Ankle sprain – Recovery process and rehabilitation

The ankle is divided into the talocrural joint and the subtalar joint. The talocrural joint is formed by the talus below and the fibula and tibia above. The bones are shaped in a way that allows the movements of raising and lowering the foot. The subtalar joint is the joint between the talus, the calcaneus and the navicular bone, which allows the foot to roll inwards (inversion) and outwards (eversion).

Ankle ligaments are important for the static stability of the joint. The external ligaments prevent the foot from bending excessively outward, while the internal ligaments prevent the foot from bending excessively inward. Equally important are the transverse and long ligaments, which further strengthen and stabilise the joint.

Lower leg muscles play a key role in ankle movement. The calf, shin, and sole muscles help lift, lower, and rotate the foot and maintain dynamic stability of the joint.

Tendons, such as the Achilles tendon at the back of the heel, connect muscles to bones and allow force to be transmitted between them, which is crucial for effective movement.

The ankle joint capsule surrounds the joint and produces synovial fluid, which reduces friction between the bones and allows for smooth movement.

The foot is made up of 26 bones, which together with muscles, ligaments and tendons form 33 joints.

As many as 85% of all ankle sprain occur with the foot simultaneously rolling inwards and twisting upwards, which is technically called an inversion ankle sprain with plantar flexion. The congenital shape of the foot arch, which is high and/or shortened, significantly contributes to this mechanism. In 85% of cases of inversion sprains, the ligaments on the lateral side of the foot are also injured. The most frequently injured ligaments are the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL).

If the foot rolls excessively outward at the moment of injury, which is called eversion, there is a high probability of injury to the deltoid ligament, which lies on the medial part of the foot. These types of sprains account for approximately 5% of all ankle sprains.

There is also a so-called high ankle sprain, which involves damage to the syndesmotic ligaments, but this is a rarer type of ankle injury.

The mechanism of injury in this case is ankle rotation, which often occurs in contact sports, as opposed to an inversion ankle sprain, which usually occurs in non-contact conditions.

Book an appointment for rehabilitation after an ankle sprain

The consequences of an ankle sprain are noticeable immediately after the injury. The following symptoms occur:

· heel and ankle pain,

· ankle swelling,

· reduced mobility,

· reduced function and

· ankle instability.

How long the consequences will persist and how serious they will be depends primarily on the magnitude of the force that was exerted on the joint.

Ankle sprains are divided into three categories depending on the severity of the injury:

Grade I represents strained or overstretched ligaments without tearing. Swelling is present with minimal or no loss of ankle function. The most important characteristic is that we can put full weight on the joint soon after the injury.

Grade II represents partial tearing of the ligaments. There is significant swelling, bruising, moderate loss of ankle function, ankle instability may occur, and weight bearing on the leg is difficult.

Grade III represents a complete tearing of the ligaments with immediate and severe swelling, significant bruising is evident. The joint is unstable and cannot bear weight.

Is it necessary to see a doctor?

Yes, you need to see a doctor. The doctor will evaluate the grade of the sprain, palpate the affected area, and use specific tests. This will rule out more serious conditions such as bone fractures, ankle dislocations, neurological deficits, and circulatory disorders.

If this type of pathology is suspected, X-ray, magnetic resonance imaging, or ultrasound diagnostics are performed. Surgical treatment is undertaken in cases of severe complications such as complex bone fractures, cartilage damage, or chronic joint instability.

Book an appointment for rehabilitation after an ankle sprain

Are you perhaps familiar with the English acronym RICE (Rest, Ice, Compression, Elevation), which denotes the principle of treating musculoskeletal injuries in the acute phase? Sports science is developing quite rapidly, and with it also the principles of rehabilitation.

A new term has emerged that denotes a more modern approach to these types of injuries. It is called POLICE, which means police officer in Slovenian. So does this mean that you need to rest completely if you sprain your ankle? No! And it is precisely for this purpose that a new acronym was created, meaning:

• P = Protection

• O = Optimal

• L = Load

• I = Ice

• C = Compression

• E = Elevation

Ankle sprains require rest and protection.

In the initial days after an injury, it is necessary to avoid further tissue damage, which means that we need an adequate amount of rest. However, this does not mean that we have to remain completely inactive. In the first weeks, it is appropriate to use functional splints, as they facilitate and encourage movement while reducing the risk of re-injury.

Book an appointment for rehabilitation after an ankle sprain

Optimal load will promote the healing process, as bones, tendons, ligaments, and muscles need some load to promote healing. This is the most important part of recovering from an ankle sprain. Proper gradual loading requires a broader knowledge of kinesiology and physiotherapy, so do not attempt rehabilitation on your own, but rather seek professional help.

In the acute phase of ankle sprain rehabilitation, i.e. the first days after the sprain, we perform exercises without loading. This can be as simple as raising and lowering the foot while lying down, circling with the foot, or rolling the foot outward and inward.
While sitting with your feet on the ground, gradually try to add some weight onto the injured leg, increasing the intensity over time.

In the middle phase of the rehabilitation programme, we add intensity by increasing the load on the leg, adding exercises to strengthen the calf muscles and gain full range of motion, as well as proprioceptive exercises.

The last phase represents the performing everyday activities or, in the case of an athlete, sport-specific exercises. At the end of rehabilitation, the ankle must be fully functional, mobile, and stable.

Cooling in the first 48 hours helps reduce pain and swelling

Cooling slows down tissue metabolism and thus further tissue swelling. Cooling also reduces the sensation of pain, which can significantly reduce the use of analgesics. It is good to remember that ice should only be applied during the first 48 hours after the injury. Ice packs should never be applied directly to bare skin and should not be applied for longer than 20 minutes at a time.

Procedures used in recovery after an ankle sprain include compression and elevation

In addition to ice and exercise, compression and elevation of the injured ankle will also help reduce oedema and improve your well-being. Using an elastic bandage, you do not just wrap the ankle, but continue up the shin towards the knee.

What kind of help do we provide at Medicofit clinic after an ankle sprain?

In the physiotherapy unit, we perform manual techniques that serve as effective pain control, reduce muscle tension, and restore range of motion. Manual techniques for ankle sprain rehabilitation at Medicofit clinic include local soft tissue mobilisation, trigger point therapy of calf muscles that allow movement in the ankle, ERGON techniques, transverse friction, and other manual techniques.

SIXTUS ultrasound therapy can be applied to damaged ligaments immediately, and its mode of action (transmitting high-frequency sound vibrations deep into tissue) successfully eliminates pain, accelerates healing, and prevents tissue scarring.

TECAR therapy and SUMMUS laser have also proven to be successful, triggering the body’s natural self-healing mechanisms and accelerating the regeneration process of damaged ligaments. Therapy also improves blood and lymphatic flow, which means more effective delivery of oxygen and nutrients to the target cells of the damaged area.

Medicofit clinic kinesiotherapists will prepare a programme of therapeutic exercises for you with appropriate progression towards full ankle function and pain-free and confident movement.

At Medicofit clinic, we are aware that an ankle sprain is an injury that must be taken extremely seriously and rehabilitated appropriately, otherwise it can cause long-term undesirable consequences that can lead to significant disability.