Ankle Sprain: Symptoms, Treatment (What to do in the first 24 hours) and How to Prevent Recurrences

To ankle sprainalso known as tibio-tarsal sprainis one of the most common musculoskeletal injuries, affecting people of all ages and levels of physical activity.

Epidemiology

Ankle sprains are among the most common injuries in sports. Prospective studies indicate a cumulative incidence rate of 11.5 per 1000 exposures and a prevalence of 11.8%. The most common form is sprain with inversion and internal rotation of the foot, often with associated plantar flexion. The anterior peroneal-astragalus ligament (APAL) is the most frequently injured in these cases.

In the most serious cases of ankle sprainOther ligaments, such as the peroneus calcaneus or deltoid, may also be compromised.

The average time to return to sport after an ankle sprain varies between 16 and 24 days. However, many athletes experience recurrences or chronic problems. Recurrence rates are high, especially in sports such as basketball, volleyball and American football.

An ankle sprain can develop into chronic instability, with a feeling of joint failure, persistent pain and functional limitation. Around 40% of people with repeated sprains develop this condition, with a negative impact on quality of life and physical activity.

Risk Factors

The main factors that increase the risk of ankle sprain include:

• Previous history of sprains;

• Muscular weakness of the ankle stabilisers;

• Changes in balance and proprioception;

• Congenital ligament instability;

• Slippery or uneven surfaces;

• Muscle fatigue, especially in athletes.

Differential Diagnosis in Physiotherapy and Osteopathy

It is important to differentiate tibio-tarsal sprain of other injuries that involve pain in the area, such as fractures or osteochondral lesions. Tests such as the anterior drawer and talar tilt help to identify specific ligament injuries.

Injury Mechanism

Most ankle sprains occur due to a forced inversion and plantar flexion movement. In less common situations, eversion movements (foot outwards) can injure the deltoid ligament.

Classification by Grade

Ankle sprains are classified into three degrees:

• Grade I (light): Mild ligament strain, moderate pain, no instability;

• Grade II (moderate): Partial rupture, oedema, intense pain and some instability;

• Grade III (severe): Total rupture, marked instability and functional limitation.

Week One: PEACE & LOVE Therapeutic Approach

In the acute phase (first 5-7 days) with special attention to the first 24 hours, the approach PEACE & LOVE is recommended:

PEACE

• Protection: avoid aggravating movements;

• Elevation: reduce oedema;

• Avoid anti-inflammatory drugs: so as not to interfere with healing;

• Compression: control swelling;

• Education: inform the patient about the recovery process from the ankle sprain.

LOVE

• Charge: gradual introduction of pain-free movement;

• Optimism: encourage a positive mindset;

• Vascularisation: maintain circulation with light activities;

• Exercise: mobility and progressive muscle strengthening.

Physiotherapy and Osteopathy Interventions

Physiotherapy and osteopathy should start early after the ankle sprainosteopathy, with techniques such as gentle mobilisation, lymphatic drainage and myofascial release. Osteopathy is effective in correcting altered biomechanical patterns and improving circulation.

Post-sprain rehabilitation

• Subacute phase (2-4 weeks): mobilisations, initial proprioception and muscle strengthening;

• Functional phase (4-8 weeks): advanced proprioceptive training, muscle strengthening and reintegration into sport with specific exercises.

Osteopathy can complement rehabilitation with joint and neuromuscular techniques applied to the ankle, knee, hip and spine.

Return to Sport

Returning to sport after a ankle sprain should be gradual, respecting the body's signals. The use of kinesiotape can help prevent relapses and improve stability.

Chronic Tibio-Tarsal Instability

When there is residual ligament laxity and proprioceptive deficits, chronic ankle instability can set in, resulting in recurrent sprains. The approach involves strengthening the stabilising muscles, improving balance and motor control.

Causes and Evaluation

• Mechanical instability: ligament laxity;

• Functional instability: neuromuscular deficit.

Clinical assessment is essential, using physical tests and tools such as the CAIT and FAAM to identify the functional impact of instability.

Treatment and Prevention

• Functional rehabilitation: strength, balance and neuromuscular control exercises;

• Surgical intervention: reserved for severe cases or those not responding to conservative treatment;

• Prevention: specific training programmes and the use of external supports during risky activities.

Prognosis

With a proper rehabilitation plan and ongoing monitoring, most people are able to fully recover from a ankle sprainThis significantly reduces the risk of new injuries and improves the overall function of the foot and ankle.

Physiotherapy has a major impact on recovery from sports injuries, the recoveries from cruciate ligament ruptures are a very common example, along with foot sprains.