Ankle Sprain

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

An ankle sprain is an injury to one or more ligaments in the ankle, typically caused by a twisting or rolling of the ankle. The most commonly injured ligament is the anterior talofibular ligament (ATFL) on the outer side of the ankle.

Aetiology

Ankle sprains are caused by:

• Inversion injuries, where the foot rolls inward, stretching the ligaments on the outer side of the ankle
• Eversion injuries, less common, where the foot rolls outward, affecting the inner ligaments
• Direct trauma or awkward landings during sports or physical activities
• Walking or running on uneven surfaces

Pathophysiology

The pathophysiology of an ankle sprain involves:

• Stretching or tearing of one or more ligaments in the ankle joint
• Inflammation and bleeding within the ligament, leading to pain and swelling
• Instability of the ankle joint, depending on the severity of the sprain
• Possible involvement of other structures, such as tendons or bones, in severe sprains

Risk Factors

• Participation in sports, particularly those involving jumping, running, or sudden changes in direction
• Previous ankle injuries
• Inadequate warm-up or stretching before exercise
• Poor footwear, especially shoes without proper ankle support
• Walking or running on uneven surfaces

Signs and Symptoms

The signs and symptoms of an ankle sprain include:

• Pain in the ankle, especially when bearing weight or moving the foot
• Swelling and bruising around the affected area
• Tenderness to touch, particularly over the injured ligaments
• Limited range of motion due to pain and swelling
• Instability or a feeling that the ankle might give way (in more severe sprains)

Investigations

Specific investigations to diagnose an ankle sprain include:

• Clinical examination: Physical assessment of pain, swelling, and stability of the ankle joint.
• Imaging studies:
  • X-rays: Typically used to rule out fractures, especially in cases where the Ottawa Ankle Rule indicates a need for imaging.
  • Ultrasound: May be used to assess ligament integrity and detect tears.
  • MRI: In cases of severe or chronic ankle sprains, to evaluate the extent of ligament damage and involvement of other structures.

Management

Primary Care Management

• RICE protocol: Rest, Ice, Compression, and Elevation to reduce pain and swelling.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain and inflammation.
• Bracing or taping: To provide support and stability to the injured ankle during the healing process.
• Early mobilisation: Gradual reintroduction of movement and weight-bearing as tolerated to promote recovery.
• Rehabilitation exercises: Strengthening and balance exercises to restore function and prevent re-injury.

Specialist Management

• Physiotherapy: Referral to a physiotherapist for a structured rehabilitation programme tailored to the severity of the injury.
• Surgical intervention: Rarely required, but may be considered in cases of severe ligament damage or chronic instability.
• Ongoing rehabilitation: Long-term exercises and physiotherapy to restore full function and prevent recurrence.

References

1. NHS (2024) Ankle Sprain. Available at: https://www.nhs.uk/conditions/ankle-sprain/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Ankle and Foot Injuries. Available at: https://cks.nice.org.uk/topics/ankle-and-foot-injuries/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Ankle Sprains: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h2777 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Ankle Sprains. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/ankle-sprains/ (Accessed: 24 June 2024).

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