Sprains to the ankle are one of the most common sporting injuries. A sprain is defined as a tearing of the ligaments that connect bone to bone and help stabilise the joint.

 

Sports requiring jumping, turning and twisting movements such as basketball, volleyball, netball and football; and explosive changes of direction such as soccer, tennis and hockey are particularly vulnerable to ankle sprains.

 

ANATOMY

 

The ankle joint is a hinge joint formed between the tibia and fibula (bones of the lower leg) and the talus (a bone of the foot) and allows the foot to bend upwards (dorsiflexion) and downwards (plantarflexion). The joint also allows a small amount of rotation. Two bones of the foot, the talus and calcaneus (heel bone) connect to form the subtalar joint which allows the foot to rock side to side (inversion/eversion).

 

The joints stability comes from the structural arrangement of the bones and the surrounding ligaments. Ligaments provide stability by preventing the amount of side to side movement.

 

On the inside of the ankle (medical side), the joint is stabilised by a thick, strong fibrous ligament called the deltoid ligament. Sprains to the deltoid ligament (eversion sprains, foot twists outward) account for more than 80% of all ankle sprains.

 

The most commonly injured ligament is the anterior talofibular. Injury to this ligament results in swelling and pain on the outside of the ankle. If the force is more severe, the calcaneofibular ligaments is also damaged. The posterior talofibular ligament is less likely to be damaged. A complete tear of all ligaments may result in a dislocation of the ankle and an accompanying fracture.

 

Occasionally medial ligament injuries may be seen in conjunction with a lateral ligament injury.

 

The inferofebular ligament can also be injured. Injury to this ligament can be a cause of prolonged recovery from a sprain. Ligament sprains to the ankle joint may also involve the ligaments between the tibia and fibula bones. These injuries may involve a fracture, are often slower to recover, and may require surgery.

 

RISK

 

Acute ankle sprains result from a force being applied to the ankle joint which causes excessive range of movement at the joint. Players are immediately aware of the condition and may hear and 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 realted 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 gear

• Wearing inappropriate footwear for the activity

• Lack of external ankle support (taping, bracing) for previously injured ankles.

 

PREVENTION

 

• Undertaking training prior to competition to ensure readiness to play.

• Gradually increasing the intensity and duration of training.

• Undertaking flexibility, balance, stretching and strengthening exercises in weekly training programs.

• Including agility work in training programs so the ankle joint is capable of sustaining high acceleration forces and quick changes in direction.

• Allowing adequate recovery time between workouts or training sessions.

• Warming up to ensure surrounding muscles are ready to support the joint during activity.

• Wearing ankle taping or bracing especially for previously injured ankles.

• Wearing shoes appropriate to the sport that provide stability and support.

• Checking the training and playing area to ensure  flat and even surface.

• Drinking water before, during and after play.

• Avoiding activities that cause pain. If pain does occur, discontinuing the activity immediately and commencing RICER.