First grade ankle sprain involves stretching of the ligament with only a small amount of ligament tearing and features a low degree of swelling.
The joint remains stable and there is no loss of function, and the patient can generally bear weight either partially or fully.
Second grade ankle sprains involve stretching of the ligament, with partial tearing, and involve moderate-to-severe swelling, and bruising.
The joint will be moderately unstable and there will be moderate loss of function, and weight bearing may prove difficult.
Third grade ankle sprain injuries involve complete rupture of the ligament. Swelling and bruising of the area will be immediate, and pain will be severe.
The joint will be moderately to severely unstable, and weight bearing will involve severe pain.
Generally known as “going over on the ankle”, an ankle sprain is generally an inversion movement where the outside (lateral side) of the ankle rotates towards the ground resulting in damage to the lateral ligaments. Eversion injuries are much less common and are characterised by the inside (medial side) of the ankle moving towards the ground with resultant damage to the medial ligaments.
The most common ligament to be damaged is the Anterior Talofibular Ligament
The above graded classification tends to be used for diagnostic purposes, while in the absence of X Rays, broken ankles tend to be excluded if the patient can walk on the ankle.
In an ankle sprain, physical examination will tend to show tenderness, swelling and bruising. The degree of each presentation will be indicative of the grade of sprain, or indeed if a fracture is present. Bruising may appear at the heel rather than the site of the injury.
Tenderness at the medial or lateral malleolus, mid foot bones or fifth metatarsal may indicate the presence of a fracture, and range of motion must be examined to exclude tendon ruptures.
Gentle passive replication of the inversion movement in lateral sprains should cause pain, and plantar flexion should also aggravate the symptoms.
In the acute situation the traditional PRICEs regime should be initiated.
(P)rotection is generally provided with a “Walker Boot” e.g. Aircast Air Select or Air Select Short or ankle support such as the Push Aequi ankle brace.
(R)est promotes healing, but gentle pain free movement should be encouraged.
(I)ce in the form of ice packs, ice bags or wraps will help reduce swelling in the acute phase.
(C)ompression using an elasticated bandage or compressive brace or wrap.
(E)levation above the level of the heart when possible.
Recently, however, some practitioners have been finding remarkable results in reducing swelling using lymphatic drainage techniques with Kinesiology Tape.
In patient with ongoing weakness in the ankle joint, and in athletes generally it may be useful to use athletic taping techniques or bracing to help prevent recurrent ankle sprains.
Generally, taping is effective only when applied with the skill of a trained therapist, and may only be useful for short periods, as movement tends to loosen the tape.
Support braces may be more useful for patients in the non elite category without the back up of the sports medicine team available at most clubs.
Published: July 8, 2011
Sprained Ankle Treatments