Ankle pain Osteopath Hertfordshire

The Acute Ankle Sprain

An acute ankle sprain can affect anyone not just sports men and women. A night on the town and a few too many sherbets can lead to a slip down a curb or rolling your foot in your beautiful stilettos.

It is also one of the most common sports injuries with more than 5000 a day occurring in the UK alone and it can account for 10% of A&E visits in the USA. These numbers are staggering but what is more unbelievable is that the acute ankle sprain can lead to long term sequelae in around 50% of people, and 25% experience other pathologies in the process such as damage to the joints around the ankle.

You could say these are a serious problem but not many people realise the potential complications that can arise from a simple twisted ankle.


There are 3 types of ankle sprain inversion, eversion and diastasis and they account for 25% of all the time lost from sport.

The lateral ankle sprain or inversion sprain is the most common and accounts for 85%. Actually this type is rarely pure inversion and is often a combination of inversion, plantar flexion and rotation. An isolated anteriotalofibular tear is most common and least severe. Second, most common is combined with the calcaneal fibula ligament. The posterior talofibula ligament is seldom injured.

Next is the rare and often severe medial ankle sprain or eversion sprain, which accounts for 10% and is when the foot is everted and externally rotated. This leads to ruptures of the deltoid ligament and is often accompanied by a fracture of the lateral malleolus.

Lastly is a high ankle sprain or syndesmotic ankle sprain accounting for the last 5%. These are usually severe and are completely ruptured in combination with fractures.

So what is the clinical picture?

During the history you will be asked about the mechanism of injury, the aftermath (swelling, bruising, tendernss, function, timescale), and past history (reoccurrences or predisposing issues). This is a good indication for a diagnosis.

The examination will assess location of swelling, bruising, tenderness, foot shape, gait and hands on, passive testing.

Classification and Grading

Grade 1
* Ligament stretch without microscopic tearing
* Minimal swelling and tenderness
* Minimal functional loss
* No mechanical joint instability
* 1-2 weeks - functional recovery; 1-2 months - structural recovery
Grade 2
* Partial microsopic ligament tears
* Moderate pain
* Localised swelling and tenderness
* Mild to moderate joint instability
* Visible limp
* 1-2 months - functional recovery; 6-12 months - structural recovery
Grade 3
* Complete ligament rupture
* Marked swelling
* Hemorrhage
* Tenderness
* Functional loss
* Severe joint stability
* Unable to weight bear
* 2-6 months - functional recovery; 1 year+ - structural recovery

What to do when you have a sprain….

Do you have a fracture? Do you need an x-ray?

The Ottowa Ankle Rules.

If you meet any of the following criteria you should seek medical attention and request an x-ray.

1. You are older than 55 years of age.

2. You are unable to weight bear for 4 successive steps.

3. Local tenderness at the back of either side of your ankle.

4. Local tenderness at the top of the lumps inside and outside of your ankle

5. Local tenderness over the navicular, cuboid ot the 5th metatarsal

So you don’t have a fracture. Now what?

If you are able to weight bear then you can start mobilisation.

If you are unable to weight bear then you should use crutches and seek a medical professional for a review as you may have a grade 3 sprain with additional complications.

  1. A brief period of rigid immobilization (e.g., < 10 d)
  2. Functional management with transition to a semi-rigid external restraint
  3. Delayed surgical repair
TimingFunctional management of the acute ankle sprain
Immediately* Non-steroidal anti-inflammatory medication
* Other anti-edema measures (rest, ice, compression, elevation)
* Early mobilisation
Week 1-3* Weight bearing with a brace
* Ligament protection
* Muscle strengthening
* Ankle range of motion
* Proprioceptive or postural training - crucial
Week 4-8* Controlled mobilisation
* Controlled exercise
* Increased mechanical strength of ligament collagen fibre orientation
Month 6-12* Final maturation/remodeling
* Full return to activity
* Full neuromusular control

Perhaps you have suffered a recent or historic ankle sprain that is still causing you problems and would like to see if Hitchin Osteopathy can help.

Please call or book online we would be happy to see you!!!


Carnes, M & Vizniak, N. 2011. Conditons Manual 3rd Edition. Canada. Professional Health Systems Inc.

Hubbard, T. J., & Wikstrom, E. A. (2010). Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access Journal of Sports Medicine, 1, 115–122. [Accessed: 18 Dec. 2015] McCriskin, B. J., Cameron, K. L., Orr, J. D., & Waterman, B. R. (2015). Management and prevention of acute and chronic lateral ankle instability in athletic patient populations. World Journal of Orthopedics, 6(2), 161–171. [Accessed: 18 Dec.2015].

Peterson, L & Renstrom, P. 2003. Sports Injuries 3rd Edition. London. Martin Dunitz