The ankle joint is one of the most important and sensitive joints for athletes. Ankle sprains (ligament injuries) are the most common and among the more severe sports injuries, but they are often considered less serious and become chronic.
Cause and mechanism of onset
The ankle joint consists of three bones: the tibia, fibula, and talus; the lateral (fibular) side is surrounded by the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular ligament (Figure. 1). The medial (tibial) side is protected by a strong ligament called the deltoid ligament.
Figure 1 Ligaments of the lateral ankle joint.
Cause of the injury
The ankle joint is a joint that is more flexible in the inversion direction than in the eversion direction. Sliding or stepping on a foot can cause abrupt inversion movement and stretch or tear the outer anterior talofibular ligament. Many injuries are varus sprains, which damage the outer ligaments.
Ankle injuries are particularly common in volleyball and basketball. It is the most severe case that the inversion sprain is occurred when the athlete step on the others’ foot. (Photo 1). Sliding on the floor and twisting the feet (self-induced injury) are more likely to result in moderate injuries, most often in contact sports, such as soccer, rugby, or American football, as well as in baseball sliding, gymnastics, and tennis. Occasionally, medial side of the ankle gets injured from eversion. (Photo 2).
Injuries occur at all levels of sports, from recreational to the top-level .
Photo 1: Lateral side of the ankle which gets eversion sprain with swelling and bleeding under the skin
Photo 2: Medial side of the ankle which gets eversion sprain with sprain
For inversion sprains, lateral tenderness, fluctuance due to inversion stress, and laterality are diagnosed.
X-rays can be used to check for fractures, to check for spicules, to perform a stress X-ray to check for ligament loosening (Photos 3 and 4). Lately, MRI and ultrasound examination are adopted to diagnose in detail.
Treatment and rehabilitation
During the acute phase, after the injured area is identified, and a RICE procedure is proceeded with by splinting, bandaging, taping, and icing (Photo 5) to keep the person at rest with the limb elevated. People who have severe pain in the ankle during walking should see an orthopedic doctor, preferably a sports doctor. The three levels of injury help determine treatment and rehabilitation methods.
Achilles tendon stretching is important in the early stages of an injury because the ankle may be limited in movement (Photo 6). Taping and ankle braces have been used for solution in return to competition because they allow plantar dorsiflexion action with limitation of inversion movements. (Photo 7).
1st degree sprain: Little ligament damage and mild tenderness, which allow patients restart sports activities within 2-3 days. They can walk or run lightly.
2nd degree sprain: Partial ligament rupture, with tenderness, swelling, and inability to walk. Return to competition takes 2 to 3 weeks. Braces, taping, and splinting are needed. Please seek medical diagnosis for this case.
3rd degree sprain: Complete ligament tears cause tenderness, swelling, warmth, and bleeding under the skin, making walking difficult. It takes 1 to 2 months to return to competition. Treatment at the hospitals (rigid immobilization with a cast or brace or suturing of the ruptured ligaments) is needed.
Photo 3: The ankle is preserved at a glance
Photo 4: The same ankle in the stress
When the athlete gets first ankle sprains, adequate immobilization and enough terms of rest are required because joint mobility persists and causes repeated chronic sprains. Aggravation may also cause impingement syndrome and cartilage degeneration of the ankle joint.
Photo 6: Wall press. Please be aware that the calf and Achilles tendon are extended and ankle is dorsiflexed. A good example is the posture in the rugby.
Photo 7: With ankle braces
It is important to train the ankle joint toward four directions, anterior, posterior, lateral and medial directions. Especially, strengthening the fibular tendons instead of the damaged lateral ligaments (motion in the ankle eversion direction) for return to competition.