Inversion Ankle Sprain Injury

The inversion ankle sprain is the single most common injury in all of the sports and athletic injuries universally. If you regularly watch sporting events, and an athlete is on injured reserve, likely it is due to an inversion ankle sprain. It constitutes at minimum 40% of all sports injuries, and 25% of all missed practice or playtime. To further compound matters, the number one predisposing factor to suffer an ankle sprain is a history of a previous ankle sprain. This means that if you suffer one of these injuries you are exponentially more likely to get another and another. However, what this also indicates is that if initial injuries are not rehabilitated and treated properly you are more likely to have progressive deterioration and ankle instability to this very common and cumbersome injury.

Appropriate treatment of an ankle sprain injury involves a detailed history and physical, determining which ligaments are affected and to what degree as to whether they are sprained or torn. Spraining basically implies an overstretching of ligament tissue. Whereas tearing, if actually completely ruptured and possibly detached altogether. It also involves determining if there are any associated fractures or breaking bones with the sprain which is also possible. For example, it is possible to have any range of fractures including an avulsion fracture of the base of the fifth metatarsal, or a fracture of the anterior process of the calcaneus which is very common in this particular mechanism of a lateral ankle sprain.

Not to mention that repeated inversion ankle sprain injuries can put undue pressure within the joint itself and cause a compression or shearing injury on the surface of the cartilage, known as an osteochondral defect. Which if untreated can eventually form what resembles a crater within the ankle joint.

There are 4 grades of ankle sprain injury based on the anatomy of the ligaments injured and if they’re sprained or torn. The three basic ligaments of the lateral ankle, which are anatomically more related to the subtalar joint:

Number 1 the anterior talofibular ligament (ATF)

Number 2 the calcaneo fibular ligament (CFL)

Number 3 the posterior talofibular ligament (PTFL), which is also the most difficult ligament to sprain and injure.

Grade 1- A sprain of ATF

Grade 2- Tear of ATF and sprain of CFL

Grade 3- Tear of ATF and CFL

Grade 4- Tear of ATF and CFL and sprain/tear of PTFL

The anterior talofibular ligament is considered to be intracapsular and parts of the capsule that overlies the ankle and underlying subtalar joint. The integrity of this ligament is tested using a clinical maneuver known as the anterior drawer sign. This sign is considered positive if the talus is displaced forward 10 mm, or 4 mm more as compared with the contralateral side.

The talar tilt test is another clinical maneuver used to evaluate the integrity of the calcaneal fibular ligament, Which is extracapsular and distinctive from the ankle capsule. If this maneuver is 5° or more as compared with the contralateral side, this is considered a positive finding, Which correlates to abnormal stretching of the corresponding ligament being tested.

However, bear in mind that in individuals with functional injury, these clinical maneuvers may not necessarily be abnormal. This is because they are sensory receptors specifically affiliated with tendons, they’re known as Golgi tendon organs that are very sensitive to both tension and pressure. They function like little nerves near and around the musculotendinous junctions. They help regulate when a tendon has been overstretched and providing the corresponding reflex. When this system is normally functioning, they help to produce an inhibitory effect on the muscle/tendon unit that has been overstretched to prevent further injury to that tendon.

However, as one might imagine in cases of chronic injury to the ligaments and tendons in the ankle and subtalar joints, the baseline of being overstretched is dysfunctional. So, the damaged ankle is abnormally sprained such that the receptor feedback to the spinal cord to produce a reflex that would normally cause a subconscious reflex in a person to avoid injury, in contrast, the person with chronic ankle instability cannot furnish the same protective reflex adequately or in time. This explains why once a person has had one ankle sprain if they are not properly rehabilitated there are likely to undergo these injuries over and over again.

Once an individual has initially protected, iced, compressed, elevated, and supported an injury, there are further options including ankle bracing, taping, custom orthotics, nutritional supplements, shockwave therapy, Amniotic fluid injections, and as a last resort surgical reconstruction of the damaged tissue.

Crucial to reestablishing this neuromuscular feedback mechanism is working together with physical therapy for proprioception and neuromuscular reeducation in an attempt to help to regain some of the somatosensory feedback mechanisms that were previously injured.

Talk to your certified podiatrist today to discuss which treatment options are best for you, and the quickest and safest way possible to return to your athletic activity of choice.