St Albans Osteopathy Blog

Ankle Sprain

An Ankle sprain is one of the most common musculoskeletal injuries. Patients typically describe an episode where they roll their ankle to the inside. Patients typically have significant pain and swelling, and usually limp. However, quite often they are able to bear weight, unlike an ankle fracture where weight bearing is extremely difficult. With the ankle swollen over the outside (lateral) aspect, there is often associated redness due to the increased blood flow to this area.

Classifications

Ankle sprains are typically classified as mild, moderate, and severe. It is often difficult to tell exactly which category the ankle sprain is.

  1. A mild ankle sprain involves partial tearing of the anterior talofibular ligament. This ligament is torn and may be even stretched, but it is intact. These ankle sprains will take 4-7 days to achieve most of the recovery.
  2. A moderate ankle sprain involves a significant tearing of the anterior talofibular ligament and some tearing of the calcaneofibular ligament. This type of ankle sprain often takes 7-12 days to mostly recover.
  3. A severe ankle sprain involves disruption of all of the ligaments on the lateral aspect of the ankle, specifically the anterior talofibular ligament, the calcaneofibular, and the posterior talofibular ligament. This is a major injurythatmaytake4-6weeks,or even longer,to largely recover. Furthermore, in approximately 8-10% of patients suffering a severe ankle sprain, there will be associated injuries such as an osteochondral injury to the talar dome.  

Initial Treatment

  • R.I.C.E.  (R = Rest, I = Ice, C = Compression, E = Elevation)
  • Anti-inflammatory medicines.

Subacute Phase

  • Figure of Eight Exercises. Imagine that the tip of your big toe is a pen, then “draw” a figure of eight with your big toe. Move slowly and repeat this motion for 30-60 seconds. Take a break, and then repeat this exercise 5-10 times for a total of 5-10 minutes per day. Don’t be discouraged if your motion is limited compared to the opposite foot. It often takes time to get this motion back. Be sure not to do anything that creates excessive discomfort.
  • Resisted Eversion. A stretching band is attached to a fixed object such as a doorknob, and then wrapped around the outside of the foot (Figure 1). The foot is then moved in an outward direction against resistance. This motion is repeated 10-20 times. A total of 3-6 sets should be performed.
  • Proprioception Exercises. Perform a graduated program that works to improve proprioception until both the right and left sides have equal propriceptive ability (assuming one side is uninjured). Compare to your uninjured side (do exercises on both sides until each side is equal). Do exercises daily. Do exercises for 30 seconds and repeat for 5-10 repetitions. Gradually progress the complexity of the exercises:
  1. Basic Exercise. Stand on one foot on a flat surface with your eyes open (30 seconds)
  2. Higher difficulty. Stand on one foot on a flat surface with your eyes closed (30 seconds). Have something available to grab if you lose your balance.Even higher difficulty
  3. Stand on one foot on a flat surface with your eyes closed and move your head from side to side (30 seconds). Have something available to grab if you lose your balance.Highest difficulty
  4. Stand on one foot on a soft surface (ex. a pillow or bed) with your eyes closed, and move your head from side to side (30 seconds). Have something available to grab if you lose your balance.
May 22nd 2019
 

Philip Bayliss, St Albans Osteopathy, 43 Thames Street, Christchurch 8013 ☎️ 03 356 1353