ANKLE SPRAINS AND REHAB

Ankle sprains are one of the most common sports injuries.  When an ankle is sprained, the ligaments that hold the bones together may be partially or completely torn.  Athletes who do not properly care for an ankle sprain may develop chronic ankle weakness and instability that could hinder their return to high level competition.

Types of Sprains:
Inversion sprains - injury to the outside aspect of the ankle - usually occur when an athlete jumps and lands on another player's foot or when running on an uneven surface.   These sprains are graded according to the number of ligaments involved.

First-degree sprains involve the anterior talofibular ligament (ATF);
Second-degree sprains involve the ATF ligament and the calcaneofibular ligament (CFL);
Third-degree sprains involve the ATF, CFL, and the posterior talofibular ligament.

Eversion sprains - injury to the inside aspect of the ankle - are less common but may be more serious due to the strength of the deltoid ligament and the bony makeup of the medial ankle complex.  Athletes with flat feet or who have feet that pronate are at higher risk of an eversion injury.

Immediate care and follow-up of an ankle sprain should include "R.I.C.E."; rest, ice, compression, elevation.  If there is moderate to severe pain, crutches should be used and X-rays should be taken to rule out a fracture.  It is possible to walk with a fractured fibula (the bone on the outside of the ankle) as it is a non-weight-bearing bone.

When pain decreases, range of motion (ROM) exercises may be started, along with proprioceptive training.  The following is a guide for ankle rehabilitation.

*  Ankle Pump  -   With leg elevated, gently flex and extend ankle.

*  Ankle Circles   -  Rotate foot / ankle clockwise and counterclockwise.  Gradually increase range of motion.  Avoid pain.

*  Ankle Alphabet   -  Using your ankle and foot only, trace the letters of the alphabet.   Perform A to Z.

*  Single leg Toe Curling  -  With foot resting on a towel, slowly bunch up the towel as you curl your toes.

*  Plantar Fascia Stretch  -  Standing with the ball of the foot on a stair, reach for the bottom step with heel until a stretch is felt through the foot's arch.

*  Gastroc Stretch   -  Keeping the back leg straight with the heel on the floor and turned slightly outward, lean onto the wall until a stretch is felt in the calf.

*  Soleus Stretch   -  Standing with both knees bent and the involved foot back, gently lean into the wall until a stretch is felt in the lower calf.

As pain decreases, you can do the following exercises with rubber tubing or a towel.

*  Resisted Dorsiflexion  -  With tubing anchored in a doorjamb, pull foot toward face.   Return slowly to starting position.  Relax.

*  Resisted Inversion   -  Cross legs with involved ankle underneath.  With tubing anchored around uninvolved foot, slowly turn involved foot inward.

*  Resisted Eversion   -  With tubing anchored around uninvolved foot, slowly turn involved foot outward.

*  Standing Bilateral Heel Raise  -  Rise on the balls of the feet.  Lower slowly.

*  Standing Unilateral Heel Raise  -  Balance on the affected foot, then rise on the ball of the foot.   Lower slowly.

For balance and proprioception:

*  One Foot Balance   -  Attempt to balance on involved leg.  Begin with eyes open, looking straight ahead. 
When able to balance 30 seconds, perform exercise with eyes closed.  

Information provided by:
Anne Micinski, ATC
Mishawaka Rehabilitation Center
Cramer: The First Aider 
Volume 68, Number 2  Winter 1997