Ankle sprain

Ankle sprain are a common type of injury. Approximately 85% of all ankle sprains are inversion-type, lateral ligament injuries. Ankle sprains are most common among athletic groups. Poor rehabilitation following an initial sprain increases the likelihood of this injury recurring.

In athletics, the ankle joint is the second most usually injured body part. Basketball, football, and cricket players are prone to severe ankle sprains. Athletes with chronic ankle instability missed training, and competition, require continual treatment to stay physically active.

The anterior talofibular ligament is the most often damaged of the lateral ankle ligament complex (ATFL). The following ligaments are part of the lateral ligament complex:

1. Anterior tibiofibular ligament.
2. Cervical ligament.
3. Calcaneonavicular ligament.
4. Dorsal cuboideonavicular ligament.
5. Dorsal cuneocuboid ligament.
6. Dorsal tarsometatarsal ligament.
7. Plantar Calcaneocuboid ligament.
8. Lateral collateral ligament (Calcaneofubular part and anterior talofibular part).
9. Lateral latocalcaneal ligament.

With vigorous “pronation and rotation movements of the hindfoot,” the strong deltoid ligament complex [posterior tibiotalar (PTTL), tibiocalcaneal (TCL), tibionavicular (TNL), and anterior tibiotalar ligaments (ATTL)] is injured on the medial side. Other components of the medial ligament complex include:

• Medial talocalcaneal ligament.
• Plantar calcaneonavicular ligament.
• Talonavicular ligament.

RISK FACTORS

Athletes are predisposed to chronic ankle instability due to a combination of intrinsic and external risk factors. The most prominent risk factors are the previous sprain history, weight, limb dominance, postural sway, and foot architecture. Extrinsic risk variables include shoe type, competition duration, and activity intensity.

CLINICAL PRESENTATION

• The patient comes with an ankle inversion or forceful eversion injury.
• Only able to bear half weight or can’t bear weight on the affected side.
• If the patient complains of cold feet or paraesthesia, consider peroneal nerve neurovascular impairment.
• Tenderness, swelling, and bruising can occur on either side of the ankle.
• Passive inversion or plantar flexion with inversion should mimic lateral ligament sprain symptoms. Passive eversion should mimic signs of a sprained medial ligament.
• Special Tests: Positive Anterior Draw, Talar Tilt or Squeeze Test depending on the structures affected.

PHYSIOTHERAPY MANAGEMENT

1. Cryo therapy such as Ice packs, Ice baths, or Contrast baths.
2. Taping and follow-up to evaluate healing progression. And,
3. Compression bandage.
4. Tissue flossing.
5. Ultrasound.
6. ESWT.
7. SIS.
8. High-Intensity Laser therapy.
9. ROM exercises within the pain-free limits to improve circulation.
10. Anteroposterior manipulation.
11. Ankle stability exercises, static as well as dynamic.
12. Motor coordination exercises.
13. Strengthening exercises.
14. Ankle alphabet exercise.
15. Towel scrunches.
16. Once the pain and swelling subside and the ankle gains its stability, plyometric and agility drills can be started.