Definition
Ankle sprains are one of the most common injuries affecting the general population in competitive sports and recreational activities.
The ankle tops the charts as the #1 body part injured in sports, making up to 55% of injuries in certain sports.
Ankle sprains are highly prevalent and in the UK they account for 4% of all injuries presenting in A&E (making it 302,000 ankle sprains a year or 2 million in the USA), and 11% of all injuries in footballers according to the English Football Association. And this is without counting associated injuries such as foot or ankle bruises, fractures, lacerations and tendon ruptures.
An ankle sprain affects the ligaments fundamentally although various other tissues are damaged in the process. It occurs on twisting or rolling the ankle when landing and going over it. They are often caused by relatively minor events such as falls, slipping or tripping. As a consequence the ligaments are stretched beyond their limits and might tear.
HIGH ANKLE SPRAIN
There are two main groups of ligaments in the ankle, one slightly higher than the other and when affected these injuries take the name of “high ankle sprain”
LIGAMENTS IN THE ANKLE
Ligaments are structures that resemble a ribbon and are part of any joint in the body, connecting one bone to another bone. They provide the ideal stability to each joint to function properly. So in the ankle joint ligaments will allow for the back and forth motion but restrain the side to side movements.
The ankle ligaments can be roughly divided into three main groups:
1. Lateral ankle ligaments
These are the most affected and their injury accounts for 85% of all ankle sprains. The first ligament to be damaged is the Anterior Talofibular Ligament (ATFL). The remaining ligaments in this group are the Calcaneofibular ligament (CFL) and the Posterior Talofibular ligament (PTFL)
2. Medial ankle ligaments
This group is made of the strongest ligament in the ankle and a very important one for stability, the Deltoid ligament.
3. Syndesmotic ligaments
The syndesmosis is the articulation between the two leg bones: the tibia and the fibula. When this group of ligaments is affected, the injury is classed as “high ankle sprain”.
OTHER STRUCTURES – tendons, muscles, capsule/joint
The ankle joint is formed by a number of anatomical structures. Starting off with bones, this joint is made of the articulation of three bones: the tibia, the fibula and the talus.
The capsule is a layer that surrounds the joint like an envelope. It is relatively thin and weak but it is reinforced at each side of the joint by the strong ankle ligaments.
The next layer above the capsule is formed by tendons and muscles. A muscle contracts to create movement that is transmitted through the joint by a cord-like extension of the muscle called tendon. These can be injured during ankle sprains and may need further attention.
Other important structures around the ankle are nerves, veins and arteries. When a nerve is damaged symptoms of neuropathy can include numbness, weakness, sharp or burning pain and tingling sensation.
GRADES
Depending on the severity of the ankle sprain and the damage imparted to the ligaments, sprains are graded from mild to severe (Grade 1 to 3).
We will assess you in clinic and after the adequate investigations will determine the grade of the sprain which is helpful to develop a treatment plan
· Grade 1 (Mild sprain) – Mainly stretching and only microscopic tearing
· Grade 2 (Moderate sprain) – Partial tearing
· Grade 3 (Severe sprain) – Complete tear
The symptoms of tenderness and swelling will be increasingly worse as the injuries progress through these grades.
Although widespread in textbooks and other publications, this grading system is not always very practical
SYMPTOMS
Various symptoms such as swelling, bruising, pain, and limited range of motion are seen in the acute or subacute phase of an ankle sprain. This affects postural control and has a knock-on effect on gait and the ability to return to sports.