The Lower Ankle Sprain

By

The most common injury that occurs at the ankle joint is a sprain. This injury involves too much stretching or a rupture to a ligament or ligaments located at the ankle joint.

 Definition of a Lower Ankle Sprain

The lower ankle sprain is a type of ankle sprain. They are the most common of all ankle sprains and comprise approximately 90% of all ankle sprains. This type of sprain is named in relation to the site of injury. In a lower ankle sprain, the injury occurs at the ligaments below the ankle joint.

Grades of an Ankle Sprain

Prevalence of Ankle Sprains

There is a high incidence of ankle sprains that occur in the United States. It is estimated that 23,000 people sustain an ankle sprain every day. The ankle sprain is also one of the most common joint injuries of the body.

 Who Is At Most Risk For Ankle Sprains?

The quick answer is:

• Females are at greater risk than males.
• The young, athletic population- especially basketball players, volleyball players, and dancers.
• Military individuals.
• Individuals who frequently perform running, cutting, and jumping during fitness and sports activity.

Ankle sprains also occur in non-athletic populations. They can occur during activities of daily living like walking, transfers, stair/curb ambulation, and stepping on uneven surfaces.

Basic Ankle Joint Anatomy:

• Bones– 3 main bones:

  • Tibia– The thicker, bigger weight-bearing bone of the lower leg. The lower end of this bone that has a bony protrusion on the inside of the ankle is called the medial malleolus.
  • Fibula–  This is the thin, long bone located on the outer part of the lower leg. Its lower, outer end is called the lateral malleolus. 
  • Talus–  This bone of the foot is located below the ends of the tibia and fibula. 

• Tendons– Are structures that extend from muscles and attach to bones. Tendons with their respective muscles are responsible for ankle movement: up/down, side to side, and rotation.

• Ligaments– These are structures that connect one bone to another in a joint. Their function is to provide joint stability. The 3 main ligaments located on the outside of the ankle include: the 

  • Anterior Talofibular Ligament
  • Calcaneofibular Ligament 
  • Posterior Talofibular Ligament  
  • The main ligament located on the inner portion of the ankle is called the deltoid ligament.  To learn more about the anatomy of the ankle, go to Ankle Anatomy.

Common Ligaments involve in lower ankle sprains

The 2 Categories Of Lower Ankle Sprains:

• Lateral Ankle Sprain or Inversion Ankle Sprain:

  • The injury occurs on the outer ankle. Usually, the ankle is forced to roll inward while the foot is pointed down.

  • This is the most common type of all ankle sprains.
  • In a lower ankle inversion sprain, the anterior talofibular ligament is the most commonly damaged structure.  Sometimes, the calcaneofibular ligament may also be involved.

• Eversion Ankle Sprain or Medial Ankle Sprain

  • This is the less commonly occurring type of lower ankle sprain.

  • The deltoid ligament located at the inner aspect of the ankle joint is the injured structure in this type of sprain.
  • This injury is associated with the ankle/foot turning or rolling outward.

Causes of Lower Ankle Sprain

Most lower ankle sprains are caused by:

• Abnormally planting the foot.
• Stepping or landing on an uneven, irregular, or unstable surface.
• Falls- in which the ankle rolls or twists.

Signs and Symptoms of a Lower Ankle Sprain

After sustaining a lower ankle sprain, you may experience the following:

• Pain.
• Swelling.
• Point tenderness at injured ankle ligaments.
• Bruising.
• Redness and/or warmth at the injured site.
• Limited movement at ankle joint.
• Ankle instability- the ankle “gives out.”
• You may have heard or felt a “pop” at the ankle at the time of injury.

Grading Severity of Lower Ankle Sprains

Grade I Sprain:

• There is an overstretching of the injured ligament.
• Little to no joint instability.
• Mild pain and swelling.
• Minor difficulty with walking.

Grade II Sprain:

• Moderate, partial tearing of ankle ligament fibers.
• Moderate to severe pain and swelling is present. 
• Some joint instability.
• Some difficulty walking.
• Mild Bruising.

Grade III Sprain:

• Total ligament rupture is involved.
• Severe pain and swelling.
• Severe ankle joint instability.
• Severe difficulty walking secondary to complaints of pain. 

The grade/severity of the lower ankle sprain can be used to determine how to manage and treat the injury.  In more severe cases, you may require medical attention from a physician and/or care from a physical therapist.

When Should You Seek Medical Attention?

• The sprain does not get better and possibly gets worse after approximately 7 days after initial date of injury.
• Presence of severe ankle pain that cannot be managed.
• Inability to walk on affected ankle.
• Presence of severe pain in the foot or lower leg.

The physician will examine the injured lower leg, ankle, and/or foot to provide further medical attention and rule out other injuries like fractures, nerve damage, blood vessel damage, and tendon damage.

Immediate Care After a Lower Ankle Sprain

The best action to take for the first 2-3 days after ankle injury is to implement treatment that focuses on decreasing inflammation at the injury site.  It is recommended that the individual with a newly sprained ankle use the R.I.C.E. method:

• Rest- stay away from physical activity involving the injured ankle. The ankle may be immobilized with a brace, splint, or walking boot.  Crutches may also be used.
• Ice- put ice packs on the injured ankle for 15-20 minutes, every 3 hours.  Special precaution and physician approval may be needed for individuals that have decreased sensation at the ankle/foot, history of Diabetes, and history of vascular disease.
• Compression- use an ACE bandage to help manage initial swelling at the injured ankle.
• Elevation- position the injured ankle at a level higher than the heart to use gravity to help drain fluid causing swelling at the ankle.

Treatment Interventions for a Lower Ankle Sprain

• The physician may prescribe anti-inflammatory medications or pain medications- may be over the counter or prescribed meds.
• Assistive devices like crutches, walking aids, and walking boots can be used to minimize pain and possible further swelling and take the load off the injured ankle while allowing the injured individual to be ambulatory.
• Use of ankle braces, supports, elastic bandage, or athletic tape- for support, stability, and to help keep swelling down.

Physical Therapy for Ankle Sprains

Physical Therapy for Ankle Sprains

May include, but not limited to:

• Treatments like ice, heat, electrical stimulation, ultrasound, and medical laser can be used to decrease pain and inflammation.
• Manual techniques performed by the therapist like massage to reduce swelling.
• Kinetic or Kinematic taping- to manage swelling or help increase support at the ankle.
• Therapeutic exercise- to increase or restore ankle flexibility, ROM, strength, endurance, stability, joint awareness in space, balance, coordination, and agility.
• Functional Exercise- to help return to specific sports activity, recreational activity, or daily activities in life.
• Home Exercise Program Instruction/Education- allows the individual to do PT exercises independently on “off” days from clinical PT sessions and when pt. is discharged from PT.  

Surgery for Ankle Sprains

Not very common in patients with lower ankle sprains. Ankle surgery is sometimes done to repair or reconstruct ankle ligaments that will not heal after extensive traditional treatments for an ankle sprain have been attempted.

Full healing from a lower ankle sprain can be expected as early as 2 weeks and as far out as app