Most people will experience an ankle sprain at some point in their life, ankle sprains are the most frequently seen sporting injury and are particularly prevalent amongst professional sportsmen.
The most common cause is the internal rotation of the foot. Sprained ankles can also be caused by eversion (an external rotation of the foot) and sometimes both injuries can coincide. The ligament most prone to an inversion injury is the anterior talofibular (AT) followed by the calcaneal peroneal (CP) and the posterior talofibular (PT). While eversion injuries more often result from an injury to the deltoid ligament.
The swelling is usually immediate and the pain can be very intense. Movement is severely limited due to the swelling, whilst the ankle’s stability can also be affected in more severe cases.
If the area around the ankle is remarkably swollen, an X-ray is usually performed to rule-out the presence of any fractures.
An ultrasound performed a few days after the injury can help to highlight distortion and ligament damage. In rare cases, the examination can be completed with an MRI or CT scan.
Rehabilitation following acute traumatic injuries is crucial for the restoration of joint stability and for it to function dynamically. It is also important that the patient continues a maintenance program once their rehabilitation is complete in order to avoid the problem recurring.
The distortion of the ankle, in most cases occurs in patients who practice sports activity, but can also occur in daily life. Frequently the trauma is in reverse, but can also present in eversion.
In most cases the patient after the trauma has already been to the emergency room and therefore is already in possession of an RX to exclude fractures and has a taping or guardian to immobilize the articulation. is presented in our center already the day after the trauma for a visit and an ultrasound to determine the degree of distortion (depending on the number of ligament injuries). Only with an accurate diagnosis can determine the appropriate treatment program.
The first goal of the rehabilitation protocol is the reduction of swelling and pain through the use of ultrasound, lasers and drainage massage and ice. At this stage it is important to apply the RICE protocol, an acronym that defines the procedures to follow: Rest, Ice, Compression, Elevation (limb unloading).
Once the swelling is reduced you should recover full joint movement of the ankle through soft pompage, active and passive mobilization, specific stretching of the leg muscles and massage of the muscles of the foot in order to retrieve the correct walking.
At the same time you can begin the most important part of the treatment protocol, that is the recovery of strength and proprioception, through toning exercises of the muscles underlying the ankle, as the calf, the tibialis anterior and posterior, peroneus, intrinsic foot, plantar muscles.
At this stage it is also important to do the strengthening of the core muscles and the gluteus medius (important to laterally stabilize the limb).
Then you can proceed to more complex exercises as proprioceptive tablets, trails, jumps on the trampoline, the heels-toes gaits on board inside/outside.
The last phase of the treatment program involves the re-education on the sports field with sport specific gait patterns, cornering running, trails, jumps and specific fundamentals and a re-injury prevention program.