Question 1

Overview of the anatomy

Accepted Answer

The ankle joint is formed where the bones in your lower leg (tibia and fibula) meet the talus bone in your foot. The bone endings are covered in smooth cartilage and a thick sinewy capsule surrounds the whole joint, holding it together.

The joint is further reinforced by ligaments that attach into the bones on the inside, front, and outside of the ankle. The muscles in the lower leg move and control your ankle via tendons that cross over the joint in several directions.

When you sprain your ankle, you usually injure several of these structures in and around your ankle and foot.

Question 2

Ankle sprain symptoms

Accepted Answer

When you sprain your ankle, you usually injure several structures in and around your ankle and your foot. Sometimes, you can even sprain your knee at the same time.

The severity of your sprain will determine your symptoms. Including how intense they feel and how fast they resolve.

Mild sprains:

You may be able to walk with only a bit of discomfort, but walking on uneven ground will likely hurt.
There may be some swelling and bruising around your ankle or foot. This would likely occur over the outer side of your ankle if your foot rolled inwards when you sprained it. The swelling is usually in the injured ligament area, but the bruising may be lower.
It’s common for the muscles on the outer side of your lower leg (the peroneals) to hurt. They help stop your foot from rolling in too much and are often strained when you sprain your ankle.
Your ankle may feel stiff, and it will likely hurt if you try to turn your foot all the way in or out, as well as point your toes up or down.

Severe sprains:

Walking will likely be quite painful and limited to short distances only. If you cannot place any weight on your foot, you should see a doctor as this may signify a broken bone.
Your ankle and foot will likely be very swollen (all around) and quite bruised.
You may have injured several muscles, which can cause pain over the front, outer side, and/or back of your lower leg.
Your ankle joint will be stiff and painful if you try to force movements. This happens for a few reasons. 1. The swelling in your ankle makes it difficult to move. 2. The injured joint surfaces hurt when they’re moved closer together. 3. The injured tendons and ligaments are sore when they’re lengthened as you move your foot.
It's usually very stiff first thing in the morning, but this improves as you gently move your foot.

Question 3

When to see a doctor

Accepted Answer

You should consult your doctor or physiotherapist before using the app to ensure your diagnosis is correct and your injury is ready to start rehab exercises.

If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

You cannot put any weight on your foot and walk 4 steps.
You feel pain when pressing on the bones on the inner or outer sides of your ankle (medial and lateral malleolus) or the little bone along the outer edge of your foot. This may signal that you've broken a bone.
You heard a pop, crack, or snap when you sprained your ankle. This may indicate a more serious bone, ligament, or tendon injury.
Your foot feels cold, and it looks pale compared to the other foot. This could mean your circulation isn't optimal, and it's better to have it checked by a doctor.
Any part of your leg (thigh, calf, or foot) is very swollen, red, hot to touch, or throbs with pain. This may be a sign of a blood clot, and you should have it investigated as soon as possible.
Pain keeps you awake or interrupts your sleep. It's normal to have slight discomfort in bed, though.
You feel pins and needles or tingling in your leg. This can suggest a nerve injury, and our rehab plan may not suit you.
Your symptoms are getting worse.
Your injury is not recovering as expected (see expected recovery times below).

Question 4

Causes of ankle sprains

Accepted Answer

Most ankle sprains in runners are due to unexpected events that suddenly cause your foot to move into awkward positions. For example, when you step on a stone or a dog runs into you.

Sometimes your joint position sense (your brain's ability to know where and how to move your leg) isn't working at its best. This can lead to you rolling your ankle without any clear cause. Often, when you've had a previous injury to your ankle or leg, it reduces your position sense.

The good news is that you can retrain it easily with balance exercises. And these are included in the app's program.

Question 5

Rehab, recovery times & prevention

Accepted Answer

Rehab

Most people can recover from ankle sprains with a conservative rehabilitation plan incorporating the following elements and steps:

First, follow the PRICE protocol (protect, rest, ice, compression, elevation) to allow your acute injury to settle.
Carry out a short period of complete rest if necessary. This can help calm your injury, ease your pain, and control the initial swelling. But, add gentle movements within a few days post-injury to help you recover better. This is in line with the current research.
Use a brace to protect your ligaments when you start moving. Please see the reading resources for more information on the best types.
Use pain to guide your activities.
Follow a progressive exercise program to restore strength and control in your foot and ankle muscles.
Do balancing exercises to help you improve your position sense.
Strengthen your core and hip muscles to improve the control and position sense in your legs.
Perform mobility exercises to help you regain your full ankle range of motion.
Once you've recovered enough strength and control, ease back into your sports.

Our rehabilitation plan will guide you through this process.

We are all different!

We encourage you to read the article about individual differences included in this plan's reading list. It provides helpful explanations about things you may experience in the program. For example, why you may find it easier to balance on your injured leg than on your uninjured one. Or how to adapt your rehab aims if a previous injury (e.g., a fracture) has permanently reduced your movement range.

Recovery times

The average recovery times are:

Minor sprains: 2 to 6 weeks
Moderate sprains: 8 to 16 weeks
Severe sprains that include bone bruising or cartilage injuries: 6 months or longer

Prevention

Using a brace or tape to support your ankle can significantly reduce the risk of both new and recurring ankle sprains.

Coordination and balance exercises can improve your position sense, which helps to reduce the risk of recurring sprains. So, use them to your advantage and make them a regular feature in your weekly training schedule.

Question 6

Research References

Accepted Answer

Aguilaniu, A., et al. (2021). “Current practice for safe return-to-play after lateral ankle sprain: A survey among French-speaking physicians.” Foot and Ankle Surgery.
Anandacoomarasamy, A., and L. Barnsley. “Long term outcomes of inversion ankle injuries.” British journal of sports medicine39.3 (2005): e14-e14.
Bellows, R., & Wong, C. K. (2018). The effect of bracing and balance training on ankle sprain incidence among athletes: a systematic review with meta-analysis. International journal of sports physical therapy, 13(3), 379.
Bleakley, C. M., et al. (2019). “Rehabilitation exercises reduce reinjury post ankle sprain, but the content and parameters of an optimal exercise program have yet to be established: a systematic review and meta-analysis.” Archives of physical medicine and rehabilitation 100(7): 1367-1375.
Delahunt, E., et al. (2018). “Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.” British Journal of Sports Medicine 52(20): 1304-1310.
Doherty, C., et al. (2017). “Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.” British journal of sports medicine 51(2): 113-125.
Ferran NA, Maffulli N. Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin. 2006 Sep;11(3):659-62. doi: 10.1016/j.fcl.2006.07.002. PMID: 16971255.
Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998 Oct;19(10):653-60. doi: 10.1177/107110079801901002. PMID: 9801078.
Gribble, Phillip A., et al. “Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains.” British Journal of Sports Medicine50.24 (2016): 1496-1505.
Hale, S. A., et al. (2007). “The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability.” Journal of Orthopaedic & Sports Physical Therapy 37(6): 303-311.
Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop. 2020 Dec 18;11(12):534-558. doi: 10.5312/wjo.v11.i12.534. PMID: 33362991; PMCID: PMC7745493.
Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019 Jun;54(6):603-610. doi: 10.4085/1062-6050-447-17. Epub 2019 May 28. PMID: 31135209; PMCID: PMC6602402.
Ismail, M. M., et al. (2010). “Plyometric training versus resistive exercises after acute lateral ankle sprain.” Foot & Ankle International 31(6): 523-530.
Janssen, K. W., et al. (2014). “Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial.” British Journal of Sports Medicine 48(16): 1235-1239.
Janssen, K. W. (2018). “Infographic: Ankle sprain treatment and prevention timeline.” British Journal of Sports Medicine 52(15): 953-954.
Kaminski, T., et al. (2003). “Effect of strength and proprioception training on eversion to inversion strength ratios in subjects with unilateral functional ankle instability.” British Journal of Sports Medicine 37(5): 410-415.
Kerkhoffs GM, Struijs PA, Marti RK, Assendelft WJ, Blankevoort L, van Dijk CN. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev. 2002;(3):CD002938. doi: 10.1002/14651858.CD002938. Update in: Cochrane Database Syst Rev. 2013;3:CD002938. PMID: 12137665
Langarika-Rocafort, A., et al. (2017). “Intra-rater reliability and agreement of various methods of measurement to assess dorsiflexion in the Weight Bearing Dorsiflexion Lunge Test (WBLT) among female athletes.” Physical Therapy in Sport 23: 37-44.
Loudon JK, Reiman MP, Sylvain J. The efficacy of manual joint mobilisation/manipulation in treatment of lateral ankle sprains: a systematic review. Br J Sports Med. 2014 Mar;48(5):365-70. doi: 10.1136/bjsports-2013-092763. Epub 2013 Aug 26. PMID: 23980032.
Maeda N, Urabe Y, Tsutsumi S, et al. Effect of Semi-Rigid and Soft Ankle Braces on Static and Dynamic Postural Stability in Young Male Adults. J Sports Sci Med. 2016;15(2):352-357. Published 2016 May 23.
Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA, Kivlan BR, Carreira D. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021 Apr;51(4):CPG1-CPG80. doi: 10.2519/jospt.2021.0302. PMID: 33789434.
McCann, R. S., et al. (2018). “Isometric Hip Strength and Dynamic Stability of Individuals With Chronic Ankle Instability.” Journal of Athletic Training 53(7): 672-678.
O’Connor, S. R., et al. (2013). “Predicting Functional Recovery after Acute Ankle Sprain.” PLoS One 8(8): e72124. doi:72110.71371/journal.pone.0072124.
Riva, D., et al. (2016). “Proprioceptive Training and Injury Prevention in a Professional Men’s Basketball Team: A Six-Year Prospective Study.” Journal of strength and conditioning research 30(2): 461-475.
Schiftan, G. S., et al. (2015). “The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis.” Journal of Science and Medicine in Sport 18(3): 238-244.
Smith, M. D., et al. (2021). “Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus.” British Journal of Sports Medicine 55(22): 1270-1276.
Smith, B. I., et al. (2018). “Effects of hip strengthening on neuromuscular control, hip strength, and self-reported functional deficits in individuals with chronic ankle instability.” Journal of sport rehabilitation 27(4): 364-370.
Tayeb, R. (2013). “DIAGNOSTIC VALUE OF OTTAWA ANKLE RULES: SIMPLE GUIDELINES WITH HIGH SENSITIVITY.” British Journal of Sports Medicine 47(10): e3.
van Dijk, C. N. and G. Vuurberg (2017). “There is no such thing as a simple ankle sprain: clinical commentary on the 2016 International Ankle Consortium position statement.” British Journal of Sports Medicine 51(6): 485-486.
Vuurberg, G., et al. (2018). “Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.” British Journal of Sports Medicine 52(15): 956-956.
Wang, X., et al. (2013). “Clinical Value of the Ottawa Ankle Rules for Diagnosis of Fractures in Acute ” PLoS One
Wang DY, Jiao C, Ao YF, Yu JK, Guo QW, Xie X, Chen LX, Zhao F, Pi YB, Li N, Hu YL, Jiang D. Risk Factors for Osteochondral Lesions and Osteophytes in Chronic Lateral Ankle Instability: A Case Series of 1169 Patients. Orthop J Sports Med. 2020 May 26;8(5):2325967120922821.
Wagemans J, Bleakley C, Taeymans J, et al. Exercise-based rehabilitation reduces re-injury following acute lateral ankle sprain: A systematic review update with meta-analysis. PLoS One. 2022;17(2):e0262023. Published 2022 Feb 8.
Wester, J. U., et al. (1996). “Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study.” Journal of Orthopaedic & Sports Physical Therapy 23(5): 332-336.
Zinder SM, Granata KP, Shultz SJ, Gansneder BM. Ankle bracing and the neuromuscular factors influencing joint stiffness. J Athl Train. 2009 Jul-Aug;44(4):363-9. doi: 10.4085/1062-6050-44.4.363. PMID: 19593418; PMCID: PMC2707072
ZECH, A., et al. (2009). “Neuromuscular Training for Rehabilitation of Sports Injuries: A Systematic Review.” Medicine & Science in Sports & Exercise 41(10): 1831-1841.

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