The Ankle Sprain

The ankle sprain usually affects the ligaments on the outside or lateral aspect of the the ankle. The injury occurs when the joint is in an unstable position, albeit often just momentarily, when there is weight on the ankle.

The foot is usually in a downward pointing position, called 'the loose pack position'. In this position the boney congruency of the joint is minimal. There is thus a greater reliance on the ligaments to maintain joint stability. On occasions the ligaments are not strong enough or trained enough to cope with such demands. When this occurs the ligament stretches or tears and we call it a sprained ankle.

As with all ligament injuries there are degrees of trauma, commonly classified into GRADES ONE TO THREE. With one being a minor tear of a few fibres through grade two which is a tear involving approximately half of the structure to grade three which is a total rupture.

Inversion Injury

If someone suffers a severe ankle injury or sprain of the outside or lateral ligaments that has a force strong enough, the medial or inside structures can be contused or crushed. This is caused by the ankle joint being compressed on the inside as the foot is forced into a position known as maximum inversion. Soreness and pain over the medial ligaments due to an injury of this nature can be confusing. This can result in the injury being misdiagnosed or one side of the ankle being overlooked.

It is common for the part of the lateral ligament situated nearest the front of the ankle joint to be injured whilst the other two parts of the ligament remain unaffected. This particular part of the ligament is called THE ANTERIOR TALO-FIBULAR LIGAMENT and is also often injured if there is a rotary component, as there almost always is, to the force.

This part of the ligament can be totally ruptured if the force is great enough. However it is relatively easy to learn to live without this structure intact by developing compensatory mechanisms of ankle control.

Eversion Injury

The medial or deltoid ligaments are stronger and do not get injured nearly as frequently as the lateral ones. This is because there is less natural movement that stretches them compared to the opposite movement that stretches the lateral ligaments. They are not therefore put under as much stress. It is often the case though that they get bruised as mentioned above, when the lateral ligaments are overstretched or by a direct blow or kick.

Treatment of an Ankle Sprain.

The immediate treatment of this type of ankle sprain should consist of the classic R.I.C.E. regime (rest, ice, compression and elevation).

For specific details of the R.I.C.E. regime click here.

Expert assessment, treatment and advice should then be sought to progress the ankle sprain through the various stages. The aims broadly though are as follows:

* To prevent further injury

* Regain movement of the foot and ankle joints

* Regain normal muscle activity and function to the desired level.

Sprains of the ankle ligaments can be accompanied by a fracture in the area. An ankle injury or sprain like this is not straightforward to diagnose and an x ray may be needed to rule out the presence of a fracture.

See the section on ankle fractures for more information.

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