Ankle Sprains

Ankle sprains are ranked in severity. This ranking notes how much the ligaments or tendons have been affected. More severe ankle sprains will have further changes evident on ultra sound and xray, plus further joint range of motion during testing. The following classes of ankle injuries are:

a. Grade I – With Grade I ankle sprains the ligaments and tendons have been stretched beyond their normal limits. Grade I ankle sprains generally present with mild swelling, tenderness and limited loss of function. The symptoms are often present for only 2 -8 days. Treatment usually involves the application of ice and rest. If early return to activity is required after an acute ankle injury a course of dry needling will help reduce inflammation in the muscles and tendons. Most ankle sprains fall into this category.

b. Grade II ankle sprains happen when the ligaments or tendons partially tear. This is a severe ankle sprain. Ultrasound is commonly used to diagnose ankle sprains. Grade II sprains present with moderate swelling, tenderness on palpation and areas of increased trauma along with pain when mobile. Balance (proprioception) is affected with limited range of motion and instability present. NSAIDS are commonly advisable for pain relief. Rehabilitation is longer then a Grade I, usually around 20 days and therapy is suggested with bracing or taping being commonly required and passive movement to prevent joint stiffness. Strengthening exercises should be prescribed by your therapist.

c. Grade III ankle sprains happen when the ligament tears completely, tendon rupture (complete tear of tendon) or an avulsion fracture occur. This is a severe ankle sprain. Grade III sprains present with significant pain and moderate swelling. Balance is affected, limited range of motion and instability within the joint is present. A visit to a health professional is required to obtain an accurate diagnosis along with an Xray and ultrasound referral, due to a risk of bone fracture and surgical opinion is advisable. NSAIDS are commonly prescribed for pain relief. Rehabilitation is long, involving crutches or air cast walkers to immobilise the ankle while weight bearing and passive exercises are advisable.

Where Grade II and Grade III ankle sprains are present it is strongly recommended to seek advice from a health professional otherwise chronic ankle instability can occur along with further injury. A doctor, physical therapist or our podiatrists can assist with proper treatment and exercise prescription including passive exercises eg. ankle alphabet, stretching and strengthening exercises all improve ankle stability.

High ankle sprain will increase range of motion in the ankle. This type of ankle sprain occurs along with twisting in the leg bones and a spiral fracture could be evident. This will affect the ankle syndesmosis (the tibiofibular joint); and difficulty bearing weight and severe pain will be evident.

Ankle bracing is another way of protecting you from a sprained ankle. Bracing is best for people with chronic ankle instability, if you are going through rehabilitation or have hypermobile joints. Ankle braces come in four main types, these being:

• Lace-ups (fabric based that may/may not have wrap around straps)

• Neoprene compression braces

• Hinged (semi-rigid plastic shell with wrap around strap)

• Hinged-Cuff (semi-rigid or flexible shell with straps)

Bracing will control inversion and eversion through the ankle joint but should not be relied upon completely as this can weaken the muscles, ligaments and tendons and have a concern with neurological feed back / proprioception.

Exercises to strengthen the ankle post ankle sprain are very important as they assist with the recovery process, and development of fine nerves as well as restoring function to the joint. These exercises fall into 4 groups,

1. Strengthening exercises

2. Stretching Exercises

3. Balance Exercises

4. Functional Exercises.

Rest and trauma associated with an ankle sprain will weaken the muscle groups around the ankle. These strengthening exercises focus on the 4 muscle groups around the ankle:

1. Dorsiflexors. The dorsiflexors are the muscles on top of the ankle and are located in the shin and travel down to the top of the foot and toes. A great exercise to strengthen this muscle group is to loop a theraband around a table leg and your foot and pull your foot back towards you – repeat this 20-30 times twice daily.

1. Plantar flexors. The plantar flexors are the muscles in your calf and consist of the gastrocnemius and soleus muscles. This muscle group is very powerful and assists in stabilising the ankle and propulsion. A great exercise to strengthen this group of muscle is to stand on both feet, shoulder width apart and take your heels off the ground and come up onto your toes. Hold this position and slowly return the heel to the floor, repeat 15 times.
2. Everters. The everters are called the peroneal muscles. This muscle group is in the outside area of your lower leg. A great exercise to strengthen the peroneals is to place a theraband around both feet firmly. During this exercise you rotate your ankles out so your forefoot move away from each other. Slowly return to the start position and repeat 15 times.
3. Inverters. The inverters sit in the deep lower leg calf and assist in supporting the arch of the foot and ankle. An excellent strengthening exercise for your inverters is to loop a theraband around a table leg and your foot and pull your foot inwards and upwards.

Stretching Exercises

Stretching exercises are important to improve the length of muscle. When muscle is in trauma from a strain it is important to do routine stretches to restore proper function. A calf stretch along with ankle alphabet exercises are good exercises to perform.

Balance Exercises

Balance exercises help to improve proprioception, our sixth sense. The ankle holds many nerves which can be damaged in an ankle sprain, the more severe the injury more nerve damage can result.

Functional Exercises

Athletic training requires the introduction of functional exercises that mimic the activity that is normally performed in sport. Such functional exercises could involve hopping, lunges, lateral steps, high jumps etc. and should only be performed when the injury has completely healed.

Orthotics can help stabilise your injured ankle and prevent further injury. Orthotics at Erica Dash Podiatry are made from a weight bearing cast and will not over correct your ankle. All of our orthotics are fabricated by your prescribing podiatrist.

Dry needling and acupuncture techniques are an excellent way to heal your muscles and reduce inflammation. Only some of the podiatrists at Erica Dash Podiatry are trained in providing dry needling and acupuncture techniques so be sure to mention your interest with this therapy when booking your appointment.

Shockwave therapy is an effective treatment for Grade I and Grade II ankle sprains as it increases blood flow to your tissues and promotes healing of your ligament tears without the need for surgery.

High powered laser therapy is excellent for treating acute and chronic injuries, including ankle sprains. Our high powered laser has unique analgesic abilities to help decrease pain immediately. it decreases inflammation around the nerve which promotes long term relief.

The therapy is not painful, all you as a patient should experience is gentle warmth, if choosing laser therapy as a treatment option you will require a number of treatments as one treatment is generally not enough.

Laser therapy will help you get out of pain quickly and reduce the need for medication. It will help reduce swelling and promote better tissue healing, and it will enable treatment sessions to be progressed faster; therefore enabling you to return to doing what you love. Laser therapy is often used in conjunction with other therapies.