Acute ankle sprains are a commonly reported sports injury that accounts for 15% of all injuries sustained by U.S. college athletes. Athletic trainers commonly treat ankle sprains, which is essential for reducing the risk of issues that can develop later on, such as chronic ankle instability and osteoarthritis.

The Most Common Types of Ankle Sprains

The ankle is the most congruent joint in the body, but also the most commonly injured joint in sports. Majority of ankle sprains are lateral, but high ankle sprains (HAS) can be found in 11-74% of ankle sprains. Deltoid are less common. Often times multiple ligament structures may be involved with injury.

Though injuries to the deltoid ligament are less common, this ligament is one of the primary stabilizers of the ankle and, therefore, should always be carefully evaluated during an ankle injury. Chondral injuries to the talocrural joint, fractures and subtalar joint also occur from time to time and should be taken into consideration when evaluating ankle injuries.

What Are the Best Treatments for Ankle Sprains?

Protective taping or bracing and an aggressive rehabilitation exercise routine can often help athletes with ankle sprains quickly resume their sports activities. Many athletic trainers are highly experienced and proficient with ankle taping, given the high prevalence of ankle sprains.

Ankle taping provides stability to the ankle to support the quick healing of soft tissues. It also compresses the ankle joint to reduce inflammation. In a 10-year study conducted at Rutgers University, researchers learned that lateral ligament injuries resulted in minimal time lost in sports activities compared with no taping in those who suffered a HAS. 

Recovery Timeline for an Ankle Sprain

Most lateral ligament injuries have a full recovery timeline of between six and eight weeks, though many athletes choose to return to their sports much earlier. Resuming activities too early after an ankle sprain can increase the risk for reinjury and advanced joint laxity, which can then result in chronic ankle instability, osteoarthritis and chondral changes.

Though athletes can experience a successful early return to sports, continued rehabilitation should be a best practice, as it is key to reducing the risk of long-term injuries or disability later on.

The Importance of Complete Rehabilitation

Chronic ankle injuries are generally associated with an increased severity of injury, incomplete rehabilitation and neurologic impairment in terms of proprioception decline. These injuries may also co-occur with injuries that affect the tendon or joint surface.

Someone with syndesmotic injuries may also experience lateral injuries of the calcaneofibular ligament (CFL) as well as injuries to the anterior inferior tibiofibular ligament (AITFL). This occurs due to how the CFL crosses the subtalar joint to help control lateral tilt of the talus while also assisting with control of rotational motion. Therefore, a syndesmotic injury can impact your athletes’ functioning in a significant way.

It’s also important to note that the distal tibia and fibula, as well as an intact syndesmotic ligament, function much like a crescent wrench gripping a nut. If the wrench (or bones and ligaments) isn’t tight, you won’t be able to grip the nut.

In a 1976 study published in The Journal of Bone and Joint Surgery, researchers found that a 1 mm widening of the syndesmosis resulted in a 42% decrease in weight-bearing ability. This can be evidenced by an athlete’s inability to do a single leg hop from their toes without letting the heel touch the ground. In this position of “en pointe,” the talus everts and acts like a fulcrum against the fibula. If the AITFL is injured, the athlete will be unable to do the leg hop due to pain and instability.

Obesity, kinesiophobia (fear of movement), lack of rehabilitation and loss of motion are other factors that can impact chronic injury. As an athletic trainer, the ability to clearly see all these factors and address the entire issue is essential to helping your athletes achieve complete rehabilitation.

The Value of CAA for High-Ankle Sprains

A conservative-aggressive approach (CAA) may be the most viable treatment method for high ankle sprains, according to results from a study conducted by UOA.

The purpose of the study was to determine the long-term impact of HAS that was treated with CAA for the management of high ankle sprains. All initially reported their outcomes as good/excellent with no evidence of heterotopic ossification (HO). In follow-up, they found that 29 of 31 patients who were treated with the CAA experienced a “good” long-term outcome as rated by patient-reported outcomes.

Of those who were available for follow-up X-rays, 10 of 11 patients had evidence of osteoarthritis (OA), while only three of 11 had evidence of significant OA. Three patients also showed evidence of HO in the interosseous membrane. All who showed significant OA and HO had recurrent ankle sprains since their original injury. It is not well known what the long-term incidence of ankle OA is in the general population. 

The UOA study not only demonstrated the value of the CAA for treatment of high ankle sprains, but revealed that these types of injuries could potentially have long-term consequences.

What Athletic Trainers Should Take Into Consideration

In conclusion, athletic trainers must be vigilant with ankle evaluation and treatment to reduce the risk of long-term injuries and disability in athletes. Follow the Ottawa Ankle Rules when considering X-rays and continue rehabilitation until fully recovered. 

Questions you should ask yourself when managing ankle sprains:

• Do you use ankle function tests such as the single leg hop test?
• Do you continue ankle rehab after an athlete’s return to sports?
• Do you re-evaluate ankle injuries for signs of chronic injury?
• Do you refer patients to physicians when sprains do not respond to conservative treatments in a timely manner?

With any ankle injury, take time to consider the long-term impact of immediate care, as it’s not always about getting an athlete back into the game. Early diagnosis and treatment decisions may have a long-term impact on osteoarthritis and overall long-term function.