Ankle Pain & Sprains

There are many different causes of ankle pain and the quickest way to heal an ankle injury is to get a proper diagnosis. The treatment for one injury can be quite different to another. This is mostly due to the complexity of the ankle and as such, the right advice can make all difference.

The most common cause of ankle pain is caused by Ankle Sprains other wise known as twisted ankles.

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Ankle Sprains

Participating in sports activities is one of the most common ways to get a sprained ankle. But even day-to-day activities such as walking on an uneven surface or slipping on the sidewalk can produce a painful stretching or tearing of the ankle ligaments. If an old sprain wasn’t completely rehabilitated, the ankle may repeatedly get sprained, resulting in chronic ankle instability.

The most common type of sprain is a Lateral Ankle Sprain/inversion sprain (or lateral ligament sprain) where the foot turns inwards, damaging the ligaments on the outside of the ankle.

A sprain where the ankle turns inwards (A Medial Ankle Sprain) is much rarer often taking significant forces to do so. This sprain damages the ligaments on the inside of the ankle.

In addition to ligament damage there may also be damage to tendons, bone and other joint tissues, which is why it is important to get a professional to diagnose your ankle sprain. If possible, an X-ray should be used, as small fractures or (avulsion fracture) are not uncommon.

Severely sprained ankles, where there are complete ruptures of the anterior talofibular, calcaneofibular and posterior talofibular ligaments, result in dislocation of the ankle joint which are often associated with a fracture

Other Causes of Ankle Pain

Sprained Ankle Ligaments
(Ankle Sprain, Ankle Instability, Inversion/Eversion injury of the ankle)
High Ankle Sprain
(Syndesmosis Sprain)
Broken Ankle
(Ankle Fracture)
Lisfrac Joint Injury
(Ruptured Tarso-Metatarsal Ligaments)
Fractured bone
(Broken foot)

 Os Trigonum
(Floating bone in back of the ankle)
Snowboarders Ankle
(Fracture of the Lateral Process of the Talus)
Tibialis Posterior Pain
(Acquired Flat Foot/Tib Post Dysfunction/tendonopathy) > More
Tendonpathy's
(Achilies Tendon, Peroneal Tendons)
Ankle Impingment
(Blocked Ankle)

Grades of Ankle Sprains

Sprained ankles, as with all ligaments sprains, are divided into grades 1-3, depending on their severity:
Grade 1 sprain:

• Some stretching or perhaps minor tearing of the lateral ankle ligaments.
• Little or no joint instability.
• Mild pain.
• There may be mild swelling around the bone on the outside of the ankle.
• Some joint stiffness or difficulty walking or running.

Grade 2 sprain:

• Moderate tearing of the ligament fibers.
• Some instability of the joint.
• Moderate to severe pain and difficulty walking.
• Swelling and stiffness in the ankle joint.
• Minor bruising may be evident.

Grade 3 sprain:

• Total rupture of a ligament.
• Gross instability of the joint.
• Severe pain initially followed later by no pain.
• Severe swelling.
• Usually extensive bruising.

Treatment of Ankle Sprains

Treatment of a sprained ankle can be separated into immediate first aid and longer term rehabilitation and strengthening.

Immediate First Aid for a sprained ankle:

Aim to reduce the swelling by RICER (Rest, Ice, Compression, Elevation, and Referral) as soon as possible.

• R is for rest. It is important to rest the injury to reduce pain and prevent further damage. Use crutches if necessary. Many therapists advocate partial weight bearing as soon as pain will allow. This is thought to accelerate return to normal activity.
• I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (when used later). Apply an ice pack or similar immediately following injury for 15 minutes. Repeat this every 2 hours.
• C is for compression - This reduces bleeding and helps reduce swelling.
• E is for Elevation - Uses gravity to reduce bleeding and swelling by allowing fluids to flow away from the site of injury. So put your feet up and get someone else to wait on you!

Following the initial painful stage, there are other treatments that can help the ankle return to normal as soon as possible. Range of motion exercises such as ankle circles can help to get the ankle moving again, as well as reducing swelling if performed with the leg elevated. The calf muscles often tighten up to protect the joint following a sprained ankle, and so gently stretching the calf muscles can also help to maintain movement at the joint.

A wobble board / balance board is an important part of the rehabilitation of ankle sprains.