Ankle distorsion/sprain - 3rd degree

Ankle distorsion, right after lumbar pain syndrome, is the second most common injury of the human musculoskeletal system. Ankle as a part of the foot region is a transition point between lower leg and the foot and daily it withstands a significant amount of load which can often, depending on the situation, be too big to handle leading to active and passive ankle stabilizers giving in and ankle distorsion happening.

Ankle joint is a touching point of the following bones, tibia or shine bone, fibula or calf bone, talus or ankle bone and calcaneus or heel bone. Ankle is built out of two joints, the upper and lower ankle joint. The upper ankle joint (articulatio talocruralis) connects the distal part of the lower leg, tibia and fibula, with talus and in this joint dorsal and plantar flexion is executed. The lower ankle joint, in which inversion and eversion are executed, consists out of two parts, the posterior (articulatio subtalaris) and the anterior ( articulatio talocalcaneonavicularis), which connects the ankle with the tarsal region of the foot.

There are active and passive ankle joint stabilizers:

ACTIVE STABILIZERS – muscles and tendons: m. peroneus longus (main foot evertor), m. tibialis anterior (main dorziflexor of the foot), m. tibialis posterior (foot invertor and plantar flexor), Achilles tendon with m. soleusom and m. gastrocnemiusom (main foot plantar flexors).

PASSIVE STABILIZERS – ligaments: tibiofibular, deltoid and lateral ligaments (lig. talofibulare anterior, lig. calcaneofibulare i lig. talofibulare posterior). 

Ankle distorsions mostly occur after the foot rotates inwardly, ie. with foot inversion during a bad landing or foot planting, when footwear slips on the surface suddenly, when you step on an object or another foot, in stepping forward, after landing, during deceleration when longer strides are used to decrease the speed of movement, etc. Ankle distorsions are common in sports or activities where lateral movements and changes of speed or direction of movement are often occurences, eg. in basketball, football, handball, field hockey, etc. They also happen with general population, eg. with kids as well as older population due to muscle weakness, sight problems, impaired balance.

Degrees of ankle distorsion:

Grade 1 – characterized by the stretching of ligaments without them being torn, with minimal or no edema and pain, function is generally normal or minimally impaired and return to full activity lasts 2-3 weeks.

Grade 2 – moderate level of distorsion characterized by a more intense pain level, with a presence of a localized edema and ankle joint stiffness and a possible partial ligament tear. Return to normal activity after 2-3 months of rehabilitation.

Grade 3 – the most severe case of distorsion characterized with intense pain which can decrease after the injury occured due to nerve fiber damage. Followed by a big edema and intensive joint stiffness and limitation of mobility. Joint feels loose and instable as a consequence of lateral ligamentary complex and joint capsule completely rupturing which can imply a surgical treatment approach in certain cases. Return to full activity after cca. 4 months.

 Ankle luxation is a less common occurence than distorsion, it happens when a much greater force is put on the ankle joint and it mostly always followed by bone fractures in the talocrural joint.

Treatment, as stated above, depends on the severity, ie. level of distorsion, but conservative approach is implemented more often than surgical. In the acute phase RICE method is applied (rest, ice, compression, elevation) in order to relieve pain, edema and to ensure the best conditions for the later functional phase of therapy. Functional phase assumes gradual and progressive regaining of ankle range of motion, lower leg and foot muscle strenght as well as joint stability and balance. Muscle strenghtening should be directed toward correct muscle activation of all muscles, but especially of eccentric strenghtening of the m. pereoneus anterior (main stabilizer during foot eversion) and m. tibialis anterior (main stabilizers during plantar flexion of the foot).

Prevention: choice of quality and adequate footwear, correct strenghtening of all lower leg and foot muscles, proper ankle stabilization routine, maintaining a balanced body weight, treating sight problems which can lead to ankle joint and other  injuries, implementing prevention programs with athletes whose activities pose a greater threat of ankle injuries, etc.