Ankle Sprain/Instability

  • Musculoskeletal injury that involves a stretch or tear in ligamentous structures.

  • Most common type of ankle sprain affects the lateral aspect of the ankle that include your Anterior Talofibular ligament (ATFL), calcaneofibular ligament (CFL) when the ankle is plantar flexed and forcefully inverted (rolling the ankle outward). (85% of sprains) 

    • The posterior talofibular ligament is rarely injured unless a talus dislocation happens. 

  • If the ankle sprain is not treated correctly through rehab and is not treated soon enough → higher chance of re-injury and ankle instability 

  • Greatest risk for ankle sprains: basketball players 

  • Medial ankle complex: deltoid ligaments: posterior tibiotalar (PTTL), tibiocalcaneal (TCL), tibionavicular (TNL) and anterior tibiotalar ligaments (ATTL) → injured with forceful pronation and rotational movements of the hindfoot. 

  • Syndesmotic (high ankle) sprain → external rotation of the leg and dorsiflexion of the ankle 

  • Signs/Symptoms of an ankle sprain:

    • Pain with weight bearing

    • Pain with palpation (to touch)

    • Bruising, edema and swelling

    • Limited ROM and instability 

  • Signs patient may need an X-Ray based off the Ottawa ankle rules to rule out possible fracture

    • Pain right behind lateral malleolus

    • Pain at base of 5th metatarsal

    • Pain right behind medial malleolus

    • Navicular bone pain

    • Inability to take > 4 steps without pain

  • Ankle sprain grades of impairment

    • Grade I: mild / minimal swelling and tenderness with little impact on function

      • Start with phase I exercise program and progress through Phase III

        • 3-4 weeks for healing with rehab in place 

    • Grade II Moderate – moderate swelling, pain and tenderness with decreased ROM and ankle instability 

      • Decrease swelling and progress into phase I of exercise program and only complete as pain free - continue to ice and elevate as swelling is still present then progress through the ankle sprain program when swelling decreases

      • 4-6 weeks for healing with rehab

    • Grade III: severe - significant swelling, tenderness, loss of function and instability. 

      • See MD for X-ray to rule out possible fracture, if cleared, focus on decrease swelling and pain and then progress through out 3 phase exercise program

      • 6-12 weeks for healing with rehab