The Simple Ankle Sprain
“It’s just a simple ankle sprain”. If you have ever been around sports, in any capacity, it is more than
likely you have heard someone say this. It’s a popular comment, as ubiquitous in sporting circles as
“Give it 110%”, or “What was the ref watching?” But the more we learn about Ankle injuries, the less
simple they become.
Ankle sprains, as a primary complaint, account for 5% of all ED admissions each year and are one of
the most common injuries in sports, accounting for roughly 15% of all sporting injuries. Most often,
this will result in an injury to one of the structures on the outside of the ankle, termed a Lateral
Ankle Sprain (LAS). This is driven by both the anatomy of the region, with smaller bony structures
and shorter, thinner ligaments, and the movements we undertake. Being bipedal, we are more likely
to catch the “outside” border of the foot when walking, turning, stepping, etc. Furthermore, Ankle
injuries have the highest recurrence rate of all musculoskeletal injuries and commonly develop into
Chronic Ankle Instability.
The ankle itself is a triplex structure, created by three unique, complex joints. These three joints, the
Inferior Tibiofibular, Talocrural and Subtalar, act together to provide the Ankle access to multiple
planes of movement and helps transfer forces up and down the leg. As well as these three primary
joints, the Ankle is also closely affected by the movements and stresses from the foot below and the
knee and hip above. These joints allow it to conform both for mobility and to help it adapt to its
changing environment and demands but come at a cost.
With so many small and closely fitting joints packed in together, each with their own series of
ligaments, and multiple tendons pulling on or around everything else, even a small injury can cause
ongoing problems. Damage to one or more of the primary ligaments, or their neighbouring tendons,
can result in deafferentation and a disruption of the joint’s positional sense, making it harder for the
brain to understand where the foot and lower leg are. What was once thought of as a “simple” Ankle
sprain might include a fracture, chondral lesion, or injuries to smaller ligaments further in the foot. If
not properly assessed, these can be missed or neglected, resulting in months of ongoing pain and
awareness. Even partial tears to some of the primary ankle ligaments can cause significant changes
in the way forces are distributed through the foot and ankle, leading to the development of
Osteoarthritic changes in the Ankle joints.
Managing an Ankle injury, even a “simple” one, takes a little bit more than “walking it off” and
“chucking some ice on it later.” All of the Performance Edge Physiotherapists can take you through a
full assessment and management plan to get you back to playing safely and without pain, regardless of
how simple the ankle injury is.