Inversion Ankle Sprain

According to my Injury classification system, Inversion sprain is considered Level 3 Injury, therefore there are three structures compromised, the alignment, muscle, and ligamentous layer. Is the most common ankle sprain, occurring 85% of the times of all sprains. The main ligament damage in this injury is the anterior talus- fibular ligament and due to the extensive tissue damage, there is an increased intra and extra articular ankle swelling contributing to a significant debilitating condition.

Patients report of pain at the side of the ankle with occasional ecchymosis (a discoloration of the skin resulting from bleeding underneath, typically caused by bruising)

Mechanism of Dysfunction

There is a typical mechanical injury pattern that contribute to this condition. Generally, the patient is in a weight bearing position with the foot slightly plantar flexed (pointed down) and rotated inward (inverted), the increased mechanical torsion with the foot held in that position, predisposed to this sprain injury.

Is important to note that for the ligament to become injured, the previous defence mechanism have to have failed to allow the biomechanical stress to damage the ligament, therefore, the treatment care must aim to restore the health of the entire ankle/foot protective structures.

Assessment Protocol

The entire lower extremity biomechanical chain must be evaluated as part of the foot/Ankle analyses as per the neurological and mechanical influences of the spine, hip, and knee.

Clinical assessment to identify the key joint dysfunctions of the Ankle/Foot (Talus, Fibula, Navicular, and calcaneus) that have contributed this condition. Soft tissue analysis to pinpoint the level of irritation in the ligament.

X-ray analysis

Anterior – Posterior (AP) X-ray ankle view is essential for proper diagnosing the master joint of the ankle (Tibia-Talus) as the origin of the inversion sprain begun with a dysfunctional of this joint. The Fibula is also assessed in this view.

Lateral Xray view is important to check the further misalignment of the talus and the possible involvement of navicular and calcaneus.

MRI

Ankle/foot MRI is essential for visualizing the extent of injury on the muscle/tendon and ligamentous layers.

Locate the exact injury point; Allows the treatment to be more specific during the application of the treatment modalities.

Identify the extent of tissue damage and the presence of scar tissue; Provides valuable information regarding prognosis and the application of friction soft tissue modalities to aid on scar tissue removal.

Rule out stress fractures not visible by the x-ray.

Treatment protocol

The treatment care should aim to restore the foot/ankle alignment and the soft tissue muscles/tendon and ligamentous layers.

Specific adjustments of key bones of the ankle and foot (Talus, Fibula, Navicular, Calcaneus and Cuboid) followed by a rehabilitation regime to strengthen the entire soft tissue support of the ankle.

Application of Low-level Laser and PEMF directly over the injured tissues to aid on the cellular level of healing as well as improving the microcirculation for the area.

Friction soft tissue therapy helps to reduce dysfunctional scar tissue

Specific stretches and strengthening to improve the resilient of the soft tissue support

Functional tape might be used to reposition the talus and fibula

Specific selected essential oil application to enhance healing

Depending on the level injury and chronicity, a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this condition.