Ankles are made to perform four basic movements, dorsiflexion and plantarflexion (raising and pointing the foot) and inversion and eversion (moving the foot inward and outward). While the joint requires sufficient mobility to allow these motions it also needs enough stability to withstand the forces of weight bearing. Ankle ligaments limit motion, hold bones in their proper places and absorb shock. When a joint is moved beyond its normal range of motion it stresses and stretches the inelastic fibers of the ligament and can cause tearing, also known as a sprain. There are three main sets of ligaments in the ankle and any set can incur a sprain. The ligament sets include the deltoid ligament, lateral ligaments and syndesmotic ligaments.

The Deltoid ligament is on the medial or inside of the ankle. The Deltoid ligament consists of superficial and deep ligaments. It is common for more than one of these ligaments to be injured at a time. The superficial ligaments include:

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

The deep ligaments include:

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

The deltoid ligaments tend to sprain less often than the lateral ligaments, but it does occur. A deltoid ligament sprain is called an eversion sprain because an uncontrolled and forceful eversion of the ankle can injure the deltoid ligament. This unexpected eversion force can occur during walking or running on uneven terrain or when stepping awkwardly, for example.

Ankle sprains are typically felt right away. Because the primary function of ligaments is to provide passive stabilization to the area, loss of stability can range from mild to severe with a ligament sprain. We can categorize a sprain based on its symptom 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.
• 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.
• 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.

PHYSICAL THERAPY FOR A SPRAINED DELTOID LIGAMENT IN THE ANKLE

In the first week or so after an ankle sprain, your physical therapist will show you how 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. They may recommend bracing or taping to protect the injured area and reduce pain, and crutches or a walker if you cannot walk without limping.

Aside from protecting the area of injury, in this very early phase of rehab, 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 therapist may apply 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. This includes more dynamic standing and resistance exercises.

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 start you on the road to recovery today.