Overview and Pathoanatomical Features
The most common mechanisms of injury for a lateral ankle sprain is forefoot adduction and hindfoot inversion, and tibial external rotation with the ankle in plantar flexion.
Anterior talofibular ligament has been found to be the weakest and the most commonly injured ligament, followed by calcaneofibular ligament and posterior talofibular ligament. Approximately 70% of all lateral sprains involve isolated anterior talofibular ligament injuries.
The Ottawa ankle rules are used to rule out fracture, and radiographs are indicated if there is pain within the malleolar zone accompanied by either tenderness over the medial malleolus or the tip of the posterior edge of the lateral malleolus or inability of the patient to bear weight for a minimum of four steps.
Differential diagnoses should include fracture, high-ankle sprain, cuboid syndrome, medial ankle sprain, and osteochondral lesion.
Assessment of Lateral Ankle Sprain
- Grade I: no loss of function, no ligament laxity, little or no hemorrhaging, no point tenderness, decreased total ankle range of motion of less than 5 degrees, and swelling of less than 0.5 cm.
- Grade II: some loss of function, positive anterior drawer test and talar tilt tests, hemorrhaging, point tenderness, decreased total ankle motion greater than 5 degrees but less than 10 degrees, and swelling between 0.5 to 2 cm.
- Grade III: near total loss of function, positive anterior drawer and talar tilt tests, hemorrhaging, extreme point tenderness, decreased total ankle motion of greater than 10 degrees, and swelling greater than 2 cm.
- For most Grade I, II, and III lateral ankle sprains, nonsurgical management has been proven effective.
- Long-term immobilization should be avoided, while short-term immobilization is beneficial regardless of severity.
- The incorporation of early manual therapy such as soft tissue massage and joint mobilizations can be used to decrease stiffness and swelling while increasing range of motion.
- Early weight bearing with support improves the overall resolution of symptoms associated with a lateral ankle sprain.
- The use of lace-up braces produces a greater reduction in short-term swelling and disability compared with semi-rigid bracing.
- Cryotherapy is indicated for use in the acute phases of healing to decrease pain and manage swelling.
- NSAIDs for pain management.
- UB 60, 62, GB 40 for lateral ankle sprain.
- KD 3, SP 5, ST41 for medial ankle sprain
- Repetitive wet cupping is effective for both acute and chronic ankle sprain.
- The optimal first cupping treatment for an ankle sprain is usually 2 to 3 days after the injury.
- Second treatment is recommended in one week for Grade II and III.