Ankle Sprain Instability

An ankle sprain is a common injury and happens when there is a sudden twist to the ankle.

Anatomy

The ligaments are soft tissue with some elasticity. There are three ligaments on the outer side of the ankle and on the inner side there is the deltoid ligament made of 5 parts. The lateral ligaments are usually injured in the ankle sprains. The first two viz. anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) are commonly injured. The ATFL prevents excessive anterior slide of talus and the and CFL prevents excessive roll of talus in the ankle mortise.

Initially the ankle is swollen, bruised and it is very painful to weightbear.

The diagnosis is made clinically although the x-rays are taken to rule out fractures. Often an external support such as a brace or a tubigrip is required, with some elevation, ice and intermittent rest. Usually the ligaments heal in 6 weeks and physiotherapy is useful.

Ankle Instability

In a small number of cases, the ligaments will not heal to be as strong as normal. This results in repetitive giving way of the ankle. Physiotherapy can be helpful in improving the stability and proprioception. If the symptoms fail to improve then the ligaments might have not completely healed or would have been stretched out.

Surgery

If conservative treatment fails then surgery is recommended to reconstruct the ligaments. The operation is done through a scar on the outer part of the ankle and sometimes it is accompanied by keyhole (arthroscopy) procedure. After the operation a nonweightbearing cast is applied for 6 weeks and thereafter physiotherapy is needed.

Early Healing Phase:

Range of Motion Exercise: These are done to encourage physiological motion of the joint.

Strength Progression: Next, you will begin a strengthening progression for the muscles around the ankle. Emphasis should be placed on the muscles that pull the foot up and out (evertors), up (dorsiflexors), and raise the heel (plantarflexors). Isometrics exercises can be used in the early stage of rehabilitation. These are strengthening exercises with the ankle at different angles, helping you stay away from painful position of the ankle. (Figure 12: picture of patient with physical therapist)

Early resistive exercises: Some types of equipment like therapeutic band, pulleys or isokinetic devices are helpful in reducing the effects of gravity, allowing you to begin strengthening without causing pain.

Balanced resistive exercises: Healthy ligaments send information to the central nervous system about the position of a joint. Once a ligament has been injured, these receptors are unable to receive and send the needed information to the brain. This increases the possibility of injury in the future. Balance exercises such as standing and walking on uneven or very soft surfaces, single leg balance, mini trampoline balance, and progressive agility's.

Further Progression:

More intensive exercises are done when painful symptoms have settled. Closed-chain exercises are done by fixing the sore-side foot on the ground. This allows the muscles around the ankle to be exercised while easing stress on the ligaments. Examples include partial squat, weight shifting, step ups/downs, single-leg balance, and lunge. These are actually the exercises can be used to heighten "motor" control in the ankle muscles. Progressive resistive exercises (PREs) are a group of exercises for the leg and ankle muscles in which the amount of weight being used is carefully increased. Moving a specific amount of weight but controlling the speed at which it is moved does this. Higher level exercises, like agilities, progressive running and cutting, polymerics, and heavy resistive training can be done to prepare the ankle for specific job or sport demands.