An injury to one or more ligaments in the ankle when the foot rolls, turns or twists in an awkward direction, resulting in stretching or tearing of the ligaments.
Ligament injury most commonly occurs in sports requiring change of direction, landing and uneven surfaces.
Ligament injury can also result from a contact injury, in which an object forces the foot into an end range position
Damage most commonly occurs to the lateral ligaments (outside of the ankle), when the ankle rolls out
The most common risk factor for an ankle sprain is previous history of ankle sprain
Signs & Symptoms
Pain in the lateral or medial side of the ankle
Bruising and swelling of the ankle and foot
Tenderness to touch
Feelings of instability
Difficulty weightbearing through affected leg
Ankle Syndesmosis Injury
PROmotion Assessment and Outcomes Measures
Subjective examination addressing mechanism of injury, aggravating positions and 24hr pain
Assessment of ability to weight bear, ankle range of motion, ligament tests and palpation of the bones and ligaments to rule out need for XR or further imaging
Assessment of balance, lower limb strength and control
Assessment of sporting footwear
How to Manage
Referral for XR if fracture is suspected.
Period of relative rest from sport +/- immobilisation in a moon boot/crutches/taping dependent on extent of injury
If applicable manual therapy to improve ankle range of motion, reduce pain and increase function
Graduated home exercise program consisting of range of motion, strengthening and balance exercises for the ankle and lower limb.
Advice regarding return to activity and load management as injury progresses.
Management may also include referral to a sports doctor for review if any further medical intervention such as imaging, differential diagnosis and assistance with management plan.
Doherty C., Delahunt E., Caulfield B., Hertel J., Ryan J., Bleakley C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Medicine; 44: 123-140.
McGovern R.P., Martin R.L. (2016). Managing ankle ligament sprains and tears: current opinion. Open Access Journal of Sports Medicine; 7: 33-42.