The human body has many different types of connective tissue that keep it together and functioning properly. Tendons attach muscle to bone and ligaments are the pieces of connective tissue that connect bones to other bones. The foot and ankle in particular have many ligaments that keep it mobile and stable. There are 4 primary movements that occur at the ankle joint, each of which are partially governed by the surrounding ligaments. These primary movements include dorsiflexion (moving your foot up towards the shin), plantar flexion (pointing foot down/going up on toes), eversion (twisting the foot away from the other foot), and inversion (turning the toes in towards the other foot). The ligaments function to prevent excessive movement in each direction that the foot moves, however, many people will experience an event where the ankle is moved in a way that causes a stretch to the ligaments beyond their normal range. This injury is called a sprain.
Ankle sprains are one of the most common injuries in the United States. Inversion (or lateral) ankle sprains are the most common type of sprain, where the ankle rolls outward and the foot turns inward. There are three ligaments that are designed to protect the ankle from excessive inversion. These are the anterior talofibular, posterior talofibular, and the calcaneofibular ligaments. Medial ankle sprains are also possible, though they are much less common. In this case the ankle rolls inward and the foot turns outward. A very strong ligament known as the deltoid ligament will be injured with this sprain. Finally, a high impact injury called a high ankle sprain may also occur. In this instance, the connective tissue that keeps the tibia and fibula together will be sprained by the impact of one of the bones in the ankle (the talus).
Physical therapy is a very important aspect to recovering from an ankle sprain. There are three grades of ankle sprains, ranging in severity from mild Grade I, moderate Grade II, and severe Grade III. Physical therapy can help with all grades of sprains. During the initial visit to physical therapy, a physical therapist will perform a foot and ankle examination to determine which ligaments have been injured. A gait examination, strength examination, and balance examination will also be important aspects to diagnosis.
Once the injury has been diagnosed, a plan of care will be determined. Typical physical therapy sessions will include range of motion, exercise, manual therapy, and neuromuscular reeducation. Rest, ice, compression, and elevation are important with all grades and types of ankle sprains. A protective brace may also add stability to the ankle and may help people return to regular activities on their feet.