Lateral ligament sprain
Ankle sprains account for around 40% of all athletic injuries. On the outside (lateral) aspect there are three sets of ligaments that hold the ankle together (below) and each can be injured. Most commonly injured is the ATFL (anterior talo-fibular ligament), when an injury is sustained at the lateral ligament complex a patient is said to have sustained a lateral ankle sprain. These injuries account for around 90% of all ankle sprains.
High ankle sprains
Less commonly at around 10% of ankle sprains are referred to as high ankle sprains. This is when there is injury to the ligaments that hold the lower tibia and fibula together; these ligaments are known collectively as the distal extremity syndesmosis. High ankle sprains are generally caused by forceful external rotation of the foot.
Medial ligament sprains
Finally on the medial (inner) side of the ankle you have the deltoid ligaments, these are very rarely sprained without the presence of an ankle fracture for example and as such isolated injuries of this ligament probably account for less than 1 % of all ankle sprains.
Grading of ankle sprains:
Ankle sprains are graded according to the severity of the tear
Grade 1 sprained ankle symtoms:
There will be only mild pain with little or no instability.
Some joint stiffness or difficulty walking or running but the athlete may be able to play on.
mild swelling around the bone on the outside of the ankle.
Grade 2 sprained ankle symptoms:
Moderate to severe pain and difficulty walking. The athlete is unlikely to be able to play on and will limp.
Minor bruising may be evident along with swelling and stiffness in the ankle joint.
There is likely to be some instability of the joint resulting from moderate tearing of some of the ligament fibres.
Grade 3 sprained ankle symtoms:
This usually results in a total or almost complete rupture of a ligament.
Severe pain will be felt initially but later by no pain.
The athlete will experience gross instability of the joint.
Severe swelling will be seen with extensive bruising.
Example: lateral ligament sprain
Specific incident injury- usually an inversion injury, with swelling and bruising- may also report pain around medial aspect of ankle joint due to impact of talus head with the medial malleoli – excessive inversion is felt then the ligament complex may be ruptured- if rupture is suspected pain may not necessarily be felt- tenderness would be felt over the lateral ligament complex
Treatment and rehabilitation protocol (based on elite level performer grade 1+)
0-5 days :PRICE , if injury is chronic transverse frictions to relevant ligament can be performed immediately. ROM exercises
5-10 days: soft tissue work- swimming , clinic band exercises
10- 18 days: straight line running. Further soft issue work and ankle mobilisations
18-21 days: gentle twisting and turning exercises
28 days: return to training
Surgery may be required for chronic ankle instability and re-occurring sprains, surgery for reconstruction of rupture
Injection therapy may be considered for chronic ankle sprains though this is uncommon