Lateral Ankle Ligament Injuries
Lateral ankle injuries are extremely common injuries, especially in sports that require running, jumping and change of direction. The majority of ankle sprains will cause damage to the ligaments on the outside of the ankle that are designed to prevent excessive inversion or inwards rolling of the ankle. Lateral ankle sprains account for 80% of all ankle sprains compared to the medial sprains only accounting for 20%.
Our ankle joint acts as a hinge joint with the upper portion being made up of the Tibia and Fibula of the lower leg and the lower component being the talus (bone that transmits our weight from the lower leg into the foot).
This joint is known as the talocrural joint and acts as a hinge to either lift the foot up (dorsiflexion) or point it down (plantar flexion). Underneath this joint the talus makes a second joint with our heel bone (calcaneus) known as the subtalar joint.
This joint is responsible for rolling the foot inward (inversion or supination of the foot) and outwards (eversion or pronation of the foot)
On the outside of the ankle (lateral side), the joint is stabilised by three smaller ligaments; the anterior talofibular (at the front), the calcaneofibular (at the side) and the posterior talofibular (at the back).
These ligaments are commonly injured when our bodyweight moves laterally and the base of support of the foot fails. This forces the foot into an inverted position by rolling inwards and overstretching the lateral ligaments causing tearing (image to the right) and damage.
The anterior talofibular ligament (ATFL) is the most common ligament injured due to its position. Most inversion sprains are accompanied with a slight plantarflexed and forward movement that places the ATFL on stretch, prior to the inversion movement which creates the damage.
Injury to the ligaments results in swelling and pain on the outside of the ankle commonly referred to as a rolled ankle. If the force is more severe, multiple ligament damage can occur with the calconeofibular ligament usually next, followed finally by the posterior talofibular ligament, which is damaged in rare cases. A complete tear of all ligaments may result in a dislocation of the ankle joint and an accompanying fracture.
In severe cases of a lateral ligament injury there can also be damage to the medial ligaments or the connective tissue (syndesmosis) that keeps the two bones of the lower leg together. We will address these other injuries in a different blog.
Acute ankle sprains result from a force being applied to the ankle joint which causes excessive movement at the joint. Players are immediately aware of the condition and may hear an audible ‘snap’ or ‘pop’, due to the tearing or stretching of the ligaments.
Proven risk factors
· Previous or existing ankle injury especially if poorly rehabilitated (biggest risk factor).
· Lack of strength and stability related to the ankle.
· Lack of, or extreme flexibility, in the ankle joint.
· Poor balance.
· Sudden change in direction (acceleration or deceleration).
· Increasing age of player.
Suspected risk factors
· Poor condition of the playing surface.
· Inappropriate, inadequate, or no warm-up.
· Wearing inappropriate footwear for the activity.
· Lack of external ankle support (taping, bracing) for previously injured ankles.
The grading used for ankle ligament injuries is the same 3 grade system used for all ligament injuries in the body:
Grade 1 = less than 10% of fibres, mild pain and instability able to continue with weight bearing
Grade 2 = 10%-95% of fibres, significant pain and instability with inability to weight bear
Grade 3 = 95%-100%of fibres, intense pain initially to minimal pain, highly unstable with weight bearing.
Lateral ligament injuries respond very well to conservative treatment and can be diagnosed and managed well by you healthcare professional. Initial acute treatment follows the Rest, Ice, Compression, Elevation protocol. This is followed by reducing pain, improving movement to the joints of the ankle and foot and then increasing strength and restoring proprioception to the ankle to minimise the risk of re-injury.
As always prevention is better than cure and there are a few key things you can do to minimise the risk of sustaining an ankle sprain in the first place.
1. Always ensure you have the correct footwear for the sport or activity you are engaging in. This needs to ensure the shoes achieve enough grip on the playing surface to minimise sliding.
2. Proprioception training – proprioception is our brains awareness of where the body is in space. It is how our joints communicate with the brain to inform it that a joint has moved too far and to activate mechanisms to prevent injury. You can train and improve your proprioception by engaging in progressively more challenging balance exercises.
3. Strengthening and flexibility of the muscles, through the hips, leg and ankle to maximise balance and support.
So that’s an overview on Ankle lateral ligament injuries and what you can do to prevent them. It’s important to remember that ankle injuries can be tricky and time consuming to heal due to the number of bones and joints involved.
However it is worth going through a complete rehabilitation the first time, as the long term complications of a chronically unstable ankle can be complex.
If you have any questions or comments please e-mail us at firstname.lastname@example.org and we will be happy to answer them for you.
If you suffer with ankle pain feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.