Ligaments are inelastic tissue fibers that connect one bone to another. They give joints the stability they need to prevent them from moving beyond their normal ranges of motion. They also hold bones in their proper places and absorb shock. The ankle has three main groups of ligaments. The Deltoid ligament is on the medial or inside of the ankle. The lateral ligaments are on the outside of the ankle while the syndesmotic ligaments are at the top of the ankle. A medial ankle sprain is an injury to the ligaments on the inside of the ankle also known as the Deltoid ligament. The Deltoid ligament consists of superficial and deep ligaments. The superficial ligaments include:

• Tibiocalcaneal ligament
• Tibionavicular ligament
• Posterior superficial tibiotalar ligament
• Tibiospring ligament

• Anterior tibiotalar ligament (ATTL)
• Posterior deep tibiotalar ligament (PDTL)

• Dorsiflexion: lifting the toes and the foot upward toward the shin
• Plantarflexion: pointing the foot downward
• Inversion: moving the foot inward
• Eversion: moving the foot outward

When the ankle everts or moves outward, the Deltoid ligament prevents it from moving too far. Medial ankle sprains often happen when walking or running on uneven terrain or stepping awkwardly such as off a curb or step. When this happens, the inelastic fibers of the Deltoid ligament can be stretched beyond its limit causing some or many of the fibers to tear. This is what is known as a sprain. Pain on the inside of the ankle at rest, with weight bearing or movement of the ankle outward are common symptoms of a medial ankle sprain. Swelling, bruising and tenderness over the area can appear. Instability is not uncommon with a high-grade medial ankle sprain.

We can categorize a sprain based on its severity:

• Grade I (mild): microscopic damage has occurred to the ligament but only mild local tenderness and minimal bruising/swelling are noted without compromising joint stability. Typically takes 2-3 weeks to heal.
• Grade II (moderate): partial tear/rupture of the ligament. Obvious swelling and tenderness noted over the injured ligament but joint instability is either minimal or absent. May require up to 6 weeks to heal.
• Grade III (severe): complete rupture of the ligament with severe swelling and tenderness. This injury may be difficult to distinguish from a fracture initially. Instability of the joint is noticeable due to the severity of the rupture. Prolonged time to heal is frequent and may require surgery to repair.

• Pain, tenderness and swelling over one of the ankle bones
• Redness and bruising
• Difficulty walking on or moving the ankle

PHYSICAL THERAPY FOR A MEDIAL ANKLE SPRAIN

In the first week or so after a medial ankle sprain, it is important to protect the recently injured and newly healing ligament. You want to minimize any movement that causes pain or places any stretch or strain across the injured site. Your PT may recommend bracing or taping to protect the injured area and reduce pain or advise you to use crutches if you cannot walk without limping.

Aside from protecting the area of injury, in this very early phase, your physical therapy treatment will focus on reducing inflammation and pain and maintaining strength in unaffected areas above the injury. To achieve these goals your physical therapy treatment may consist of the application of ice or light soft tissue work to mobilize any edema. Modalities such as electrical stimulation or ultrasound may be applied to increase circulation, decrease inflammation and control pain.

As the healing tissues become stronger, inflammation subsides and pain is reduced, it is time to move on to the next phase of rehab which consists of light muscle activation and endurance work, graded active range of motion, and more weight-bearing activities. Finally, in the later stages of healing your physical therapy treatment will focus on exercises and activities that prepare the injured ligament to withstand the stress and strain of everyday life and the sports and recreational activities we love to do.

CALL TO SCHEDULE AN EVALUATION FOR YOUR SPRAINED ANKLE WITH EVOLVE PT

While no one wants to deal with a sprained ankle, having the right care team to help you recover can make all the difference. The team of physical therapists at Evolve is here and ready to help on the road to recovery today.