About ankle sprains
The most common is to roll the ankle outwards (inversion injury), where you roll over the outside of the foot. This often happens when turning with great force, in landings after jumps, or if you step or land on an edge or an opponent's foot. Less common is to roll the ankle inwards (eversion injury), and this usually happens because of an external force acting directly on the ankle, e.g. a sliding tackle that hits the ankle, a blow or similar.
What is injured in an ankle sprain?
In an ankle sprain, the various ligaments in the ankle can be injured. It is most common to injure the outer ligaments in an inversion injury, and injury to the medial ligaments on the inside of the ankle is less common. The ligaments form connections between the bones in the foot and provide stability in the joint by limiting how much these bones can move in relation to each other. We have three ligaments on the outside of the ankle, all of which run from the lateral malleolus on the outside of the foot. One runs forwards, one runs straight down and one runs backwards. It is most common to injure the anterior one, and least common to injure the posterior one.
The injury to the ligaments can vary from a small tear to a complete rupture of one or more ligaments, and MRI scans are usually not taken when ligament injuries are suspected. A physiotherapist, manual therapist or chiropractor will be able to form an impression of the degree of injury through examination and assessment of, among other things, pain level, swelling, discolouration and stability. An ultrasound examination is an available imaging method that can be done quickly to assess possible ligament injuries. The approach to rehabilitation is largely the same in any case, but the duration will vary and it may affect stability in the long term. Regardless of the degree of injury, good results are seen with rehabilitation and the need for surgery is very rare.
Less common injuries after an ankle sprain
Sometimes fractures and injuries to the connective tissue between the two lower leg bones (syndesmosis injury) can occur after an ankle sprain. These injuries may require a different approach or in some cases surgery, so it is important to detect them as quickly as possible. Fractures are usually picked up early, as an X-ray is always taken if a fracture is suspected. The doctor or healthcare professional examining you will assess the likelihood of a fracture based on a series of criteria. X-rays are also routinely taken of young people with severe ankle sprains. Syndesmosis injuries can be harder to detect, and are often detected later as a result of lack of progress and persistent pain. The injury can be picked up on X-rays, but requires special images taken while the ankle is weight-bearing. This is often challenging right after the sprain because of severe pain. The most important thing is a good examination by a therapist, and a review of the mechanism of injury (how the sprain happened). Fortunately, this injury is rare, but it probably also goes undetected in some people.
Recurrent ankle sprains are a common problem, as the likelihood of spraining again increases considerably after your first sprain. It is therefore especially important to work actively to prevent new sprains, and it may be necessary to use tape or an ankle support when playing sport for quite a while after the sprain. For the best possible treatment of an ankle sprain, it is recommended to follow the PEACE & LOVE acronym, which covers treatment in the acute phase as well as the way back to normal activity or sport. See our separate article where we go through PEACE & LOVE using an ankle sprain as the starting point.
Have you sprained your ankle?
Our practitioners have good experience with examining ankle sprains and with treatment plans after injury.
References:
- Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94. doi: 10.2165/00007256-200737010-00006. PMID: 17190537.
- Wikstrom EA, Cain MS, Chandran A, Song K, Regan T, Migel K, Kerr ZY. Lateral Ankle Sprain and Subsequent Ankle Sprain Risk: A Systematic Review. J Athl Train. 2021 Jun 1;56(6):578-585. doi: 10.4085/1062-6050-168-20. PMID: 34375983; PMCID: PMC8223615.
- Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. J Athl Train 2019; 54: 603-610.
- https://www.physio-network.com/blog/ankle-sprain-research/
- https://www.skadefri.no/kroppsdeler/skadefri-ankel/overtrakk/