Blog 10- Understanding and Managing Lateral Ankle Sprains

Introduction 

Lateral ankle sprains are among the most common injuries encountered in sports and daily activities. Despite their frequency, they are often underestimated, leading to improper management and potential long-term complications. As a physiotherapist with over 28 years of experience, I’ve seen firsthand how effective education and structured rehabilitation can significantly improve outcomes. In this blog, we’ll delve into the etiology of lateral ankle sprains, their signs and symptoms, immediate care, appropriate exercises, the role of bracing, and strategies for prevention. 

Etiology of the Injury 

Left Ankle (lateral view)

Lateral ankle sprains typically occur when the foot rolls inward, causing excessive stretching or tearing of the ligaments on the outside of the ankle. This mechanism of injury, known as an inversion injury, often happens during activities that involve rapid changes in direction, such as basketball, soccer, or simply walking on uneven surfaces. The anterior talofibular ligament (ATFL) is the most commonly affected, followed by the calcaneofibular ligament (CFL). 

Signs and Symptoms of Lateral Ankle Sprain 

 Identifying a lateral ankle sprain involves recognizing several key signs and symptoms: 

1. Pain: Immediate sharp pain on the outside of the ankle. 

2. Swelling: Rapid swelling around the ankle joint. 

3. Bruising: Discoloration due to bleeding under the skin, appearing a few hours to days after the injury. 

4. Tenderness: Pain when touching the affected ligaments. 

5. Instability: A feeling of looseness or instability in the ankle. 

6. Difficulty Weight-Bearing: Trouble walking or bearing weight on the affected foot. 

Immediate Care: The P.O.L.I.C.E. Method 

Immediate care is crucial to minimize damage and promote healing. The P.O.L.I.C.E. method is an updated approach to the classic R.I.C.E. protocol: 

Protection: Use crutches or a brace to protect the ankle from further injury. 

Optimal Loading: Engage in gentle movement and weight-bearing activities as tolerated to promote healing. 

Ice: Apply ice packs for 12-15 minutes every 2-3 hours during the first 48-72 hours to reduce swelling and for pain relief.

Compression: Use an elastic bandage to provide compression and control swelling. 

Elevation: Elevate the ankle above heart level to decrease swelling.   

Proper Exercises 

Rehabilitation exercises should be progressive and tailored to the individual’s stage of healing.  

Stretching

• Calf Stretch: Gently stretch the calf muscles to maintain ankle flexibility. 
  

• Ankle Mobility Active Movements: Perform gentle, controlled movements of the ankle within a pain-free range to maintain mobility and promote circulation. 

Strengthening 

• Towel Scrunches: Strengthen the intrinsic muscles of the foot by scrunching a towel with the toes. 

• Resistance Band Exercises: Perform inversion, eversion, plantarflexion, and dorsiflexion exercises using resistance bands.

• Balance Exercises: Stand on one leg, progressing to standing on an unstable surface like a balance board or foam pad. 

• Single-Leg Hops: Perform controlled single-leg hops to improve dynamic stability. 

Bracing: When Is It Needed? 

Bracing can play a critical role in both acute management and long-term prevention.  

Ankle Braces Sold at Clinic

• Acute Phase: Ankle braces or splints provide stability and protect the ligaments during the initial healing phase. 

• Rehabilitation Phase: Functional braces allow movement while providing support, aiding in the transition back to normal activities. 

• Prevention: Athletes and individuals prone to recurrent sprains may benefit from wearing a brace during high-risk activities. 

Prevention 

Preventing lateral ankle sprains involves strengthening and stabilizing the ankle, as well as adopting safe practices: 

1. Strength Training: Regularly perform ankle and lower leg strengthening exercises. 

2. Proprioceptive Training: Engage in balance and coordination exercises to enhance joint awareness. 

3. Proper Footwear: Wear shoes that provide adequate support and are appropriate for the activity. 

4. Warm-Up: Always warm up before engaging in physical activity to prepare the muscles and joints. 

5. Avoid High-Risk Surfaces: Be cautious on uneven or slippery surfaces to reduce the risk of twisting the ankle. 

Additional Medical Imaging 

In cases where the pain and swelling do not subside within a few days, or if there is a suspicion of a more serious injury, such as a fracture or severe ligament tear, additional medical imaging may be necessary. X-rays are typically used to rule out fractures, while MRI or ultrasound imaging can provide detailed views of soft tissue damage. Seeking medical attention ensures a proper diagnosis and the development of an appropriate treatment plan. If you experience significant pain, inability to bear weight, or instability in the ankle, consult a healthcare provider promptly. 

Conclusion 

Lateral ankle sprains, while common, require careful management to ensure full recovery and prevent recurrence. By understanding the etiology, recognizing the signs and symptoms, applying the P.O.L.I.C.E. method, engaging in proper exercises, considering the role of bracing, and implementing prevention strategies, individuals can significantly reduce their risk of chronic ankle instability. As always, consult with a qualified physiotherapist to develop a tailored rehabilitation program that meets your specific needs and goals.  

By staying informed and proactive, you can maintain a healthy, active lifestyle free from the limitations of ankle injuries. 

Marco Chiasson, Physiotherapist

Physika