Acute Lateral Ankle Injuries
Football players frequently get acute lateral ankle injuries, which are commonly brought on by inversion trauma. After groin and hamstring injuries, it is the most frequent injury in football with an incidence of roughly 6.3%. Rehabilitation and treatment seem straightforward. Despite this, we frequently detect players in practice with unneeded residual issues, such as limited mobility in the higher ankle joint or weaker calf muscles. Is this injury being oversimplified, one could ask? Because of this, we will focus especially on the diagnosis and treatment of acute lateral ankle injuries in this blog.
The correct diagnosis is the foundation of being able to treat a football player successfully. Consequently, a consensus statement has been created for acute lateral ankle injuries. The mechanism of injury, prior acute lateral ankle injuries, capacity to support, evaluation of the ligaments, and evaluation of the bones are the five main criteria, as indicated below in figure 1.
Figure 1. Main criteria diagnostics. Taken from: Delahunt et al., 2018
The mechanism explaining the injury’s primary cause reveals details about the potential target structures. For instance, a fast inversion and/or endorotation under load frequently impact the lateral ligaments. A syndesmosis injury should be taken into consideration if there is trauma accompanied by exortation of the foot, eversion of the talus, and (hyper)dorsal flexion.
The likelihood of suffering another acute lateral ankle injury rises if you have already sustained one. Additionally, it is more likely that persistent restrictions, such as diminished proprioception, will still exist, raising the possibility of an acute lateral ankle injury.
Acute lateral ankle injury treatment
Rushing into treatment is rarely a wise choice for acute lateral ankle injuries. It’s critical to consider the stages of connective tissue repair and modify the course of treatment as appropriate. Guidelines from the KNGF, the Royal Dutch Society for Physiotherapy, can be very helpful in this. The major points during the inflammatory stage (0–3 days) are a decrease in pain and swelling, an improvement in circulation, and partial loading. It is possible to use the well-known RICE principles (rest, ice, compression, and elevation). Restoring function and increasing the demands imposed on the joint are of utmost importance during the proliferation stage (4–10 days). Here, movement, active stability, and coordination come to mind. A symmetrical gait should be attainable at this point. It’s crucial to prevent any surge in inflammatory reactions at this point. The primary areas to concentrate on during the early remodelling stage (11–21 days) include increasing muscle strength, active functional stability, mobility, walking, using stairs, and running. To avoid any persistent restrictions, adequate training is necessary at this point (as mentioned before). The promotion of regional load bearing capability as part of a framework for dealing with daily life and sport is the key focus in the late modelling stage (3-6 weeks).
The well-known, passing the ball back and forth while brushing your teeth, standing on one leg and stabilising yourself on a trampoline is insufficient for football players. Both the player and the coach frequently lose patience during this phase. After all, the ankle feels much better once again, so you can resume playing football. At this point, the PAASS framework offers a solid foundation for making a reasonable decision regarding Return to Play.
Pain Severity
Ankle Impairments
Ankle Perception
Sensorimotor Control
Sport/functional performance
Experts have outlined a variety of factors that should and should not be considered while making the RTP choice which can be seen in Figure 2 below.
| DO assess | DO NOT assess |
| Sport-specific activities | Structural integrity with additional diagnostics |
| Severity of pain during exercise | Severity of pain in the past week |
| Results of ankle movement | Pain on palpation |
| Strength of the ankle musculature | Health-related quality of life |
| Hopping | Muscle length of the ankle musculature |
| Agility | Functional Movement Screen |
| Having completed the full training program | Aerobic fitness |
| Jumping | Anaerobic fitness |
| Severity of pain in the last 24 hours | Ligament laxity |
| Own confidence in the ankle | Arthrokinematics of ankle joint |
| Proprioception | Muscle reaction time of musculature |
| Self-assessed ankle stability | Acute chronic workload |
| Psychological readiness | Kinematics of lower extremities |
| Muscle stamina of the ankle | Biomechanics of the foot |
| Dynamic balance | Linear running speed |
| Strength of ankle and lower leg musculature | Strength and muscle stamina of hip and knee musculature |
Figure 2 – Criteria to be assessed and not to be assessed in relation to RTP. Taken from: https://soccerdoc.nl/blog-28/
Ankle support can be achieved by strapping the ankle with sports tape, zinc oxide tape, or by using a good quality ankle brace.
Zinc oxide tapes is a category of tapes that are rigid (non-stretch), normally made from either cotton or the more expensive and stronger version is rayon which the zinc oxide adhesive is then sprayed on. They are therefore ideal for supporting a ligament or muscle while immobilising it and limiting its range of motion. Because zinc oxide tapes lack elastic properties, they do not stretch. This rigidity can be used to limit and stop painful motions and movements that might aggravate an injury.
Ankle braces are designed to offer compression in the treatment of a swollen or sprained ankle, and joint stability in muscle and ligament damage, and more severe ankle injuries in sport. Supports are used to stabilise weak ankle joints after sprains and strains, or to prevent injury in preference to the use of zinc oxide tape favoured in professional sport.
Some research shows that bracing using a high-quality ankle brace may provide a greater level of support over a period of time compared to taping as the tape can gradually lose its adhesiveness due to sweat during exercise.
Popular braces for acute lateral ankle injuries are the Push Ortho Aequi and Push Med Aequi Flex.
With its increased flexibility and thorough compression of the afflicted area, the Push Ortho Aequi stands out from the competition. The brace's expanded flexible shell that surrounds the ankle ensures consistent compression. When treating acute ankle injuries, the Aequi Flex is particularly successful. The malleolus is accommodated by a recess in the rigid support, which is only on the medial side of the ankle.
The functional strap can be put in place quickly after determining the degree of swelling during the (sub)acute phase. Two elastic straps that can be separately adjusted might add more compression to the joint. As a result, plantar/dorsiflexion can move with a sufficient amount of mobility while inversion and eversion are appropriately constrained.
One diagonal strap is used to secure the brace. Ankles are compressed by elastic straps. Ankle inversion and eversion movements are constrained, although sufficient mobility is provided for plantar and dorsal flexion. This indicates that ordinary walking and running are not inhibited.
The big difference between the Push Ortho Aequi and Push Med Aequi Flex is that the Aequi Flex provides a higher degree of compression for use in immediate trauma situations which can then bring down swelling and improve healing times.
An excellent ankle brace for sporting situations is the Push Sports Kicx which is made from fabric that allows moisture to move away from the skin and is specifically designed to provide a high level of support while easily fitting inside a football/rugby boot. It is also machine washable meaning it can be used game after game.
References
Delahunt, E., Bleakley, C. M., Bossard, D. S., Caulfield, B. M., Docherty, C. L., Doherty, C., Fourchet, F., Fong, D. T., Hertel, J., Hiller, C. E., Kaminski, T. W., McKeon, P. O., Refshauge, K. M., Remus, A., Verhagen, E., Vicenzino, B. T., Wikstrom, E. A., & Gribble, P. A. (2018). Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. British Journal of Sports Medicine, 52(20), 1304–1310.
SoccerDoc. (n.d.). Blog #28. https://soccerdoc.nl/blog-28/