One of the most injuries in sports participation, and especially in football, is the inversion ankle sprain. Depending upon the intensity of the movement, ligaments and blood vessels are often torn. The resulting sprain will swell profusely and require immediate first aid and medical care.

The anterior talofibular is the ligament that is most injured, and eighty to ninety percent of ankle sprains involve the lateral ligaments.

Sprains are classified as mild, moderate, or severe depending on the severity of the tissue damage. This system is not really reliable because it is really difficult to asses the degree of the injured ligament (see below usual injury.)

When the ankle is forced into inversion/external rotation, the tissues on the medial side of the foot are damaged. Injury to the medial ligaments although a lot less common, is usually longer in recovery and has late symptoms more often than the lateral sprain.

Control of swelling of the ankle immediately after the sprain is of utmost importance to a speedy recovery (see immediate care for right care procedure.) If an athlete continues to play after the ankle has been sprained, the severity of the swelling and intensity of the injury are often increased ( see RICE treatment.)

Follow up care for the sprained ankle should include an examination by a physician if pain and debility are severe.

Rehabilitation with modalities and prescribed exercises are extremely important to rapid recovery of the injury. Also, caution, as related to the intensity of participation until sufficient healing has taken place is very important.

Gentle activities and passive motion should begin as soon as safely possible; astute observation of the amount of pain with motion will help determine the proper intensity of the exercises. Maintain flexibility and increase the muscular tissue lost by the injury immobilization is a must for a good recovery (see rehabilitation procedure.)

In addition, properly applied adhesive tape may help to protect the joint from re-injury.

Basic structure:

LIGAMENTS: Anterior talofibular, Posterior talofibular, Calcaneousfibular, and Talocalcaneofibular.

BONES: Calcaneous, Tibia, and Fibula.

MUSCLES: Tibialis anterior, Tibialis posterior, and Soleus.

Usual injury

The usual injury in ankle sprain is "inversion ankle sprain", there are three degrees for this injury. Three grades:

Grade 1- Mild- 20% tear Grade 2- Moderate- 20 to 75% tear Grade 3- Severe- Complete rupture of ligament * It is really difficult to determine the percentage of tear, and only a qualify person can determine the grade of injury.

Immediate care

The immediate care is RICE - Rest, Ice, Compression and Elevation. Compression must be apply immediately. Also ice must be apply immediately for 30 min. maximum, and after that 20 to 30 minutes every two hours for 24 hours. X ray is next, it is really difficult to determine ligaments rupture with X ray. Good pressure with taping, heel lock, compression should be applied immediately and left for first night. It should be loosen slightly if too tight.

Rehabilitation:

What really helps in rehabilitation is supportive taping (pull slightly in eversion), close or open basketweave, and heel lock. Passive resistance exercise - Passive plantar flexion and extension for strengthening. Get surgical tube and wrap around foot and pull in in inversion. Progressively, manually rotate ankle with resistance. Active resistance - Progressively improve, for example, start walking move up to jogging and then running. Figures of 8's or smear pop board are good exercise for ankle sprain also calf raise machine.

*** In the Heel lock Wrap there is an important point to remember, the direction of the wrap should be going outside of the foot and not inside, this it will helps on giving the right tension to the outside ankle where pressure is more needed.

A good way to remember how to perform the Heel lock Wrap is to remember this words; go back, down and across the anckle.

The Heel-lock Wrap

The heel-lock is prevantly used to immobilize an ankle after an injury. Also, in a case of open basket wrap (normally pre-game taping technique), it is use to prevent an ankle injury.

How to perform the Open Basket technique Wrap

E-mail: Giorgio Volpi