Newsletter February 2021
Ankle sprain injuries common during winter sports
With the winter sports season in mind, one of the more common sports-related injuries that the sports medicine team treat is the lateral ankle sprain.
While basketball is often considered the most likely sport to lead to ankle sprains, bad weather is also a frequent contributing factor – whether playing in the snow or just walking on slick pavement
The ankle is a very important joint not only for athletics but also for normal ambulation. It allows a primary upward (dorsiflexion) and downward (plantarflexion) motion, as well as a side to side motion – inversion (seeing your sole) and eversion (turning the foot out).
Sprains are injuries to ligaments, which connect one bone to another. They can be classified as Grade 1 (stretch) Grade 2 (partial tear) Grade 3 (rupture, or snapping completely). Ankle sprains are often due to an inversion injury, where the ankle rolls “in”. This type of injury usually affects the ATFL, or anterior talofibular ligament. It may also affect 2 other ligaments arranged like a “T” on the outside of the ankle, the PTFL, or posterior talofibular ligament, and CFL, or calcaneofibular ligament. These ligaments are named after the two bones that they connect.
When the inversion happens, these ligaments are stretched, sometimes to the point of tearing fibers.
This will lead to immediate pain, and swelling, often a LOT of swelling. People may also have difficulty moving the ankle or putting weight on it. Many people feel a pop or a snap when they injure the ankle, which can also be audible to close bystanders.
While the majority of ankle sprains will resolve with conservative treatment like modified weight-bearing, rest, ice, anti-inflammatory medications, and bracing, other injuries can also occur. A fracture of the distal (lower end) of the fibula, which is the bony knob on the outside of your ankle, can occur, as can a fracture of the foot at the base of the 5th metatarsal bone. This is because one of the tendons (which connect muscle to bone) in the outward-facing part of the ankle, the peroneus brevis, attaches there. A sudden strong pull on that part of the bone can lead to fracture.
Less commonly, the lower end of the tibia or shin bone can be fractured at the bony knob on the inward-facing part of your ankle, as can a part of the same bone deeper and in the back of your ankle, or the talus bone which is where the tibia rests on.
Most times, initial x-rays of the ankle can rule out a fracture, though there are situations where a fracture does not show up initially but can be visible on subsequent x-rays if there is significant persistent pain.
As long as there is no fracture, recommendations are usually to start early gentle range of motion exercises to reduce the risk of stiffness. Recovery and return to sport also, on average, is quicker when this is done. Sometimes there will be a period of immobilization with a hard brace, like a walking boot. Once the swelling improves and the athlete can walk more easily, the transition to a soft brace occurs.
Exercises performed under the supervision of the high school athletic trainer are crucial to the recovery process. There are times, however, when the athlete may need to go to formal physical therapy to first re-gain range of motion, then strength, and finally balance and coordination.
Though most athletes recover quickly within a few weeks of the ankle sprain, some develop chronic pain or looseness of their ankle. Often the treatment is to engage in continued therapy and bracing/taping. Rarely, surgery is needed. Frequently, during the course of rehab, underlying muscle tightness or weakness in the ankle, or even in the knee and hip, can be uncovered and then addressed.
The dreaded high ankle sprain which takes longer to heal involves the connection between the tibia and fibula, the two leg bones. It more commonly occurs due to an Eversion injury. There is stronger ligament stability to prevent this from happening so that if the trauma was enough to cause an injury here, it is more likely to lead to more significant structural damage. Fractures can be associated with this, as well as severe instability that requires surgery.
As always, IU Health Arnett Sports Medicine strives to keep our athletes safe and get back to play as soon as they can. Stay tuned for next month’s post!
Jeffrey Wang, MD
IU Health Arnett Sports Medicine Physician
IU Health Arnett Family Medicine Physician