Healthshare Information for Guided Patient Management Index Introduction 2 Ankle anatomy 2 What is a sprained ankle? 2 Ankle Sprains What causes an ankle ? 3 Why do I need to do exercises? 3 When do I see my GP or physiotherapist? 3 What are the treatments available? 3 Exercises for ankle sprains 4

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[ 1 ] Introduction Healthshare is committed to improving your health and wellbeing. This information leaflet is produced by health professionals who are expert in improving musculoskeletal conditions. The information is based on the latest available evidence from research in the field. If you are not sure of any of the given information, please contact our physiotherapy helpline for further information.

Ankle Sprains Ankle joint anatomy

Fibula Tibia Talo-fibular Articular Surface Medial Malleolus Calcaneal Lateral Talus Fibular Ligament Malleolus

Anterior view of the right ankle region Lateral (side) view of the right lower leg

What is a sprained ankle? The term “sprain” generally indicates injury to the . A sprain is a common type of ankle injury that involves one or more of the ligaments. Sometimes there may also be damage to tendons, bone and other tissues, depending on the severity of the injury. Inversion injury or sprain: This is the most common form of ankle sprain. It happens when the heel or turns inwards, overstretching the ligaments on the outside of the ankle. Eversion injury or sprain: Less commonly the foot turns outwards, overstretching the ligaments on the inside of the ankle.

Sprained Lateral Ligament

Sprained Medial Ligament

Inversion sprain Eversion sprain

[ 2 ] What causes an ankle sprain? • Ankle sprains are common in sports injuries, especially in sports involving running and jumping, landing from a jump, fast changes in direction or with lots of stop-starts such as in football, tennis or netball. • It may also happen when walking on an uneven surface, stepping off the edge of the kerb, climbing stairs or losing your balance while wearing high heeled or platform shoes. • The chances of spraining your ankle increases if you have weak lower leg muscles, lax ligaments in the ankle or

Ankle Sprains an abnormal walking pattern. • If you have had a previous ankle sprain, you are more likely to sprain the same ankle again, especially if you have not had adequate exercises to rehabilitate your initial injury. Why do I need to do exercises? Injury to the ligaments and/or cartilage of your also damages the joint position sensors. Joint position sense is provided by small receptors in the ligaments and joint structures which tell your body the position of the joint. If this is not retrained properly after your ankle sprain, the chance of you reinjuring your ankle a second time is far higher. Therefore doing your exercises regularly and adequately is very important to rehabilitate the ankle joint after a sprain. When do I see my GP or physiotherapist? The severity of an ankle sprain can be divided into different grades and this determines the need for assessment and treatment. A mild sprain results in mild joint stiffness with no laxity of the joint and no difficulty in moving the ankle. A complete rupture results in severe slackness, loss of function and an inability to weight bear for a considerable period of time. If you are unable to weight bear, it is important that you consult your GP or physiotherapist for further assessment. What are the treatments available? Most problems resulting from an ankle sprain are due to and swelling in and around the joint. Reducing the swelling and bleeding helps the ankle to heal faster; most sprains heal completely within a few weeks. With a severe ankle sprain, the rehabilitation process becomes longer and more complex. Chronic and recurrent ankle sprains usually require a strengthening exercise programme and joint position sense training to improve the balance of the injured leg.

Initial Stage The treatment is focused on decreasing the post-injury swelling, bleeding and . Avoid The following should be avoided in the first 24hrs as they may increase the blood flow to the area and therefore may increase the swelling and slow down the healing process: • Hot showers, heat rubs or hot packs applied to the injured area. • Drinking alcohol. • Taking Aspirin: This prolongs the clotting time of blood and may cause increased bleeding into the ankle.

[ 3 ] Ankle Sprains Compression Ice Rest Protection Elevation tea towel) anddonotuseitfor longerthan30minutes atatime. swelling duringthefirst48-72hours. (useadamp Donotplace theice onto directly theskin to helpwiththenormalhealingprocess. for 20minutes to reduce theswelling. Elevate your foot higher thanyour day chestwhilelyingdown anddothis2-3timesevery bandagesprovide pressure support toAnkle thearea andhelpto decrease theswelling. Use ice packs around the ankle every two hoursforUse 15-20minutes every ice to packsaround decrease theankle painand Exercises shouldbepainfree to damage. prevent further Static exercises• canbedonefrom thethird day onwards to maintainmusclestrength. Avoid• vigorous exercise to theaffected leg. • You jointfor shouldrest theinjury. 24hoursafter the ankle isessentialifpossible, asweight Earlywalking bearingreduces thetightnessof • • •An isessentialto protect the healingligaments.It Ligamentsmustbekeptinastable position tendons, whichcanleadto tendonitis. issuspected. fracture weightpromote bearingduringthefirst2weeks, issevere partial ifyour ora injury crutches: ankle braceankle may behelpfulifthesprainis severe. These are usefulto reduce weight or bearingontheinjured ankle [ 4] Ankle Sprains Exercises sprains for ankle times x3sets. Hold for 10seconds. Repeat10 into thepillow. Slowly press theinsideof your feet feet. Keep arolled pillow between your front ofyou. Sit withyour legsstraightoutin Static inversion Early stage(2-4weeks) Hold for 10seconds. Repeat10timesx3sets. be nomovement oftheinjured foot. Slowly pullyour injured foot uptowards you. There should unaffected foot over thepillow to fixthepillow. Place arolled pillow over theinjured foot andkeepyour Sit withyour legsstraightoutinfront ofyou. Static dorsiflexion Acute stage(First 2weeks) the day. 2hoursduring Repeat 5timesevery seconds. calf. Holdthispositionfor 20 stretch isfelt inthemiddleto upper Slowly leaninto thewalluntila pointing inastraightlineto thewall. heel onthefloorandfoot Keep thebacklegstraight,with gently leanagainstthewall. Keep your handsonthewalland Calf stretch (Gastrocnemius) [ 5] Calf raises Hold for 10seconds. Repeat10timesx3sets. ankle. Slowly press your foot into thepillow withoutmoving the foot. Place arolled pillow againstthewallandunderyour injured Static plantarflexion times x3sets. Hold for 10seconds. Repeat10 foot into thepillow. Slowly press theoutsideof your against thepillow. wall andkeepyour affected foot Place arolled pillow againstthe Static eversion Repeat 3timesaday. Try to increase theholdto 30seconds. repeat 10times. hold thispositionfor 10seconds and Slowly raiseyour toes offtheground and heels. Standing withyour weight now onyour Standing toe raises Do this3timesaday. Repeat 10timesineachposition. your littletoe. middle ofyour foot andthenonto onto your bigtoe, thenonto the slowly raiseuponto your toes. First yourself againstawall, Supporting Ankle Sprains Exercises sprains for ankle day. Repeat 10timesx3setsonce a opposite . Move your foot inward to be closestto thetable. your whichshould injured ankle the bandaround thefoot of Sitting sideonto thetable, loop table. and anchorthebandaround a Tie endsofthebandtogether Resisted inversion your weight.initially to support can’t godown to thefloor, useachair Up anddown you isonerepetition. If bend forward. Try to ensure thatyour backdoes not weight from thefloor. line withyour second toe to pickupa your heel. Slowlyin bendyour knee Stand ononeleg, withyour weight on eg., acanofbeans. You willneedaweight for thisexercise Single legstandingpickup felt inthelower calf. Lean into thewalluntilastretch is pointing inastraightlineto thewall. the heelonfloorandfoot Keep thebacklegslightlybent,with gently leanagainstthewall. Keep your handsonthewalland Calf stretch 2(Soleus) Later stage(4weeks onwards) [email protected] |http://healthshare.org.uk /Continued once aday. position. Repeat10timesx3sets Return slowly to your starting towards you. around your foot, pullthefoot (tableleg)andattached object With thebandanchored to afixed Resisted dorsiflexion cushion oranarrow platform. for exampleabalance board, soft standing onanunsteady surface You canprogress thisexercise by solid to holdonto ifnecessary. sureMake you have something the above withyour eyes closed. Once you are confident, repeat Repeat 5timesoneachleg. and repeat withtheotherleg. Balance ononelegfor 30seconds Single legstanding 2 timesaday. Repeat 10timesx3sets outer shin,pullingthebandaway from thetable. Now move thetoes ofthefoot upandouttoward your table, withthebandattachedaround thefoot. fromNow the turnaround soyour isfurthest injured ankle a table. Tie endsofthebandtogether and anchorthebandaround Resisted eversion Repeat 10timesx3setsonce aday. position. starting towards thefloor. Returnslowly to pressankle, thefoot downwards and theothertiedaround your Whilst holdingoneendoftheband Resisted plantarflexion