Lateral Ankle Sprains

Lateral ankle sprains occur when an athlete rolls over the outside of the ankle (plantarflexion and inversion) when landing or changing direction. The primary ligament that gets sprained is the anterior talofibular ligament (ATFL) but may also disrupt the calcaneofibular (CFL) and posterior talofibular ligaments (PTFL) in more severe sprains. The primary concern in more severe injuries is a fracture so the Ottawa ankle rules should be used to determine the need for an x-ray.

The first step is to manage the swelling through the use of NSAIDs (discuss with your doctor), ice, elevation and compression with the use of short-stretch bandages with a horseshoe shaped foam pad to go over the lateral malleolus. A short period of immobilization and non-weightbearing status may be beneficial but should gradually progress out of this to assure the maintenance of range, mobility, and foot and ankle strength.

Early stage rehab should encourage pain-free gait without compensations along with open chain ankle activation and closed chain balance and proprioception exercises. Glute strengthening is important as it helps to provide stability proximally.

Exercises should progress in intensity to bodyweight exercises such as squats and lunges, with balance progressing to eyes closed, with distractions, and or unstable surfaces. Jumping and landing will start with double limb and progress to single limb at faster speeds and eventually simulating sports-specific movements.

Readiness for return to sport should be completed through strength testing with a handheld dynamometer, functional tests such as the Y-balance test or hop tests, and clinical judgment based on performance of sports-specific movement observing both the quality and quantity of movement. An ankle brace may be beneficial in returning to play and in reducing the recurrence of ankle sprains.