Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Approximately 2 million ankle ‘sprains’ (the word used to describe a ligament that has been over-stretched or torn) occur in the US every year alone, which gives you an idea of how many happen worldwide! Whilst many of these sprains occur in the sporting world, there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorized into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further than your trusty osteopath. Call us today on (416) 546-4887 or book online to book your appointment and begin treatment immediately.

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Many sprains occur in the sporting world, but there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorised into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further, our team can help you get back and running. Our osteopaths can help with treatment and rehab, whilst our chiropodist can help out with alignment corrections and shoe recommendations. Call us today on (416) 546-4887 or book online at beachealth.janeapp.com to book your appointment and begin treatment immediately.

 

 

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Athlete’s Foot

The term “athlete’s foot” can be very misleading because you don’t have to be an athlete to suffer from this condition. Athlete’s foot (tinea pedis) is a common contagious fungal infection affecting the skin and nails of the feet, which cause itching and irritation.

Athlete’s foot is caused by a fungal infection that manifests in a scaly, red rash on the foot that itches, especially at night. Blisters or ulcers may also appear. Athlete’s foot can affect one or both feet and can spread to your hands if you scratch or pick the infection.

Having sweaty feet confined in tight-fitting shoes or coming into contact with someone who has the conditions. Communal showers, locker rooms, and pool decks are common places where the infection can be contracted if you are not taking precautions, like wearing shower shoes.

You are at an increased risk of athlete’s foot if you’re:

  • Male
  • Wear damp socks or tight-fitting shoes
  • Share mats, rugs, bed linens, clothes or shoes with someone who has an infection
  • Walk barefoot in public areas, like locker rooms, saunas, swimming pools, and communal showers
  • Have a weakened immune system’

Prevention & Treatment:

There are over-the-counter creams that can usually effectively treat and eliminate the infection within two weeks.

You can also prevent the spread of Athlete’s foot by wearing sandals in public locker rooms and around swimming areas. Be sure to maintain clean showers and floors at home where you frequently walk barefoot and cover your feet with socks or shoes until the infection has dissipated. Also, keep your feet clean and dry if you choose to wear socks and shoes for long periods of time.

Don’t forget to continually disinfect your footwear to ensure you will not accidentally reinfect yourself.

 

When To Seek Care:

If these treatments don’t work, or if you have increasing pain, fever, swelling of the foot, blisters or open sores, it’s time to seek treatment for a possible bacterial infection. A more aggressive course of treatment may be prescribed by chiropodist (your foot specialist) at our clinic. Please call us, or book online with our chiropodist Lada Milos Lee.

Compression Stockings

Our foot specialist, Lada Milos Lee is proud to offer Ofa Bamberg line of compression therapy. Compression therapy is achieved using gradient compression, which has the greatest pressure at the base, and reduces pressure as the compression garment goes up the leg. This helps encourage the movement of fluids, including blood circulation and the lymph fluid circulation. The gentle pressure helps blood vessels and lymph  vessels absorb fluids more easily, providing relief for tissues. This helps to relieve pain  by reducing swelling and preventing accumulation of fluid buildup. Venous disorders are very common and it is estimated that 20% of men and 30% of women suffer from some form of venous disorder.

  • Do you suffer from tired, aching legs at the end of your day?
  • Do you suffer from spider or varicose veins?
  • Do you travel long distances frequently?
  • Do you sit or stand for prolonged periods of time?
  • Are you pregnant?
  • Do you struggle with some excess weight?

If you answers “YES” to any of these questions, compression stockings may be helpful in alleviating pain, reducing swelling and preventing chronic venous disorders.

Prevention of Varicose Veins

When the valves of the veins are damaged or do not function properly, blood pools and the increased volume causes pressure within the wall of the veins. This can then cause veins to bulge and distend. Over time, the veins loose their ability to bounce back, causing “spider” veins ( in the small superficial veins), and “varicose” veins ( in the larger veins). Compression therapy is effective in preventing the veins from becoming damaged and noticeable.

Sports

Studies have shown that wearing compression stockings during exercise helps reduce muscle soreness.

Travel

Long-distance travel wether by car, train or airplane, can be associated with the leg discomfort and increased risk of DVT (deep vein thrombosis). Lack of leg movement due to prolonged sitting and cramped spaces gives way to swelling of the feet and legs. The swelling contributes to leg fatigue, discomfit, and a heavy sensation in the leg. Studies have shown that a traveler not wearing a graduated compression stockings is 12.5 times more likely to develop DVT.

Wearing gradient compression stockings appeared to be effective in reducing the risk of DVT and prevent overall swelling during frequent or long travel.

Pregnancy

As the baby grows, the enlarged uterus applies pressure on the vena cava, which returns blood to the heart. The pressure can cause stasis and valve damage, which results in swelling, leg discomfort, and even varicose veins. On average 23% of pregnant women will have venous disorders as early as their first pregnancy, and this number rises to 31 % by their fourth pregnancy. Compression hosiery helps to relieve leg fatigue and discomfort by helping to prevent the superficial veins from becoming distended with blood. It also helps to reduce pressure in the tissue underneath the skin.

Are You Covered?

Compression stockings with a pressure of 20-30, or 30-40 mmHg are covered by most insurance plans on an annual basis. A physician prescription is required.

Consultation

A 20-min initial consultation is required. The appointment should be scheduled at the beginning of the day to ensure the best measurements. Styles and materials will also be discussed to determine the best product for your needs.