• Ankles are one of the most common sporting injuries.
  • A sprain is defined as a tearing of the ligaments that connect bone to bone and help stabilise the joint.
  • The degree of ligament damage depends on the amount of force generated by the injury and can vary from strain, partial tear or complete rupture of the ligament or avulsion of the bone the ligament attaches to.
  • Sports requiring jumping, turning and twisting movements and explosive changes of direction are particularly vulnerable to ankle sprains.
  • Following an ankle sprain, the ankle joint may become unstable and take a long time to recover

THE ANATOMY

  • The ankle joint is a hinge joint formed between the tibia and fibula and the talus and allows the foot to bend upwards and downwards.
  • The subtalar joint is formed by two bones of the foot, the talus and calcaneus (heel bone) they allow the foot to rock side to side.
  • The joint’s stability comes from the shape of the bones, the constraining ligaments (passive control) and the surrounding muscles and tendons (dynamic control)
  • The outside of the ankle the joint is stabilised by three smaller ligaments; the anterior talofibular the calcaneofibular and the posterior talofibular ligaments. Sprains to any of these ligaments (inversion sprains, foot twists inward) account for more than 80% of all ankle sprains.
  • The inside of the ankle the joint is stabilised by a thick, strong fibrous ligament called the deltoid ligament. Sprains to the deltoid ligament (eversion sprains, foot twists outward) account for less than 20% of all ankle sprains.
  • Injury to any ligament results in local swelling bruising and pain the more severe the injury the greater the degree of these symptoms.
  • Ligament sprains to the ankle joint may also involve the ligaments between the tibia and fibula bones. These injuries may involve a fracture, are often slower to recover, and may require surgery.
  • There is always a possibility of bony injury or fracture, a good rule of thumb to assess for a fracture is severe point tenderness over the bones of your ankle/ lower leg and an inability to put weight through your foot.

RISK OF INJURY

Acute ankle sprains result from a force being applied to the ankle joint that cause an excessive range of movement at the joint.

PROVEN RISKS FACTORS

  • Previous or existing ankle injury especially if poorly rehabilitated (biggest risk factor).
  • Lack of strength and stability related to the ankle.
  • Lack of, or extreme flexibility, in the ankle joint.
  • Poor balance.
  • Sudden change in direction (acceleration or deceleration).
  • Increasing age of player.

SUSPECTED RISKS FACTORS

  • Poor condition of the playing surface.
  • Inappropriate, inadequate, or no warm-up.
  • Wearing inappropriate footwear for the activity.
  • Lack of external ankle support (taping, bracing) for previously injured ankles.

INJURY PREVENTION

  • Undertaking training prior to competition to ensure readiness to play.
  • Gradually increasing the intensity and duration of training.
  • Undertaking flexibility, balance, stretching and strengthening exercises in weekly training programs.
  • Including agility work in training programs so the ankle joint is capable of sustaining high acceleration forces and quick changes in direction.
  • Allowing adequate recovery time between workouts or training sessions.
  • Warming up to ensure surrounding muscles are ready to support the joint during activity.
  • Wearing ankle taping or bracing especially for previously injured ankles.
  • Wearing shoes appropriate to the sport that provide stability and support.
  • Checking the training and playing area to ensure a flat and even surface.
  • Drinking water before, during and after play.
  • Avoiding activities that cause pain. If pain does occur, discontinuing the activity immediately and commencing RICER.

SIGNS AND SYMPTOMS

  • Sprains are graded on a scale of 1 to 3 (mild, moderate, and severe) depending on the degree of tearing to the ligaments.
  • Symptoms are usually pain swelling decreased movement and decreased weight bearing causing a limp.
  • The degree of local symptoms usually correspond with the mechanism and force of the injury.
  • X-rays are performed to rule out a fracture or dislocation if there is marked pain and swelling, severe point tenderness over the bones of your ankle/ lower leg and an inability to put any weight through your foot.

IMMEDIATE MANAGEMENT

  • As for any soft tissue injury RICER protocol – rest, ice, compression, elevation and referral.
  • RICE protocol should be followed for 48–72 hours.  The aim is to reduce the swelling and metabolic rate associated with inflammation that can cause damage to non-injured tissues and within the joint.
  • The ankle should be rested in an elevated position with an ice pack applied for 20 minutes every two hours (never apply ice directly to the skin).
  • A correctly sized compression bandage should also be applied
  • The no HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.

REHABILITATION

  • Most ankle sprains heal within 2 to 6 weeks, however severe sprains many take as long as 12 weeks.
  • A comprehensive rehabilitation program minimises the chance of the injury recurring and includes flexibility, balance, stretching, strengthening and sport specific exercises.  During this time taping or bracing the ankle may be prescribed to provide support until full function is regained.
  • If, while performing a rehabilitation exercise, ankle joint pain or discomfort is experienced, stop immediately and re-consult a sports medicine professional.
  • Players with significant ligament injuries (Grade 2 or 3) are advised to use bracing or protective taping when playing sport for a minimum of 6 to 12 months’ post injury.

REFERRAL: A sports medicine professional should be seen as soon as possible after the injury to determine the extent of injury and to advise on treatment and rehabilitation. In evaluating the injury, the sports medicine professional may order an x-ray or other investigation to determine the extent of the injury.

CONSULT A TRAINED PROFESSIONAL

  • The information above is general and is provided as a summary of the most common ankle injuries. It is not a substitute for professional medical advice and you should always consult a trained professional practising in sports medicine in relation to any injury.
  • You use or rely on the information above at your own risk and no party involved in the production of this resource accepts any responsibility for the information contained within it or your use of that information.