Ankle sprains are a very common injury due to the ankle being a synovial joint which is the most movable joint in the body. This injury is especially most common in athletes because of their very active lifestyle 1 . The purpose of the ligaments in the ankle are to hold bones together and keep joints in position to have full mobility 2-3. Determining what kind of ankle sprain a person has is based off of the degree to which the ankle ligaments have been suddenly twisted or the amount of flexion or extension motion that has caused tearing, pain, or swelling to the ankle 4-6. There are three different types of ankle sprains; first degree, second degree, and third degree 7-8. Rehabilitation to treat and prevent the ligaments of the ankle also vary depending on the degree of the sprain or frequency of the injury 9-12. The purpose of this essay is to discuss the importance of ligaments in the ankle due to them being the underlying factor of the different degrees of ankle sprains causing ligament injuries, treatments for ankle sprains, and further prevention of future ankle injuries.
Ligaments are a type of connective tissue that are tough yet flexible enough, meaning their purpose is to stabilize bones but also be elastic enough to be mobile 2. There are three different areas of the ankle that the ligaments can be classified as, the lateral ligaments, the deltoid ligament on the medial of the ankle, and the ligaments of the distal tibiofibular joint that joins the end point of the ankle to the bones of the leg 3. Depending on which way the ankle has suddenly twisted causing an injury determines which ligament in the ankle has been strained or ruptured. This kind of injury is very common in athletes all around the world because of the amount of dependency the athlete puts on their feet with quick actions such as direction change 1,6,10. The degree to which an ankle injury has occured is deciphered based on number of ligaments affected and the amount of instability of the joint 2.
Being able to identify which degree the ankle is injured helps to treat the ankle sprain and prevent future injuries to the ankle joint. Firstly, identifying the severity of the ankle injury is important to the next step which is to treat the injury accordingly. An ankle sprain is characterized by the amount of swelling, pain, and/or amount of ligaments affected. A first degree ankle sprain is when the ligaments are twisted or stretched to an extent that is not normal per the person but not torn 4. In this case inflammation and some swelling will occur making the ankle stiff and some slight joint instability could happen. The area around the ligaments affected may turn red and become warm due to the amount of blood being rushed to the site of the injury.
A second degree ankle sprain is when the ligaments are partially torn but not completely ruptured 4,8. A second degree ankle sprain is the most common type of ankle sprain. This degree of ankle sprain causes significant swelling and moderate pain with some trouble of walking due to one or more ligaments being slightly torn 4,6. Bruising might also occur with a slight loss of mobility in the joint. A second degree ankle sprain can occur again or the rehabilitation time might be longer if not treated correctly the first time.
A third degree ankle sprain, which are much more severe than a first or second degree sprain, one or more ligaments are completely torn or ruptured causing a substantial amount of swelling and inflammation as well as instability of the joint. Athletes that experience ankle injuries often suffer from swelling and long term pain causing future injuries to be more likely 5. A tear or a rupture could happen due to the repetitiveness of an acute sprain, recurring tears in an athletic person should be treated professionally because a recurring tear could result in immobilization of the ligaments in the ankle permanently 8. Diagnosing an ankle injury to which severity it is helps with the treatment for rehabilitation and prevention of future injuries.
Fully treating an injured ankle is important to one's health for now and in the future. It is said that treating the injured ankle as soon as possible with the protocol of resting, icing, compression, and elevation (RICE) will help with a quick recovery 9. The protocol of RICE begins with resting the ankle by eliminating weight on the injured ankle 9. Secondly icing the ankle for about twenty minutes will help decrease the swelling and reduce pain 10. Next applying compression by properly wrapping the ankle in an elastic bandage helps control further swelling and internal rush of blood around the ligaments 9. Lastly elevating the ankle to reduce blood flow to the swollen area will help reduce more swelling with resting 9. These are the first steps to alleviating pressure and pain from the ankle. This protocol is provent to prevent future pain in the ankle and regain function up to 50% faster in patients that quickly reacted to the injury instead of waiting to treat 9. This form of treatment is enough to help a grade one ankle sprain to achieve a full recovery.
Next, for those who have a more serious injury such as a grade two or three ankle sprain need to seek treatment from a doctor to further help the recovery of the ligaments in the ankle. Those who experience difficulty having weight on their ankles, swelling, and/or pain and are experiencing a second degree ankle sprain can be eligible for an ankle brace to help along with rehabilitation 10. Ankle bracing is considered a type of professional medical orthosis applied particularly to the ankle joint, meaning anything of orthosis making to keep the ankle joint in place which limits the movement of the ankle joint will help the torn ligaments rejoin for a full recovery 10. It is said that athletes wearing the brace had lower incidents of straining their ankles further 10.
Third grade ankle sprains might have a longer healing time if ankle bracing is not effective in stabilizing the ankle joint. Surgery might be the only option for a ruptured ligament due to the ligament not being able to heal on its own. Some surgeries might include suturing the torn ligament and supplementing the lost ligament portion with a peroneus brevis tendon meaning taking a tendon specifically from the posterior edge of the fibula and reconnecting it to the sutured ligament will help to have full mobility of the ankle 11. This is the last resolution to recovery if the ligaments are completely ruptured and self healing with bracing does not work.
Most importantly, it is urged to take precocious measures after rehabilitation from any ankle sprain to take care of one’s self in prevention of future injuries. Ankle instability within the joints are a problem that causes the body to be off balanced. Researchers have came to a conclusion that some of athletes’ instability could possibly be coming from the type of shoes they wear while exercising or with their everyday shoes 9. Their solution to this problem is to get molded orthotics, specially made for the patient that slide into the soles of the shoes, which decrease ankle pain and soreness as well as improves balance 10.
This solution is the ideal way to start proprioceptive training. Proprioceptive training includes exercises that help balance the body by teaching itself to control the joints positioning. Proprioceptive training of the ankle is proven to help reduce ankle sprains in those with histories of ankle sprains, as well as in those who did not have a history in ankle sprains 12. This technique is successful due to its ability to strengthen the athletes balance and not strain a ligament due to being unbalanced while performing an athletic action 12. Proprioceptive training is recommended for people that are active due to the successful results it has shown in all of its participants within the study.
To conclude, it is important to take care of one’s self because the ligaments in the ankle are easy to tear or rupture, hindering the performance in one’s sport or generally in one’s day to day activities. The ligaments in the ankle are important due to them being the underlying factor of the different degrees of ankle sprains causing ligament injuries, treatments for ankle sprains, and further prevention of future ankle injuries. Treating one’s body with precaution to prevent injuries such as wearing orthotics and practicing proprioceptive training strengthens the ankle ligaments and allows a smoother athletic activity to be completed as well as being stable in one’s day to day life style.