Ankle sprain
Ankle sprains are most often classified by the degree of ligament damage, but there are other classifications as well.
The clinical classification is as follows:
1. Minimal injury – a stretched ligament with no displacement on stress testing
2. Partial tear of the ligament with minimal displacement on stress testing
3. Complete tear of one or more ligaments with translational displacement on stress testing
The tests carried out by the specialist doctor include the talar tilt test and the anterior drawer test, among many others.
Anatomy: The anterior talofibular ligament (ATFL) is the most commonly injured ligament in an ankle sprain. It is followed by injury to the calcaneofibular ligament (CFL) and, finally, the posterior talofibular ligament (PTFL). Together these three ligaments form the lateral ligament complex.
In the acute phase, the RICE technique should be used (rest, ice, compression and elevation), and painkillers are often used too, either locally or systemically, as well as heparin gels (locally). Immobilisation is short-term, with an elastic bandage or, for more severe damage, an orthosis or even a plaster cast. Functional treatment includes mobilising the ankle as early as possible. External support with semi-rigid orthoses or braces, elastic bandages or tape is often essential during rehabilitation.
Early rehabilitation includes exercises to strengthen the structures of the ankle – the ligaments, muscles and joint capsule. It continues with proprioception and coordination exercises, i.e. retraining. Surgical treatment is needed for more severe injuries involving the syndesmosis – the interosseous membrane – and osteochondral lesions.
Recovery from an ankle injury and assessment:
Long-lasting discomfort and pain are significant signs that point to difficult healing and a poorer functional return to activities. The injured person usually reports instability when walking or on slightly uneven ground. Objective signs such as swelling, instability on medical examination and limited range of motion also call for a diagnostic work-up with ultrasound, X-ray, CT and MRI. Functional measurements are needed when returning to sport, training or competition. Examination and assessment are carried out every 2–4 weeks to detect any complications.
Athletes and people who play high-risk sports such as basketball, volleyball or football are at increased risk of re-injuring the ankle and injuring the ligaments. People who have had an ankle injury have a five or more times higher risk of injuring it again. Taping is a minor aid that should not be ignored, but it sometimes has the opposite effect.
Prevention of ankle injuries and prophylactic measures include external support around the ankle, such as semi-rigid orthoses, air-filled braces and sports footwear that holds the ankle more firmly, but the most important is functional training on balance discs and other unstable surfaces to improve coordination and restore proprioception.
