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ANKLE
Ankle Sprains



ANKLE  SPRAINS
 

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Description
Ankle sprains are very common injuries. They occur when the foot is rolled inward, usually on another player's foot when landing from a jump, or stepping on an uneven surface. When the sprain occurs, damage can be done to the ligaments on the outside of the ankle. Ligament injuries are graded as type I- III:

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Figure 1: Lateral Ankle Ligaments
(Safran et al, 2003.)


Prevention

Further ankle sprains can be prevented by ankle strengthening exercises and allowing for warm-up before activities.


Symptoms
After a sprain the ankle can be swollen and painful to walk. Grade III or severe sprains may require the patient to use crutches. The ankle may also feel unstable.


Non-Surgical Treatment
Immediately after an ankle sprain the ankle should be Rested, Iced, Compressed, and Elevated (RICE). Ice should be applied by placing ice cubes into a zip-lock freezer bag and wrapping the bag around the ankle. Ice should be on for 30 minutes then off for 30 minutes. Blue ice should never be used as it can freeze the skin resulting in “freezer burn which can be serious." Compression can be applied through the use of an ACE bandage. Eleveation of the ankle should be above the heart. If there is significant difficulty walking then a physician should evaluate the injury and x-rays should be obtained to rule out a fracture.

Weight bearing can usually be progressed as pain allows. Sometimes a walking boot or crutches are used temporarily. Often an air-cast is used after the walking boot is discontinued. A functional ankle brace can then be used to transition back to sports.

Anti-inflammatory medications (Advil, Aleve, or prescription anti-inflammatories) can be used to reduce pain with inflammation as long as there are no contraindications.

After the initial period range of motion and then strengthening exercises should begin. These exercises can be done at home or with a physical therapist. Exercises should always be pain-free.


Surgical Treatment

Surgery is rarely needed after an ankle sprain. Possible indications for surgery include continued instability despite rehabilitation, or pain from an injury to the ankle joint.


Prognosis

Most patients are able to return to all activities after an ankle sprain. However, rehabilitation is critical for successful return to sport. Recovery can take 4-6 weeks on average.



REHABILITATION

Strengthening Exercises
Pain free exercises including range of motion movements and strength training will accelerate recovery.

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Figure 2: Dorsiflexion and Plantarflexion range of motion
(Safran et al, 2003).

 

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Figure 3: Alphabet Range of Motion-
Using the big toe to draw the alphabet. (Safran et al, 2003.)

 

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Figure 4: Plantarflexors. Using a towel or rubber tubing for resistance
push against or away from your body.

 

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Figure 5: Towel Curls. Place your foot on a towel and
curls your toes and foot to grip the towel.

 

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Figure 6: Dorsiflexors. Using rubber tubing
for resistance pull the foot towards you.

 

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Figure 7: Walk on heel and toes,
then inner and outer foot.