An ankle sprain happens when the ankle rolls, twists or is forced beyond its normal range of movement this can result in damage to the ligaments, tendons and bones in the ankle. Ankle sprains are often referred to as a rolled or twisted ankle they are among the most common sports and musculoskeletal injuries despite this they are often poorly managed. This poor management means the ankle remains loose and weak after the injury and often gets sprained again.

The most common form of ankle sprains are inversion sprain where the inside of the foot is over extended underneath the body(see picture). This type of sprain results in pain and potentially swelling and bruising on the outside of the ankle normally in the area around your malleoli (the boney lump on the outside of your ankle). Eversion and high ankle sprains are also possible but less common examples of ankle sprains, for the purpose of this blog we will be focusing on inversion sprains

There are a number of factors that can lead to an ankle sprain and sometimes a combination of reasons can cause one. Among the most common reasons are:

• Uneven or slippery ground
• Fall and stumbles
• Poor footwear
• Weakness and limagent looseness from previous sprains
• Sporting sprains from changes in direction or trauma suffered during sport
• Foot type and walking running/technique

To answer this we’ll first have a quick anatomy lesson. The outside of the ankle has three primary ligaments that keep it stable the anterior-talo fibular ligament(ATFL), the calcaneo-fibular(CCF) ligament and the posterior talo-fibular ligament(PFTL) (see the diagram). There are also the peroneus longus and peroneus brevis tendons passing through this area muscles whose job it is to keep the foot stable when we walk.

All of these  ligaments, the bones they attach to and the peroneal tendons can all be damaged in an ankle sprain.

When the ankle is forced beyond its normal range of movement in an ankle sprain these structures can become strained, torn or ruptured. The most common damage in this scenario is to the ligaments of the ankle with ATFL most commonly injured followed by the CCF ligament. When this happens we often get bruising, swelling and a significant amount of pain. To assist us in working out how damaged your ankle is our clinicians often use the Ottowa ankle rules which are a good guide as to whether a bone may be broken or not.

Like most musculoskeletal injuries ankle come in more and less severe cases. To help us determine how much damage has been done to an ankle during a sprain we will often refer you for an xray, ultrasound, CT or MRI scan depending on what we feel is most appropriate. This will help accurately work out how much damage has been done and what treatment is required to help you get better.

Once we have determined how severely your ankle has been damaged the next step is putting together a treatment plan to help you get better. The main focus of this is initially on pain management this is done by using the treatments from the acronym POLICE which has replaced its predecessor RICE, POLICE stands for:

• Pain management
• Optimal Loading(relative rest)
• Ice
• Compression
• Elevation

The goal of these early treatments is to manage pain and reducing loading while the body begins its early phase of healing. This is a great time to come and get assessed and we can help organise scans and a moon boot if needed.

The next phase once pain and swelling are beginning to reduce will focus on gradually recapturing range of motion and movement in the ankle. Once full range of motion has been restored we set about trying to rebuild strength and stability in the ankle and targeting a return to sport and normal activities.

This large step is crucial in making sure that the risk of reinjury is managed.