Ankle Sprains & Strains

Definition

A Sprain occurs when ligament fibers tear. This rarely happens in the middle, but rather a tear at the proximal or distal point of attachment, a small fragment of bone may be avulsed with the ligament instead of the ligament alone being torn.

Mechanism of Injury

An inversion sprain occurs when the ankle turns inward.  The anterior talofibular ligament is most commonly affected with the calcaneofibular ligament tearing if the stress occurs with the ankle at right angles. Subluxation occurs at the ankle joint, implying a partial separation of the ankle bones.

Symptoms

Pain and swelling beneath the extensor tendons, along with weight bearing instability. Ecchymosis may occur, indicating inversion to a greater degree than normal, and the talus separates from the lateral malleolus. The foot can be moved into a position so that the sole is inverted at practically a right angle with the ground.

Signs

Palpation of pain and/ or excessive motion upon ankle orthotic testing. Abnormal gait pattern. Loss of ankle strength upon testing. Ankle mortise instability upon stress testing. Multiple lower extremity subluxations ( talus, fibula, cuboid, calcaneus, etc.).

X- Ray

Stress X-rays taken with the foot inverted reveal the abnormal tilt of the talus within the mortise. An excess of a 15 degree talar tilt indicates the presence and extent of ligamentous tear.  Ankle series of radiographs is indicated to rule out fracture.

DYSKINETIC MUSCLES

• Peroneus Longus
• Peroneus Brevis
• Peroneus Tertius
• Extensor Digitorum Longus

TREATMENT

• "PRICE" formula is applied.
  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation

• Manipulation of involved subluxations
• Daily ice sessions (20 minutes), followed by pain-free, short-arc, range of motion exercises.
• Immobilization of severe sprain (Grade III)
• Ankle srengthening , as tolerance allows.
• Proprioception exercises prior to return to aggressive activities.
• Firm-Flex Plus orthotics

THERAPEUTIC EXERCISES

Thera Ciser Ankle series, with emphasis on Eversion and Dorsiflexion.

PREVENTATIVE MEASURES

• Avoid wearing worn shoes that have become non-supportive
• Regular routine of active eversion exercises
• Firmflex plus orthotics
• Tape the ankle prior to aggressive activities
• Ankle Brace
• Achilles stretching