A lateral ankle sprain is a common musculoskeletal injury in which one or more of the ligaments of the lateral (outside) ankle partially or completely tears due to sudden stretching. Additionally, you might also hear a lateral ankle sprain referred to as an inversion or supination ankle sprain.
What are the lateral ankle ligaments?
There are three main ligaments that make up the lateral collateral ligament complex surrounding the ankle:
- Anterior talofibular ligament (ATFL) – weakest ligament
- Calcaneofibular ligament (CFL) – moderate strength
- Posterior talofibular ligament (PTFL) – strongest ligament
These ligaments travel in a clock-like fashion. If you picture the outside of your right ankle with your lateral malleolus as the center of the clock, the ATFL runs approximately to 3 o’clock, the CFL to 7 o’clock, and the PTFL to 9 o’clock. Together, these ligaments provide stability when inverting or supinating the foot, like during initial contact when running or when landing a jump. This is also when lateral ankle sprains are most likely to occur.
Signs and Symptoms of A Lateral Ankle Sprain
Common signs and symptoms of an acute lateral ankle sprain include:
- Feeling/hearing a “pop” around the lateral ankle
- Pain around the ankle
- Swelling (edema / effusion) surrounding the lateral malleolus
- Bruising/redness which can also extend along the lateral edge of the foot and/or calf
- Loss of range of motion/stiffness, especially with inversion and supination motions – can be due to pain or swelling
- Inability to bear weight on injured lower extremity which also can be due to pain
Diagnosis of Lateral Ankle Sprain
There are several grades of lateral ankle sprains:
- Grade 1 – most common and shortest recovery time
- Grade 2 – severe sprain, but incomplete tear
- Grade 3 – most severe sprain, complete tear
The grade level depends on which ligament was torn and the degree of tearing. Grade 1 tears are not true tears, but rather extreme stretching of the ATFL ligament. Grade 2 sprains consist of partial or incomplete tears and involve the ATFL and CFL. Lastly, a Grade 3 tear occurs with the ATFL, CFL, and PTFL and involves a complete tearing of tissue.
There are several different tests a medical doctor or physical therapist can use to diagnose a lateral ankle sprain, but occasionally a radiograph (x-ray) or MRI may be required to rule out a fracture.
Home Treatments for Lateral Ankle Sprain
Whether you seek out a medical professional for diagnosis or choose to rehab your injured ankle at home, there are several treatment options and exercises to treat lateral ankle sprains at home.
Stage I – This stage of treatment should be initiated as soon as the injury occurs and up to day 3. Any good beginner program should include RICE – Rest, Ice, Compression, and Elevation. Especially in the first few hours after injury, ice and compression can do wonders to treat inflammation, swelling, and pain. *
- Rest – Avoid weight-bearing as much as possible for the first 24-48 hours post-injury.
- Ice – Apply an ice gel pack around the injured site for up to 15 minutes 4x per day for 3 days post-injury but be sure to cover the ice pack with a thin towel layer to prevent frostbite.
- Compression – Use an elastic, compression bandage, such as an Ace™ wrap, around the ankle in a figure 8 pattern, starting near the toes and working up to the bottom of the calf. Have approximately 50% of overlap between each layer and make sure that there are no gaps.
- Elevation – elevate injured ankle above heart for 2-3 hours per day to reduce bruising and swelling.
*Note – do not use compression if you’ve experienced a recent Deep Vein Thrombosis (DVT), have a history of organ failure, or other contraindications. Likewise, refrain from using cold packs if you experience cold hypersensitivity or intolerance.
Stage II – Usually around 3 days after injury, you can likely progress to the second stage of treatment, which lasts approximately to day 7. Continue to use a supportive device, such a compression wrap or a brace. If you used crutches to keep weight off of the ankle, continue to do so but use them a little less as your PT or physician recommends. You can also start to incorporate heat into your treatment, but if you still experience any swelling or heat around the injured site, be sure to alternate between both heat and ice. Switch between warm water and cool water soaks, letting your ankle soak for 5 minutes each up to twice a day.
Ankle Exercises: Home Treatment
The key to optimal ligament repair is to avoid immobilizing the ligaments too long. A little movement can go a long way. On that note, range of motion (ROM) exercises are highly recommended to gently mobilize the injured tissue.
- Ankle Alphabet: Rest on the floor or sit in a chair with your heel on the ground. Use your big toe to trace out letters of the alphabet in the air, using only your ankle for movement.
- Towel Stretch: Rest on the floor with your leg stretched out and wrap a towel around the arch of your foot. Gently pull the towel toward you until you feel a stretch in your calf. Hold for 30-60 seconds and then relax. The stretch should not be painful to any area of your foot.
- Standing Soleus Stretch: Stand facing a wall and stagger your legs so that your injured leg is behind you. Point your toes inward slightly and bend your knees a bit. Gently lean into the wall until you feel a mild stretch in your calf, keeping your heel on the ground at all times. Hold for 30-60 seconds and then relax.
Stage III – at this point, you can start to incorporate light ankle strengthening exercises, like heel raises, lateral step ups, and mini lunges. Be sure to take it slow though during the first few weeks and always check with a PT or physician to make sure you are ready for this stage of rehab. Complete rehab of a lateral ankle sprain typically takes 6-8 weeks and putting too much stress on the damaged ligaments can delay or even reverse the healing process.
A medical physician or physical therapist is best suited to outline specific rehab strategies for your needs. They can also find out what caused the initial injury, like muscular strength deficits, joint laxity, etc., to help prevent future injuries and chronic ankle instability. With patience and adequate therapy, you will be able to get back to the activities you love quickly!
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This article was written by Gabrielle Kremers, a current DPT student at the University of Central Arkansas who plans to specialize in outpatient sports and orthopedics upon graduating. In her free time, she enjoys a good game of ultimate frisbee, playing board games, and finding ways to be eco-friendly.