Ankle sprain

Ankle sprains are the most common form of trauma, with 2.2 million consultations per year in the United States alone¹.
In France, ankle sprains are a frequent occurrence, with 6,000 cases per day². 70% of individuals may develop chronic instability over a short period after the initial injury¹. This is why appropriate treatment is essential. Although it is the most common form of trauma to this joint, the ankle can also be affected by fractures and inflammation. More rarely, osteoarthritis can occur.

The ankle 

The ankle is a complex joint located between the leg and the foot. It is made up of a set of bones. 

This includes the tibia, fibula and talus. The fibula is the smallest bone in the leg. The talus is the ankle bone. These bones are held together by several ligaments, which ensure the stability of the joint.
There are different types of ankle trauma. Traumatic injuries include sprains and fractures. These are injuries that affect the bones or ligaments.. 
On the other hand, we talk about musculotendinous pathologies when the lesions affect the tendons. These include tendinopathies. 

Ankle sprains: a frequent trauma

Ankle sprains are caused by stretching or tearing of the ligaments in the joint. This mainly concerns the lateral ligaments, in 85% of cases^4,5. Ankle sprains can be classified as mild, with a stretched ligament, or severe, if the ligaments are ruptured and/or a fracture is added⁵.

The different stages of severity of a sprain:   

Mild sprain (stage I): The patient feels minimal pain⁶, and there is discrete oedema⁶. The patient also experienced minimal functional discomfort⁶ and a proprioceptive deficit. You can use the Thuasne MalleoAction splint to immobilise a sprain at this stage.

Moderate sprain (stage II): The patient feels more intense pain⁶, and there is visible swelling and bruising⁷. There is definite functional discomfort⁷ and slight instability⁷. For immobilisation of a sprain at this stage, you can use the MalleoDynastab BOA splint from Thuasne.

Severe sprain (stage III): Persistent pain⁶, significant swelling and extensive bruising⁶. Significant functional discomfort 6. For immobilisation of a sprain at this stage, you can use the Thuasne XLR8 walking boot.

Certain factors are more likely to lead to an ankle sprain: 

Playing sports: contact sports (football, etc.) and pivot sports, in which changes of direction are abrupt (tennis, basketball, etc.)⁸. 50% of ankle sprains occur during sports activities¹⁹. Walking on uneven ground (risk of slipping) or on uneven surfaces⁹. Wearing unstable shoes (high heels), ill-adapted to the activity, or worn-out shoes^{10, 11}. Structural abnormalities, such as flat feet or legs of unequal length⁸.

Sprained ankle: what to do and how to treat it? 

Relieving an ankle sprain involves resting with the affected limb elevated, applying ice to relieve pain, applying a compression bandage¹², which is what is known as the RICE protocol, taking painkillers¹³ and using walking sticks to get around. The ankle must be immobilised with splints or walking boots for 3 to 6 weeks¹⁴. For rehabilitation and resumption of activity, physiotherapy and wearing an ankle brace are recommended⁶. 

In the case of a fracture, surgery, walking boots or a plaster cast may be necessary. If you think you have sprained your ankle, do not hesitate to consult a doctor for a clinical examination.

What is the role of the physiotherapist in ankle sprains?

The physiotherapist plays a key role in the rehabilitation and recovery from an ankle sprain. Their intervention aims to reduce pain, restore mobility and prevent recurrence through a progressive and personalised approach. 

Reduction of pain and swelling
In the initial phase, the physiotherapist may recommend drainage techniques, cryotherapy and gentle exercises to limit inflammation and improve the patient's comfort¹⁵.

Restoration of mobility and muscle strengthening 
Once the pain has stabilised, mobility and progressive strengthening exercises are introduced to restore joint range of motion and improve ankle stability. Adapted balance exercise programmes have been shown to be effective in reducing the risk of recurrence¹⁵.

Improving balance and proprioception
Sprains can alter proprioception (perception of the position of the ankle in space), thus increasing the risk of further injury. The physiotherapist will set up specific exercises to strengthen neuromuscular control and avoid chronic instability¹⁵.

Prevention of recurrence
Appropriate care significantly reduces the risk of further sprains. Post-sprain rehabilitation exercises halve the recurrence rate after 12 months¹⁶.