Ankle sprains are extremely common; an estimated 2 million individuals experience an ankle sprain in the US each year. Many of these are recurrent injuries which often result in chronic ankle instability (1). It is estimated that 73% of individuals who suffer lateral ankle sprains end up developing chronic ankle instability (2). Prompt treatment of lateral ankle sprains is important to prevent chronic ankle instability (3). The literature suggests
- 4-5 days of RICE (rest-ice-compression-elevation) of the ankle to decrease pain and swelling in the initial acute phase after an ankle sprain. Ice should be applied for 10 to 15 minutes to the injured area; keep the ice pack on until the area is numb. It is beneficial to ice several times per day initially with at least 10 minutes between icing bouts.
- The literature also suggests that some ankle sprains may require 10-14 days of immobilization in a cast or brace and then progression to a lace up brace to decrease the risk of recurrent injury (4). During this initial period post injury, it is also important to start gentle movement of the ankle within pain tolerance.
- The ankle should be moved up and down as well as in and out 3 sets of 10 repetitions each direction. The range of motion in and out especially will be limited by pain.
Videos of these exercise are available at: htt://MSA-PT.medbridgego.com
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After the initial recover phase, as the pain levels reduce, it is important to begin gentle stretching of the calf and ankle. After an ankle sprain, it’s common to experience decreased ankle range of motion which may predispose an individual to ankle reinjury and can limit walking and stairs negotiation (5).
- Calf stretching can be performed seated with the leg straight and a yoga strap, piece of rope, or dog leash around the ball of the foot. Gently pull the ball of the foot towards you using the arms to do the work and relaxing the foot and ankle. You will feel a stretch in the calf or ankle.
- As the ankle becomes less painful, you can switch to a standing calf stretch. Lean against the wall with one foot forward and the injured foot back. Bend the front knee, lean forward and feel a gentle calf and ankle stretch. Hold each calf stretch for 30 seconds and do at least 3 repetitions.
Balance training can also be helpful for prevention of recurrence of ankle sprains (6). After an ankle sprain, the body is less responsive to feedback from the joint receptors, muscles, tendons, and skin mechanoreceptors (7). This can contribute to poor postural and movement control (8) and increase the risk for reinjury. Balance training specifically improves this body awareness and reduces the risk of rolling the ankle again. A balance training program will likely start with tandem stance balance and progress to single leg stance activities. The balance exercises should be performed near a countertop. Individuals should use as little upper body assistance on the surface to feel slightly wobbly but safe.
- Tandem stance balance eyes open: Stand facing the countertop with both feet in a line, the front foot’s heel touching the back foot’s toes. Try to hold that position for up to 30 seconds. If you do lose your balance, then get back into the starting position and try again for the duration of the 30 seconds. After the 30 seconds, switch your position so that you get some practice with the other foot in front. Do 3 repetitions of 30 seconds on each side.
- Tandem stance balance eyes closed: Follow the same set up as in the previous exercise but close your eyes. This exercise is quite a bit harder than when done with the eyes open so you will likely need more hand assistance on the countertop to remain safe. Do 3 repetitions of 30 seconds with each foot forward.
- Progress to single leg stance for eyes open and eyes closed balance when tandem stance balance gets too easy.
A video of the calf stretching and balance exercises are available at: htt://MSA-PT.medbridgego.com
Enter access code: D79Q4Y62
The above is an example of an initial balance and stretching program. More individualized programs are designed by physical therapists to progressively challenge the ankle to maximize strength, balance and restore normal ankle range of motion. Physical therapy treatment has been shown to be effective for prevention of chronic ankle instability (9). Your Weil podiatrist can help you decide if physical therapy is appropriate for you.
If you have had a recent ankle sprain or are experiencing residual ankle instability and/or pain, consider making an appointment with one of our highly qualified podiatrists at the Weil Foot & Ankle Institute.
1. Cornwall MW, Jain T, Hagel T. Tibial and calcaneal coupling during walking in those with chronic ankle instability. Gait Posture. 2019 May; 70:130-5.
2. Anandacoomarasamy A, Barnsley L. Long term oucomes of inversion ankle injuries. Br J Sports Med. 2005; 39(3):e14.
3. Gruskay JA, Brusalis CM, Heath MR, Fabricant PD. Pediatric and adolescent ankle instability: diagnosis and treatment options. Curr Opin Pediatr. 2019 Feb; 31(1):69-78.
4. Van den Berkerom MP, Kerkhoffs GM, McCollum GA, Calder JD, Van Dijk CN. Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc. 2013 Jun; 21(6):1390-5.
5. Terada M, Pietrosimone BG, Gribble PA. Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review. J Athl Train. 2013 Sept-Oct; 48(5):696-709.
6. Jain TK, Wauneka CN, Liu W. Four weeks of balance training does not affect ankle joint stiffness in subjects with unilateral chronic ankle instability. Int J Sports Exerc Med. 2016;2pii:036.
7. Freeman MA, Dean MR, Hanhan IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. 1965 Nov; 47(4):678-85.
8. Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. 1997 Jan-Feb; 25(1).