A seemingly minor injury: an ankle sprain. Convincing people of the severity of an injury is seldom a good strategy in healthcare, but ankle sprains resulting in chronic ankle instability is very frequent, very easy to rehab properly and can result in on-going issues, including osteoarthritis. It’s important to regard ankle sprains as important because it could result in surgical treatment if untreated. There is good reason for this blog – around 55% of people who suffer from ankle sprains do not consult a medical professional which probably explains the high percentage of patients who experience chronic ankle instability.

Ankle sprains are the second biggest reason for A&E visits, the NHS predicts they see 302,000 new ankle sprains and 42,000 severe new ankle sprains a year. About 80% of all ankles sprain more than once, and 20% of ankle sprains turn chronic. You can determine if you have chronic ankle instability if you sprain the ankle a lot, feel unstable, have a lot of pain around the ligament area and the ankle clicks a lot.

So what happens? The incident can damage the ligaments shown on the image next to the text, 66% of ankle sprains only damage the anterior talofibular ligament, the rest have significant enough trauma to damage the calcaneofibular ligament as well. Sprains are graded:

  • Grade 1: Good stability without laxity but tender
  • Grade 2: Partial tear, laxity at the end of movement
  • Grade 3: Rupture, gross laxity and instability

The typical reason for ankle sprains is stepping off uneven surfaces, bad challenges in sport, awkward landing from a joint, or if you’re unlucky and you have chronic ankle instability it can occur at any time when walking!

When do I require an X-Ray?

There is nothing more frustrating when you damage your ankle and go to A&E only to find out you have a 4 hour waiting list and at the end of it all you’ve only sprained the ligaments. It is of course important not to be put off from seeking medical assessment so here is a section dedicated to helping you out.

X-rays are a good way of finding fractures, but they are at the bottom of the concern list, despite the discomfort it causes. This does mean there will be a big waiting time in A&E. If a fracture is found, then the tests shown in the attached video would be positive alongside the facts given at the case history. If there is no sign of a fracture then rehab can start straight away, and at the Movement and Wellbeing Clinic we can offer a more holistic support mechanism than NHS physiotherapy.

  • Inability to weight bear
  • High impact injury, such as a motorbike accident or after a heavy sporting challenge
  • Bony tenderness
  • A lot of swelling/bruising

It will be important to know that patients need to present with an accumulation of these factors, rather than just one. As a final note, like with most things, get your Osteopath’s or anther allied healthcare practitioner’s opinion rather than judge for yourself.

A twist in the tale

So, we’ve found out the stats behind ankle instability and the subsequent anatomy behind it, however new research has come to light that suggests the ligament may not be the source of the problem, despite the area of tenderness. Like all good stories the narrative guides you to one belief then does a complete U-turn – and medicine is a similar story. Studies have shown the distal fibula head (the outside lower leg bone that is involved with ankle injuries) has a positional fault due to the impact, and studies show this fault when they X-Ray damaged ankles.

Another fact that supports this is that the swelling in an ankle sprain is inside the joint, whereas the ligament is on the outside. Logically, damage to the ligament would result in swelling on the outside of the joint. There will be damage to the ligaments, but some experts in the field believe a more serious injury occurs as the fibula head is wrenched forwards, causing damage at the joint between the fibula and tibia, just above the ankle.

The biggest assurance I can give as an osteopath is that we make sure the latest evidence is used in your care. This is why, as a reflective practitioner, I offer you the explanation (and contradictions in the studies) but find the most suitable way of treating your individual injury.

Finally, how is this resolved?

Expert assessment is vital initially – as previously mentioned there is a risk of a fracture with any ankle sprain. Once this has been cleared, ankle sprains require appropriate self-care (namely PRICE), as well as osteopathic adjustment and an exercise program to ensure full recovery.

So, if you want to avoid ankle sprain re-occurrence, possible osteoarthritis and optimise your performance don’t hesitate to get in touch.

For any further questions, please don’t hesitate to ask:

0161 209 2980


Ed Madeley M.Ost