Ankle sprains account for 45% of all injuries to lower extremity joints. Ankle sprains are one of the most common musculoskeletal injuries in general and they also have one of the highest recurrence rates. 20% of ankle sprains deform the articular cartilage and recurrent ankle sprains lead to chronic ankle instability and osteoarthritis in the long run. In most cases (85%), lateral ligaments of the ankle are injured.
The ligaments that are injured most often with ankle sprains are the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL).
Depending on the trauma severity, lateral ligament injuries of the ankle correspond to 3 different degrees of severity:
- a stretched ligament, minimal functional impairment, no bruising, weight can be put on the ankle
- partially torn ligaments, moderate functional impairment, moderate pain and swelling, bruising is common, it is difficult to put all the weight on the ankle
- complete tear of the ligaments, severe functional impairment with significant swelling and bruising, no weight can be put on the ankle
A major risk factor for ankle sprains is the shape of the innate anatomical position of the foot arch. A high and/or short foot arch causes the feet to roll inward, which makes it more likely to get injured.
The most common ankle sprain mechanism is simultaneous rolling of the ankle inward and the foot upward; this is professionally known as an inversion ankle sprain with plantar flexion. The inversion type of trauma means that our own weight places excessive pressure on the outer side of the ankle, causing the ligaments and muscles, which maintain lateral stabilisation, to stretch, partially tear, or completely tear.
If an ankle sprain is suspected, it is necessary to see a doctor and immediately undergo diagnostic imaging (magnetic resonance imaging – MRI, X-ray, or ultrasound). It is vital to exclude worse complications, such as ankle fracture or dislocation. In most cases of severe ankle sprains, x-ray imaging is performed.
In the majority of cases, the treatment of ankle sprains is conservative. Surgical intervention is necessary only in the case of accompanying complicated bone fractures, cartilage injuries, or chronic ankle instability. Treatment follows the RICE method (rest, ice, compression, elevation) for the first 72 hours after the injury. Crutches may be used to bring relief in the event of severe symptoms.
The acute phase after the injury is followed by the phase of functional rehabilitation, which includes a specialised exercise programme that has always been superior in the long-term success of treatment in comparison to the first therapeutic phase.