Different types of ankle sprains and the best ways to recover
Most of us have experienced this once: we slipped, went into a pothole or tripped, and before you know it we have an ankle that is twice the size and incredibly painful.
But what are the different types of sprains, how do we grade them, and how do we get back to 'normal' the quickest way possible?
The ankle, similarly to the wrist, is quite mobile, but does a lot more weight bearing. The body uses ligaments (tough fibrous bands of tissue) to support and stabilize such a mobile joint. Looking at the ankle, we have three ligaments protecting and guiding the lateral (outer) side of the ankle and one on the inner (medial) aspect. The anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) are lateral, whereas the deltoid ligament is medially. There is one special ligament running the whole length between the fibula and tibia, called the interosseous ligament.
The three most common types of ankle sprains:
1) Inversion sprain (toes go in; you 'roll over it')
Foot is inverted, plantar flexed and rotated
Lateral ligaments will be affected (ATFL tear most of the time)
Peroneal muscle strain can cause pain on lateral leg
Severe cases can cause injury to peroneal nerve
2) Eversion sprain (toes go out)
Quite rare
When it happens, normally a severe injury
Deltoid ligament torn to some degree
3) Diastasis/syndesmosis (damage to ligament between tibia and fibula)
Often associated with a fracture, as that ligament is quite tough
All sprains and strains are generally graded the same, with Grade 1 being easy and Grade 3 being severe (sometimes needing intensive care and recovery).
1) Grade 1:
No bruising, mild swelling maybe some tenderness
Can walk on toes still
Maybe small limp
No laxity in joint, but some pain at the end range of motion
Recovery 1-2 weeks
2) Grade 2:
Bruising present on only one side of the foot, quite extensive swelling
Tenderness in an area (one whole side or both sides of ankle)
Cannot walk or raise onto toes
Visible limp when walking
Slight joint laxity and pain with most or all ankle movements
Recovery 4-8 weeks
3) Grade 3:
Extensive bruising and swelling on both sides of the foot (can traction all the way to the toes)
Tenderness on both sides of the foot
Unable to weight bear on ankle
Large laxity in joint when swelling settles a bit
Recovery 2-6 months (with care)
What should you do when it happens? Here are the tips and tricks:
1) Within 24-72hrs (acute):
RICE protocol - Rest, Ice, Compression, Elevation. Recent studies have shown that intermittent icing (10 minutes on, 10 minutes off, every 2 hours) results in better pain management than the previous protocol (20 minutes on every 2 hours).
Mobilise ankle in pain-free range of motion
Start weight bearing as soon as pain allows (even if crutches are needed)
*Watch out for significant swelling/bruising or changes to the ankle - this could indicate major damage and may need a trip to hospital
2) Post-acute phase (recovery may vary depending on grading of tear)
Use ankle support if needed
Strengthen injured muscles with resistance band (inversion or eversion depending on injury)
Do single leg stance (eyes open first then close) next to a wall. Then increase difficulty by doing it on a soft surface (pillow, foam mat) or wobble board
Ankle adjustments - a study from 2013 compared outcomes from home exercises and adjusting with home exercises. Both groups completed the same exercise programme at home (balance, strength and mobility- weight bearing). Combining manual therapy with exercises resulted in greater improvements, short- as well as long-term for pain control and return to function/exercise.
3) Return to previous sport/activity
Rope skipping or hopping to help increase sudden loaded exercises with impact
Return to sport specific drills
Previous ankle sprains put you at a higher risk of having future ankle problems if not managed after recovery. If you’re concerned about your ankles, come in and ask your chiro to check them out, and let’s get you back to enjoying your sports!
Vuurberg G, Hoorntje A, Wink LM, et al Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline British Journal of Sports Medicine 2018; 52:956.
Kerkhoffs GM, van den Bekerom M, Elders LAM, et al Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline British Journal of Sports Medicine 2012; 46:854-860.
Walls RJ, Ross KA, Fraser EJ, et al. Football injuries of the ankle: A review of injury mechanisms, diagnosis and management. World J Orthop. 2016;7(1):8–19. Published 2016 Jan 18. doi:10.5312/wjo.v7.i1.8