MECHANISM OF INJURY
The most common mechanism of injury at the ankle is an inward turning of the sole of the foot (supination/inversion). Depending on the force and degree of movement different injuries can occur, such as:
- Damage and tearing of the ligament between the talus and fibular bones (the anterior talofibular ligament)
- Avulsion fracture (pulling away a small piece of bone) of the fibular
- Fracture of the fibular at the joint line level
- More serious ankle fractures.
Ligament injury is usually (⅔ of cases) isolated to the ATFL. A combination of ATFL and CFL ruptures occur in 20-25%. The PTFL is rarely injured. The deltoid (medial) ligament and syndesmosis are usually only ruptured in severe trauma and in combination with fractures.
Grade I – Ligament stretch without tearing, minimal swelling or tenderness, minimal functional loss, no
mechanical joint instability.
Grade II – Partial microscopic ligament tear with moderate pain, swelling and tenderness over the involved structures. Some loss of joint motion and mild to moderate joint instability.
Grade III – Complete ligament rupture with marked swelling, haemorrhage and tenderness. Loss of function and severe instability. Difficult fully weight bearing.
MANAGEMENT & TREATMENT
First 48 hours:
P.R.I.C.E principles are applied
Gentle active range of motion exercises
Avoid painful activities
Weight bearing with a brace or other stabilizing support
X-rays are rarely done unless bony injury is suspected
After 48 hours:
Continue with range of motion exercises and weight bearing as pain allows.
Assessment by a qualified therapist to assess the degree of damage is recommended.
Proprioceptive exercises and strengthening exercises as instructed by your therapist.
A general rule of thumb will be:
Grade I injury; 1 – 2 weeks
Grade II injury; 2 – 4 weeks
Grade III injury; 4 – 8 weeks
However problems may remain for 6-9 months. Return to maybe anything from 4 – 12 weeks dependent on the sport and extent of the injury. (Be guided by your therapist).