Ankle sprains are a common sporting injury. The mechanism of injury usually involves stretching of the outside ligaments of the joint which happens when the foot rolls inwards upon landing. This is called a lateral ankle sprain and is the most common type that occurs. Occasionally the inside ligaments can be injured too, when the impact is high or when the joint is moved forcefully outwards.
People often ask why or how a rolled ankle can occur. Sometimes the reason is largely unclear. For others, there may be a lengthy history of issues with ongoing ligament laxity or joint instability. This increases the risk of re-injury to the area. Other factors which increase the risk of a further occurrence can include unsupportive shoes, uneven terrain, a lack of balance, weakness of the foot and leg muscles, and high impact landings from sport or activity.
Without adequate treatment and ankle sprain rehab, the joint can remain sore or weak. What is often seen after a roll occurs is a premature return to activity or sport without the right exercise rehabilitation. While this can feel fine at the time as the individual will try to push their limits to get back to sport, it can have lasting effects on the body. When the range of motion of the foot joint complex remains unchecked, the balance and control around the joint can function poorly compared to the uninjured side. This can lead to an increased risk of getting another sprain – exactly what you don’t want.
Types of ankle sprains
Most sprains occur from an inversion movement where the ankle rolls in. This is called a lateral ankle sprain.The most commonly injured ligaments are the lateral (outside) ligaments.
- These commonly include the Anterior Talofibular Ligaments (ATFL), Calcaneofibular ligament (CFL)
- The ligament on the inside of the joint is called the Deltoid Ligament which is much stronger and more difficult to injure, but can be affected with more serious sprains
- High ankle damage refers to an injury to the Anterior Inferior Tibiofibular Ligaments (AITFL) and syndesmosis which bind the tibia and fibula together
- A syndesmosis issue is much more debilitating, requiring longer recovery time.
What does it typically feel like after an ankle sprain?
The mechanism of rolling your ankle is a clear indicator that you are likely to have injured it. Pain can vary a lot between individuals. Some may feel mild pain yet are able to continue walking on the foot. Others, however, are completely unable to bear weight or put pressure through the foot while standing. They will try to walk on the foot but can find that pain is too high and may require crutches or a moon boot.
Symptoms and function vary in appearance and feel from person to person and depend on the extent of the overall damage. The foot and leg area can appear bruised, swollen and painful to touch. The range of motion can feel limited, with clients often reporting the movement is stiff and uncomfortable. This is due to swelling and impact to the local ligaments, joints and tendons.
Ankle Sprain Treatment
Initial treatment will include:
- Rest immediately post injury to allow the area to settle
- Ice for 20 minutes every 2 hours
- Compression bandage at ankle
- Elevation of the ankle
Ideal rehabilitation could involve progressive mobility, strengthening & stability exercises.
Depending on the severity of the injury, a rolled ankle generally takes 3-6 weeks to resolve enough to be pain-free. It also common to have poor balance following injury.
Should I Ice My Ankle?
Yes. An injured ankle requires icing for the first 24-48 hours. Ice will help to reduce swelling and provide short-term comfort to make it easier to walk on.
Will Nurofen Help?
Anti-inflammatories medications can be helpful in the short term for the first two weeks after a sprain. They work by easing your pain and reducing swelling around the joint. This can help the ankle feel more comfortable, and get you back to walking sooner.
Do I Need A Boot?
Boots are usually advised if walking is too painful on the injured ankle (for most mild sprains they are not needed). They are used to ‘immobilise the ankle’ by taking pressure off the foot, allowing pain and swelling to settle quicker. If you need to wear either a moon boot or crutches it should be no longer then ten days. The best outcomes occur when an exercise program is also being done to maintain a healthy range of movement, whilst wearing a boot or using crutches. When a client does not try to maintain motion while in the boot, the joint usually remains stiffer when the boot comes off. Tailored exercise during an offloading treatment in a boot are key to having a healthy foot and leg when the boot comes off.
Check out more information about Moon Boot Fittings at Pod Fit Podiatry!
When Should I Walk Again?
As soon as you can! Early walking and gradual exercise is shown to have the best result for pain-relief and return to activity and sport. Without early ambulation, there can be prolonged stiffness and pain. Motion exercises for strength and control should be started as early as possible. Your podiatrist can get you back to activity ASAP.
Greater strength and balance has shown to reduce re-occurrence and will accelerate your return to work and sport. While it can seem scary to put pressure back onto the foot, those who try to gradually increase their exercises in a controlled way fare the best overall.
Should I Use A Brace?
Braces can help with comfort and return to play! Better outcomes have been reported with lace-up or semi-rigid braces for 4-6 weeks after injury. These have resulted in better outcomes than rigid strapping, Kinesio tape/ immobilisation and elastic bandages. While braces are not for everyone, one can start to feel reliant on support during play and can use a brace for months or years ongoing.
Braces have been shown to reduce the risk of recurrent ankle sprains. The best outcomes are when braces are used with concurrent strengthening and balance training!
When & why Podiatry can help manage your ankle sprains:
We strongly suggest that you seek podiatry intervention if:
- You are unable to put weight on the affected leg
- Pain is not easing over the day/night
- Pain and stiffness are not improving
Will Treatment Help?
Yes. A podiatrist will assess the joint movement, flexibility, function and position. It is important to have a baseline for all of these measurements so that rehab will result in the symmetry between strength and function on both sides. This is where the best results long term can occur to reduce the risk of reinjury. A treatment plan will be set into place to ensure return back to activity or sport and getting the area feeling 100% once again.
Treatment includes a combination of hands-on therapy, coupled with graduated exercises specific to your chosen sport or activity. It’s important to note there is no one magic treatment as such. Hands-on therapy settles pain and swelling faster. Treatments such as Dry Needling, Shockwave Therapy and massage can help reduce swelling fast. Manual mobilisation therapy helps to improve range of motion and reduces pain in the short term. Best results are when manual therapy is provided in conjunction with an exercise program. We also provide activity-specific footwear advice to ensure appropriate support, as well as a custom flexible insert.
At Pod Fit we can guide return to sport with exercises to develop the stability of the joint. Exercise rehabilitation will form a crucial part of your treatment, with strengthening exercises forming the main part of your return to play. Treatment may include mobility exercises to start with such as a calf stretch, then will progress to calf and foot strength, and eventually dynamic movements like hopping and bounding. Your podiatrist will help you work towards getting back to sport quicker and in better form. This is particularly important in reducing the likelihood of repeat sprains.
How To Strengthen Your Ankle After A Sprain
While every person and presentation differ, a simple approach to rehab exercises is to start with mobility, then progress strength, and finally push the foot and leg with dynamic exercises for return to sport or activity. There is not a one size fits all guide when it comes to what exercise should be done at what stage. Under guidance from a podiatrist, your program will be gradually challenged as you become stronger so that you can not only get back to sport but have a low risk of another sprained ankle down the track.
Ankle sprain rehab exercise program example:
- Mobility exercises – calf stretch, alphabet exercises, theraband exercises
- Strength exercises – calf raises, squats, lunges, balance activities
- Dynamic exercises – jumping, hopping, bounding, hops from a height.