprioception

• Maturation (remodeling) phase: day 21 to 2 years, focus on ROM, strength, mobility, neuromuscular reeducation, return to sport/activity. 

  
  

When it comes to recovery, it is important to work with a professional that understands the tissue healing process to know when to load and progress the muscles/ligaments safely. This is where working with a physical therapist can be beneficial. Physical therapy (PT) plays a vital role in rehabilitation, especially for moderate to severe sprains. Working with a PT that can evaluate, treat and create a plan of care specific to that person's goal. Physical therapy can also ensure that you are returning to physical activity at the correct time. Returning too soon can lead to re-injury, a gradual reintroduction is key.

In conclusion, lateral ankle sprains, though common, can be effectively treated with the right apporach. Whether it's mild or severe sprain, addressing the injury early with the correct rehabilitation and professional guidance is key to a full recovery

Thanks for reading!

Dr. Noelle O’Hara, DPT

https://pmc.ncbi.nlm.nih.gov/articles/PMC164373/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8219268/