Sprained ankles are one of the most common injuries, and also one of the most mismanaged. There is a perception that ankle sprains are a minor injury, and they are in the sense that most won’t be painful after a couple of weeks of rest.
But untreated ankle sprains can have consequences months or even years down the line which could be avoided by early intervention with physiotherapy.
There are a few different types of ankle sprain, but the one that most people are familiar with – and have likely experienced – is a supination sprain. Supination refers to rotation towards the body, which, in ankle sprains, means that the foot “rolls” outwards so that the sole is facing the other foot.
This sudden outward roll of the ankle is usually caused by the foot treading on an uneven surface or landing from a jump. Hitting a curb when running, landing on another player during sports or your foot getting stuck in a pothole are all common causes of ankle sprains.
Beginner runners are also particularly susceptible to ankle sprains as they often will not have the ankle strength and stability necessary for running, causing the foot to roll outwards.
There is a predictable sequence for which ligaments will be injured depending on the severity of the sprain, with the talofibular ligament (ATFL) and calcaneofibular ligament (CFL) the most likely to be injured, followed by the posterior talofibular ligament (PTFL), which is rarely damaged.
A twist in the ankle which goes beyond damaging the PTFL will usually also cause fractured or broken bones in the foot – which is an injury that people definitely don’t ignore.
Ankle sprains are a common injury which many people don’t consider worth visiting a physiotherapist for. Most of us have memories of twisting our ankles as children (a time we are particularly vulnerable to sprains) and recovering in a couple of weeks without much issue.
But the tougher ligaments in an adult body do not heal quite so easily, and twisted ankles will often leave residual symptoms which can cause further complications down the line.
Even a slight change in the flexibility and strength of a ligament following an ankle sprain can result in slight changes in the movement and balance in your foot. This can cause compensatory movement patterns – which is when the way that you move alters following an injury.
These compensatory movement patterns often have a psychological component as well. Following an ankle sprain, you may be more fearful of putting your full weight on the affected ankle, changing the way that you walk and run.
Compensatory movement patterns can quite easily develop without you noticing. If they are not corrected they can lead to structural changes in your body which increase your risk of injury, as muscles, tendons and ligaments are being subjected to forces they are not adapted for.
This can also result from changes in proprioception, which your brain’s awareness of how your joints are positioned. Proprioception is why you know where your hands and feet are even if you can’t see them.
Just a couple of weeks of not being able to move a painful, swollen ankle properly is enough time for changes in your proprioception to occur which may linger even after your ankle has recovered.
Because of the interrelation between the ankles, knees and hips, a change in movement and function in the ankle can have long reaching consequences all the way up your legs.
The laxity of ligaments on the outside of the ankle can increase following damage from an injury, making them less able to keep the foot in place.
If you assume an ankle sprain is a minor issue and continue as you were before without giving it the time and attention required to heal, you’ll be more vulnerable to suffering a sprain again.
Over time, laxity in the ankle ligaments can develop into chronic ankle instability, where the ankle rolls outwards even under minor load. This often leads to a vicious cycle where ankle instability leads to repeated ankle sprains, which further reduce stability, leading to further sprains.
It’s important to intervene with physiotherapy as soon as possible if you are suffering from recurrent ankle sprains. Ligaments take a long time to heal and are difficult to strengthen. Chronic ankle instability is likely to require constant management, but with guidance from a physiotherapist, it’s easy to incorporate this management into your exercise routine.
In severe cases, chronic ankle instability can cause so much damage to the ligaments that surgery may be required.
Ideally, you will see us within three days of having an ankle sprain. The sooner you see us, the better we will be able to manage your recovery.
Our first step is to diagnose which ligaments have been affected and check if there is any damage to the bones in your feet. This may require an X-ray or MRI scan.
Severe injuries may warrant wearing a protective boot for a few weeks to allow the ligaments or bones to heal. We may also recommend that you be seen by an orthopedic surgeon.
In most cases, where there is less ligament damage and no evidence of a fracture, the next step is to restore as much movement to the ankle as possible.
This involves gentle, controlled movements and prescribed exercises for you to do at home, combined with pain relief and anti-inflammatories to deal with tenderness and swelling.
Once the pain and swelling have subsided, we will prescribe a few simple balance and strengthening exercises to restore full function to your ankle and address any restrictions in movement which may have occurred during your recovery.
Following severe ankle injuries or if there is a risk of recurrent sprains, we may also recommend taping and braces to provide additional support to the ankle while we continue rehabilitation so that your progress isn’t set back by a further injury.
For minor sprains, we can expect your full range of motion to be restored within a few weeks with minimal risk of recurrence. Our aim as physiotherapists isn’t just to treat injuries, but to prevent them from happening in the future.
If you would like to book an appointment with the clinic, call us now on 0207 937 1628 or email us at info@westlondonphysio.co.uk .
Liam McCloskey – Musculoskeletal Physiotherapist
BSC(PHYSIO)(HONS) MCSP HCPC
