What are Lateral Ankle Sprains?
Lateral ankle sprains are among the most prevalent musculoskeletal injuries, particularly in active and sports populations. They involve damage to the ligaments on the outer side of the ankle, leading to pain, swelling, and impaired mobility. Understanding the specific anatomy, recognizing the signs and symptoms, and implementing effective treatment strategies are crucial for optimal recovery. 1,2
ANATOMY OF THE LATERAL ANKLE
The ankle joint comprises of several bones including the tibia, fibula, and talus, stabilised by a network of ligaments. On the lateral (outer) side, the primary ligaments are:
Anterior Talofibular Ligament (ATFL): Connects the talus to the fibula; most commonly injured in lateral ankle sprains.
Calcaneofibular Ligament (CFL): Runs from the fibula to the calcaneus (heel bone); often injured in more severe sprains.
Posterior Talofibular Ligament (PTFL): Connects the talus to the fibula at the back; least commonly injured.
On some occasions rather than the ligament tearing, the ligament can pull on the bone and cause an avulsion fracture. With lateral ankle sprains there may be tenderness on the fibula which is part of the Ottawa rules and may require a X-Ray to rule out a fracture.3
LIGAMENT SPRAIN GRADING
Ligament sprains have 3 gradings with grade 1 being a partial tear and grade 3 being a complete tear of the ligament. It is common to have grade 3 tears of the lateral ligaments that heal well as they have good blood supply and healing capacity.
SIGNS AND SYMPTOMS
The severity of a lateral ankle sprain can vary, but common signs and symptoms include:4,5,6
Pain: generally localised on the outer side of the ankle, especially during weight-bearing activities and movements of the ankle.
Swelling: increased inflammation and fluid in the area as a body’s natural response to injury.
Bruising: discoloration may appear around the ankle and foot.
Limited Range of Motion: pain and difficulty moving the ankle joint.
Instability: a feeling of the ankle "giving way," particularly in more severe sprains and feeling unstable when walking.
LATERAL ANKLE SPRAINS TREATMENT
Effective management of lateral ankle sprains involves several phases and follows PEACE and LOVE:6,7,8
Acute Phase (First 48-72 Hours) follows PEACE:
Protect: Avoid activities that cause further pain to the injured area in the first few days
Elevate: Elevate the injury above your heart to control swelling, utilise the muscle pump with or without active movement.
Avoid Anti-Inflammatories and Ice: These can reduce tissue healing and blood flow to the injured area. Ice may help numb severe pain temporarily.
Compression: Apply compression to the area to manage swelling and support the muscle pump.
Educate: Resist unnecessary passive treatments and imaging. Professional guidance can help determine if and when imaging is necessary, potentially saving you from unneeded procedures.
Subacute Phase (3-7 Days Post-Injury) follow LOVE:
Load: Gradually apply load within pain tolerance to encourage recovery.
Optimism: A positive outlook can significantly enhance your healing process.
Vascularisation: Engage in exercise that promotes blood flow, excluding the injured limb if necessary.
Exercise: Incorporate pain-free exercises to support and accelerate recovery with range of motion exercises to prevent stiffness. It also is important to focus on strengthening the muscles around the ankle.
Rehabilitation Phase (1-3 Weeks Post-Injury):
Balance Training: Incorporate exercises to improve proprioception and prevent future sprains.
Functional Exercises: Progress to activities that mimic daily movements or sports-specific tasks.
Gradual Return to Activity: Slowly reintroduce weight-bearing activities, ensuring no pain or swelling occurs.
Plyometric training: plyometric training plays an important role in return the ankle to be able to tolerate running and jumping task to then return to sport.
PREVENTION OF LATERAL ANKLE SPRAINS
To reduce the risk of recurrent lateral ankle sprains:7,8
Engaging in exercises that enhance strength, balance and control of the ankle to reduce the risk of future sprains.
When returning to sport and activities the risk of re-injury can be reduced by using ankle braces or taping to provide additional support.
A structured rehabilitation program focusing on restoring range of motion, strength and balance is essential to the prevention of lateral ankle sprains and chronic instability. It is also important to build up the running volumes and laid through the ankle to ensure the ankle is able to tolerate running before integrating back into sport.
REFERENCES:
Ferran N. A. & Maffulli N. Epidemiology of Sprains of the Lateral Ankle Ligament Complex. Foot and Ankle Clinics. 2006 Sept; 11(3), 659–662. https://doi.org/10.1016/j.fcl.2006.07.002
Medina McKeon J. M. & Hoch M. C. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. Journal of Athletic Training. 2019 Jun; 54(6), 589–602. https://doi.org/10.4085/1062-6050-472-17
Bachmann L. M. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003 Feb; 326(7386), 417–417. https://doi.org/10.1136/bmj.326.7386.417
Delahunt, E. & Remus A. Risk Factors for Lateral Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 2019 Jun; 54(6), 611–616. https://doi.org/10.4085/1062-6050-44-18
Green T., Willson G., Martin D., & Fallon K. What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? A systematic review. BMC Musculoskeletal Disorders. 2019 Aug; 20(1). https://doi.org/10.1186/s12891-019-2750-6
Kobayashi T., & Gamada K. Lateral Ankle Sprain and Chronic Ankle Instability. Foot & Ankle Specialist. 2014 Jun, 7(4), 298–326. https://doi.org/10.1177/1938640014539813
Kaminski, T. W., Needle, A. R., & Delahunt, E. Prevention of Lateral Ankle Sprains. Journal of Athletic Training. 2019 Jun; 54(6), 650–661. https://doi.org/10.4085/1062-6050-487-17
Vuurberg G., Hoorntje A., Wink L. M., van der Doelen B. F. W., van den Bekerom M. P., Dekker R., van Dijk C. N., Krips R., Loogman M. C. M., Ridderikhof M. L., Smithuis F. F., Stufkens S. A. S., Verhagen E. A. L. M., de Bie R. A. & Kerkhoffs G. M. M. J. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine. 2018 Mar 52(15), 956–956. https://bjsm.bmj.com/content/52/15/956
