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Lateral ankle ligament injuries (also known as inversion injuries) commonly occur when catching the heel on the edge of a step when descending stairs, twisting the ankle unexpectedly on uneven ground or when playing sports requiring rapid changes of direction such as football, rugby, basketball and netball. The stretching, twisting and/or tearing of the ligament results in a classic ankle sprain.
Ligaments are the strong bands of connective tissue which run through our joints to help provide strength and stability. The most important ligament complex of the ankle, the lateral ligament complex (on the outside of the ankle) provides the secondary support to the joint when the ankle rolls inwards (inverts).
At the time of injury
Pain and a rapid onset of swelling to the outside of the ankle (due to the ligament bleeding). The extent of pain and swelling will depend on which ligament is injured, and the severity of the injury.
First few weeks after injury
Pain and swelling should begin to reduce. The main symptom often becomes significant stiffness to the ankle joint. Early and regular movements and rehabilitative exercises are vital, reducing this stiffness as quickly as possible.
Ongoing symptoms
Some individuals may experience ongoing ankle joint instability, giving way and pain. Unfortunately, it is very difficult to predict who may experience these symptoms as there is little correlation between the severity of ankle ligament injury and ongoing ankle instability. Fortunately, adhering to a supervised ankle joint strengthening and co-ordination rehabilitation routine will significantly reduce the chances of developing ongoing ankle pain and instability.
How are lateral ankle ligament injuries diagnosed?
A lateral ankle ligament injury can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination. The main feature on examination is instability or loosening of specific movements of the ankle (special tests) designed to stress the lateral ankle ligament complex. X-rays or other scans are NOT routinely required, but may be requested to exclude any associated fracture or cartilage injury or to plan surgery if needed.
Acute phase management
MICE = Movement, Ice, Compression, Elevation
Acute phase management is aimed at reducing swelling and alleviating pain to allow rehabilitation to commence as early as possible following injury.
The following self-help videos explain how to safely follow a MICE routine after an injury:
[Ankle foot compress video] https://youtu.be/OfzOFTe1RSU [Icing for ankle video] https://youtu.be/u-ZzAdfeuO0Ongoing management
First line management requires a supervised rehabilitation program of exercises to ensure the ankle restores its full range of motion and to ensure appropriate grading of strengthening and co-ordination exercises are undertaken.
If you are having continued difficulty weight bearing please see your GP/healthcare professional as you may require an x-ray.
The following self-help videos are helpful to follow in the early stages after an injury to maintain flexibility and strength to the affected ankle joint:
[Gastroc heel raises video] https://youtu.be/ZPjDtNJa02U [Gastrocnemius stretches video] https://youtu.be/eu1la_OCDUI [Soleus stretches] https://youtu.be/topnlvvhsnM
