Lateral Ankle Sprain

An ankle injury can disrupt your daily life, athletic performance, or rehabilitation goals.

Among the most common of these injuries is the lateral ankle sprain (LAS), which occurs when the ligaments on the outer side of the ankle are stretched or torn due to sudden twisting or rolling of the foot.

To aid your understanding and recovery process, I’ve outlined key information about the injury, its underlying mechanics, and effective management strategies.

The Anatomy Behind Lateral Ankle Sprains

The ankle is a complex structure, comprising several joints that work together to provide mobility and stability. The talocrural joint, where the tibia, fibula, and talus meet, acts like a hinge, enabling the up-and-down motions of dorsiflexion and plantarflexion. Its shape offers natural stability during weight-bearing, particularly in dorsiflexion, where the talus fits snugly between the tibia and fibula.

Below this lies the subtalar joint, which connects the talus to the calcaneus (heel bone). This joint allows inversion (the sole of the foot turning inward) and eversion (the sole turning outward). Finally, the transverse-tarsal joint involves the talus, calcaneus, navicular, and cuboid bones. These joints work together to produce the intricate movements needed for walking, running, and balance.

What Happens During an Ankle Sprain?

Most lateral ankle sprains occur when the foot rolls inward excessively, causing overstretching or tearing of the lateral ligaments.

The anterior talofibular ligament (ATFL) is the most commonly affected, as it is the first to experience tension during inversion. The calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) may also be involved in more severe cases.

LAS is one of the most common MSK injuries counting for 85% of all ankle injuries.

• Extrinsic Factors include:

Previous injury

Shoe type

Surface

•Intrinsic Factors include:

Sex more prevalent in women)

Height

BMI

Signs and Symptoms

Patients with a lateral ankle sprain often experience immediate pain and swelling on the outer side of the ankle. Bruising may develop within hours, and walking or bearing weight can become challenging. Reduced range of motion and joint instability are also common. If left untreated, repeated sprains may weaken the ankle, leading to chronic instability and an increased risk of future injuries.

Diagnosis and Assessment

A proper diagnosis is essential to distinguish a simple sprain from other potential injuries, such as fractures or high ankle sprains. Key clinical assessments include:

• Observing for swelling, bruising, and deformities.

• Palpating the ligaments to identify areas of tenderness.

• Performing tests like the anterior drawer test (to assess ATFL integrity) and the talar tilt test (to evaluate CFL stability).

Imaging, such as X-rays or MRIs, may be required in cases of severe injury or suspected complications.

LAS GRADING

•Grade 1 - mild, painful, minimal tearing of the ligament fibers

•Grade 2 - moderate, painful, significant tearing of the ligament fibers

•Grade 3 - severe, sometimes not painful, complete rupture of the fibers

Differential diagnosis

•CFL / PTFL

•High-ankle sprain

•Malleolar / tib-fib / base of the 5th / navicular #

•Peroneal tendon strain

Phases of Healing and Management

Managing a lateral ankle sprain involves three critical phases:

1. Acute Phase (0-72 hours):
   The primary goal is to minimize pain and swelling. Techniques include the PEACE and LOVE protocol (used to be RICE) and using braces or supports to immobilize the ankle. Anti-inflammatory medications may also be recommended.

1. Subacute Phase (3-14 days):

   
   As swelling subsides, focus shifts to restoring range of motion through gentle exercises like ankle circles and toe stretches. Active range of motion (AROM) exercises help maintain mobility without straining the ligaments.

   Ankle immobilisation results in negative outcomes. Taping / mobile braces / support are ok. Early loading is key!

   Physiotherapy rehab will consist on help you get rid of your crutches if you needed them (return ti Full Weight bearing), Gait re-education, manual therapy (massage, deep friction , joint mobilisations) and exercises such as:

2. Rehabilitation Phase (2-8 weeks):

Strengthening the muscles around the ankle is critical to restoring function and preventing future injuries. Exercises like resisted dorsiflexion, single-leg balance, and heel raises are introduced progressively. Advanced proprioceptive training, such as using a wobble board, prepares the ankle for dynamic movements.

3. Return to Sports

If all goes well, within 6 to 12 weeks, we should focus on returning to sports. The exercises will become more intense and focus on explosivity, change of directions and proprioception.

How We Can Help You

We can help you from day 1 to recover properly and safely from your ankle sprain. Please contact us on info@benjiphysio.co.uk for further info.