Have you twisted your ankle… again?

We’ve all been there. That horrible moment when you miss a step and fall awkwardly off the curb, or are tackled from the side with your foot planted (usually on the sports field, but not necessarily), feeling that awful snap in your ankle. High heeled shoes and icy weather have a lot to answer for too. Now we can’t go attributing twisted ankles to wearing high heels all of the time, but certain footwear – and certain activities – do seem to cause more problem s than others

• The most common injury reported with a “twisted ankle” is a sprain to the lateral ligaments of the ankle (the ones on the outside as opposed to the inside [medial]). Normally the symptoms will include swelling, pain, bruising, heat and redness, along with stiffness over a period of time.

• One of the big differences between ligaments (which hold bones together) and muscles is that muscles are contractile, meaning that you can actively and purposefully shorten them. By over-working a muscle, you may strain it (note that’s “strain” with a “t”). Ligaments are generally stiffer (thankfully, otherwise our bones would be wobbling all over the place), but when we stretch them too far, we can sprain them (with a “p”).

• Let’s start with a diagram of the bones of the foot. The ones we’ll be concentrating on are the tibia and fibula (which make up the lower leg), the talus and the calcaneus (heel). The other bones in the foot are important for movement, but not strictly involved at the ankle joint.

• The ankle joint itself is formed by the tibia (the shin bone), the fibula (the smaller lower leg bone) and the talus. It  is a hinge joint, meaning it moves up and down (dorsiflexion and plantarflexion) but not side to side – these movements are prevented by the strong medial and lateral ligaments, the medial being stronger than the lateral (which is one reason we tend to injure the lateral ones more often).

The lateral ligament is actually split into 3 parts (see the diagram below): the anterior and posterior talofibular ligaments and the calcaneo fibular ligament. The most commonly injured part is the anterior talofibular ligament.

There are 3 types of ligament sprain, each varying in intensity.

Grade I sprains are those with very little damage. You’ll see some local swelling and feel a moderate amount of pain, particularly if you twist whilst standing on the injured ankle. However, this should ease off fairly quickly following the advice below.

A grade II sprain involves damage to more of the fibers of the ligaments, therefore the swelling will be more pronounced and will appear much more quickly than in a grade I. You’ll be in more pain (sorry about that), and may find it difficult to weight-bear on the injured foot. The good news is that the joint itself remains relatively stable, and the ligaments are still able to hold the bones in place.

The most severe sprain is a grade III. This is a complete rupture of the ligament, meaning that the bones at the ankle joint will lose some of their stability. There will be a lot of swelling and, unfortunately, a fair amount of pain too.

The best way to determine how severe your ankle sprain is, is to have your physiotherapist assess the injury.

•  So what do you do with a twisted ankle?

The main aims of treatment will be to reduce the pain and swelling in your ankle and to help the tissue healing begin. There are lots of things you can do to facilitate this by using the PRICE mnemonic.

• P is for Protect. This means be aware of your injury and protect your ankle by further damage e.g. by using crutches, or by keeping the weight off of the injured side as much as possible. (In other words, come off of the pitch and wear sensible shoes for the time being.)

• R is for Rest. When an injury is sustained to a ligament, some of the small blood vessels supplying the tissue will break. This starves small parts of the tissue of oxygen and nutrients, meaning that the tissue necrosis or dies. It is important to rest as much as possible to limit the amount of oxygen required and therefore limit how much of the tissue dies. Larger injuries may require total rest as your body may be in shock. Smaller injuries will require rest of the affected ankle, but otherwise allow you to continue activity. As your healing continues, the periods of rest will be reduced.

• I is for Ice. Making the affected area cold will reduce the swelling in the area and lower the metabolism of the tissues – in short this means the tissues need less oxygen, and so the rate of tissue death slows. This is all good for recovery. If you’ve had an injury, the best thing to do is use ice or an ice pack, wrap it in a moist tea towel or use a barrier between the ice and skin (very important to avoid ice burns) and place that over the painful area for 15 minutes every 2 hours or so throughout the first 2 days.

• C is for Compression. You’ll be well aware by now that ankle injuries tend to swell. By using a simple elastic bandage such as tubigrip [or] crepe bandage, you can provide a uniform compression around the foot, ankle and lower leg to reduce the accumulation and spread of the swelling, which is very common in this type of injury partly due to gravity allowing fluid to pool at the foot.

• E is for Elevation. you were waiting for this. I’m not one to encourage you to put your feet up… except in this case. Normally the shifting of fluid from the legs is aided by the pumping of the calf muscles, but when you are restricted to rest, the excess fluid from the injury tends to gather around the ankle. Using a stool to place your foot on, this will encourage rest and protection, as well as help drain the excess fluid back up the leg and towards the heart

                               Wrapping crepe bandage


Grade I sprains can be treated solely with the PRICE first aid, however grades II and III strains will likely need some form of support such as taping, or a cast or splint, and some solid advice on how to deal with the injury, particularly in the early stages of recovery

• Use of electrotherapy such as ultrasound and laser treatment can reduce pain and inflammation and promote healing

ankle taping procedure. The superior anchor(second photo)   was applied in a standardized way according to the subject's body dimensions,at 35% of the distance from the lateral malleolus to the fibula head.

• Once the swelling has started to ease slightly (generally after the first day or 2 for grade I sprains) you can begin some gentle exercises to help your ankle regain normal movement. Your physiotherapist can help you by designing a specific programme for you which will help you recover from injury and return to your normal activities as soon as possible, as well as helping you avoid future ankle sprains (even if you really MUST wear those high heel

 Disclamier;This information might have been copied from different sources to give the best accessible