Ankle Sprain

An ankle sprain happens when an ankle ligament—which is the fibrous tissue that connects one bone to another—gets stretched or torn.

Causes

There are a number of reasons why an ankle sprain may occur. Some common ones include:

• Landing awkwardly while playing sports
• Walking or running on an uneven surface
• Improper sport technique from working out when fatigued or over training

Symptoms

Common symptoms related to an ankle sprain are:

• Outside of ankle pain, tenderness, swelling or bruising
• Painful weight bearing
• Stiffness or inability to fully move ankle

Diagnosis

To determine if your child has an ankle sprain our specialists will perform a physical exam that includes flexibility tests, stress tests, muscle tests and gait analysis. These additional tests will help our specialized team better understand your child’s condition, assess range of motion and identify abnormalities that might occur in bone alignment or muscle function.

After a physical exam, our specialists may also order imaging tests such as an X-ray, MRI, ultrasound or computed tomography to confirm your child has a sprained ankle and not a fracture.

Treatment

Initial treatment for ankle injury includes the following easy to remember acronym, LUSKIN:

Standing Calf Stretch
Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 12-18 inches behind your uninjured leg. Keep your injured leg straight and your heel on the floor and keep your toes pointed towards the wall. Next, do a slight lunge by bending the knee of the forward leg. Lean into the wall until you feel a stretch in your calf muscle. Hold this position for 30-60 seconds, and repeat 3 times.

Half-Kneeling Ankle Mobility
Start by placing the knee of the uninvolved leg down on the floor and the involved leg out in front of your body so you are in a 90 degree lunge. Your knee should be stacked on top of your ankle. Keeping your foot/ heel flat on the floor, slowly shift your hips forward so that your knee moves over your toes deepening your lunge. Hold for 5-10 seconds. Press your hips back to starting position. Repeat for 3 sets of 10 repetitions. Try to press your knee further out over your toes with each repetition.

Ankle Alphabets
You can do this exercise sitting or lying down. Pretend you are writing each of the letters of the alphabet with your foot. This will move your ankle in all directions. The movement should come from your ankle, not from your hip or knee. Do this twice.

Heel Raises
While standing on the floor or on a small step , balance yourself on both feet and hold onto a wall for balance. Rise up on your toes, hold for five seconds, and then lower yourself back down. Repeat 10 times , and do 3 sets of 10. Once you are comfortable with this, try on one leg. 3 sets of 10.

Resisted Dorsiflexion
Sitting with your leg out straight and your foot near a door, wrap the tubing around the ball of your foot. Anchor the other end of the tubing to the door by tying a knot in the tubing, slipping it between the door and the frame, and closing the door, or have a friend of family member hold the band for you. Pull your toes toward your face. Return slowly to the starting position. Repeat 10 times , and do 3 sets of 10.

Resisted Plantar Flexion
Sitting with your leg outstretched, loop the middle section of the tubing around the ball of your foot. Hold the ends of the tubing in both hands. Gently press the ball of your foot down, and point your toes, stretching the THERA -BAND. Return to the starting position. Repeat 10 times, and do 3 sets of 10.

Resisted Inversion
Sit with your legs straight out and cross your uninjured leg over your injured ankle. Wrap the tubing around the ball of your injured foot and then loop it around your uninjured foot so that the THERA-BAND is anchored at one end. Hold the other end of the THERA-BAND in your hand. Turn your injured foot inward and upward. This will stretch the tubing. Return to the starting position. Repeat 10 times, and do 3 sets of 10.

Resisted Eversion
Sitting with both legs out stretched and the tubing looped around both feet, slowly turn your injured foot upward and outward. Hold this position for 5 seconds. Repeat 10 times, and do 3 sets of 10.

Single Leg Balance
Stand without any support, and attempt to balance on your injured leg. Begin with your eyes open, and then try to perform the exercise with your eyes closed or on a pillow with your non-standing foot in front of you, to the side of you, and behind you for 30 seconds each. Repeat three times.

Return to Sport

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If
you return too soon, you may worsen your injury, which could lead to further injury. Everyone
recovers at a different rate.
Returning to your sport or activity will be determined by how soon your ankle recovers, not by how
many days or weeks it has been since your injury has occurred. In general, the longer you have
symptoms before you start treatment, the longer it will take to get better.

You may safely return to your sport or activity when, starting from the top of the list and
progressing to the end, each of the following is true:

• You have full range of motion in the injured ankle, compared to the uninjured ankle
• You have full strength of the injured ankle compared to the uninjured ankle and are able to
  complete the above exercises without pain
• You can jog straight ahead without pain or limping
• You can sprint straight ahead without pain or limping
• You can jump on both legs without pain, and you can jump on the injured leg without pain
• You can pivot and cut without pain at full speed
  Return to your sport at about 50% effort, and increase by about 10% each week. If you begin with
  pain, you may need to rest for a few days before returning to activities

Prevention

• Perform proper warm up exercises
• Engage in ankle strengthening exercises
• Wear proper, well-fitting shoes when exercising
• Stretch gently and adequately before and after athletic or recreational activities
• Ensure proper technique is being used when playing sports and avoid playing fatigued
• If you’ve had previous ankle sprains consider ankle tape or a lace up ankle brace

Recovery

At-Home Care

Common at-home treatment options for ankle sprains include:

• Icing the Area: Put ice packs wrapped in a towel or thin cloth on your child’s affected area for 20–30 minutes every 3-4 hours for the first 2-3 days. If pain does not go away, contact your healthcare provider.
• Elevating the Injured Limb: If your child has a broken leg, elevate it by placing it on a pillow when your child is lying down. Elevating it above the heart level can help reduce swelling and pain.
• Taking Non-Prescription Medication: Take a non-steroidal, anti-inflammatory drug (NSAID), such as ibuprofen as recommended by your healthcare provider.
• Exercising: Your doctor may recommend doing exercises at home. These are designed to stretch the affected joint, maintain range of motion in the joint and strengthen your child’s joint.

Below are common exercises a doctor may recommend to help your child recover after an ankle sprain. Always check with your doctor to find out which exercises are right for your child.

As soon as your child can tolerate pressure on the ball of their foot, they can begin stretching their ankle using the towel stretch. When this stretch is too easy, try the standing calf stretch and the soleus stretch. They can do exercises 4 and 5 when their ankle swelling has stopped increasing. They may do exercises 6 through 10 when they can stand on their injured ankle without pain.