Ankle Sprain discussed in plain language for therapists.

1. Ankle Sprain
Presented By:-
Kunal Vashist,PT
Back 2 Fitness

2. Background
• Ankle Sprain is an injury to the ligaments around
the ankle.
• Typically caused by sudden, strong contraction
,direct impact, or by a sudden, forceful twist.
• Presenting with pain and swelling but ability to
walk on foot with discomfort usually excludes a
fracture.
• The typical ankle sprain is an inversion injury that
occurs in the plantar-flexed position. (85%) – aka
Inversion Sprain or supination Sprain.

3. • Predisposing factors :
• H/o Prev. Ankle Sprain
• Chronic Ankle Instability
• Rigid Supinated Foot
• Reccurence may lead to osteoarthritis and
articular degeneration.
• Residual symptoms affect 72% of patients
(6wks to 18 months)

4. • Longstanding Symptoms diagnosed as
“sprained ankle syndrome.”
• 55% patients don’t visit health care
proffessionals.
• Underestimating severity of ankle sprain may
lead to reccurent injuries / residual symptoms.

5. Anatomy

7. Lateral Ligaments

8. Medial Ligaments

9. Muscles around Medial Malleolus

10. Muscles around lateral Malleolus

11. Functional Anatomy
• Ankle Complex – 3 Articulations
 Talocrural Joint
 Subtalar Joint
 Distal Tibiofibular Syndesmosis

12. Movements occurs in 3 Cardinal Planes:
• Sagittal Plane Motion – Plantar Flexion – Dorsi
Flexion
• Frontal Plane Motion – Inversion – Eversion
• Transverse Plane Motion – Internal / External
Rotation.

13. Coupled Rearfoot Motion
 Pronation – Dorsi flexion+ Eversion+ External
Rotation.
 Supination – Plantar flexion + Inversion +
Internal Rotation

15. Ankle Stability
• Congruity of the articular surfaces when the
joints are loaded
• Static ligamentous restraints
• Musculo-tendinous units, which allow for
dynamic stabilization of the joints

16. Patho-Physiology

17. TABLE 1
Grades of Ankle Sprain
Sign/symptom Grade I Grade II Grade III
Ligament tear None Partial Complete
Loss of functional Minimal Some Great
ability
Pain Minimal Moderate Severe
Swelling Minimal Moderate Severe
Ecchymosis Usually not Common Yes
Difficulty bearing None Usual Almost always
weight

19. Patho-Mechanics
• Lateral Ankle Sprain –
• Excessive supination of rear foot on externally
rotated leg during gait or landing from a jump.
• Excessive inversion and internal rotation of
the rearfoot, coupled with external rotation of
the lower leg, results in strain to the lateral
ankle ligaments.

20. • First Ligament to be damaged – Anterior Talo-
Fibular Ligament followed most often by
Calcaneo-Fibular Ligament.
• Ruptured ATFL increases Transverse plane
motion stressing the ligament further.
(Rotational Instability)
• Damage to Talocrural Joint Capsule with
ligamentous stabilizers of subtalar joint.

21. • Increased Supination moment at Subtalar
joint leads to excessive inversion and internal
rotation of rear foot in closed kinetic chain.
• May happen with rigid supinated foot or with
more laterally deviated subtalar joint axis.
• Then if supination moment > compensatory
Pronation (Peroneals), Leads to Excessive
inversion and internal rotation.

22. • Further, Predisposition to first time ankle
sprain includes:
• Structural – Tibial Varum
• Functional –
» poor postural control performance
» Impaired Propriocepton
» Eversion > Inversion
» Plantarflexion strength > Dorsiflexion Strength

23. • Acute Ankle Sprain – Tender & swollen ankle –
Painfull Movements but full weight bearing.
WHY most individuals who suffer an
initial ankle sprain are prone to recurrent
sprains ???