Ankle soft tissue injury

Introduction

The purpose of this information is to give you a general guide to restore the normal function at your ankle following your ankle sprain. The information will also advise you on some advice to reduce pain and swelling.

Restoring normal ankle movements and walking as soon as possible are crucial to avoid post-injury stiffness and weakness. The more you move and use your foot and ankle, the quicker it will recover. 

What is an ankle sprain?

Soft tissue ankle injuries (ankle sprains) are common injuries, especially in active people. It is normal to have pain, swelling and stiffness afterwards.

The ankle has ligaments on the outside, which normally function to stop the ankle rolling over and causing injury to the tendons, muscle or bones. An ankle sprain is when these ligaments become overstretched and tear. The severity of the damage could range from minimal (a few fibres damaged) to extensive (majority of the ligaments torn). The severity of the torn ligament/s will determine the amount of time to make a full recovery.

What are the symptoms?

These vary from person to person. People may experience:

• Swelling
• Pain
• Loss of movement and strength around the ankle and foot
• Reduced ability to bear weight through the ankle.

What are the causes?

The injury is usually caused when rolling over the outside part of the ankle when running or walking on uneven ground. It could, however, result from a direct blow during sporting activity or during a fall.

In the first 24 hours – follow the steps below. 

Protection

During the first 24 hours the foot or ankle should be protected from undue activity. This may cause further injury or delay healing. This means stopping activities which increase your symptoms. 

If you have been given a supportive boot (Moon Boot) or crutches, this is for support and reassurance only.

It would help if you aim to stop using the supportive boot within one week. It should NOT be kept on for longer than two weeks.

You do NOT need to be seen by a healthcare professional first to remove the supportive boot. This can be done in short spells with the boot taken off and doing the above exercises. Moving your ankle the first few times without the boot can be uncomfortable, but “little and often” is helpful. This is particularly true for children and younger people, who can be anxious and may need extra support and encouragement. If you feel you can manage without the boot then it can stop using it.

Rest

Reduce any activity that makes your pain much worse. This may mean you need to use elbow crutches to help you walk. If you have been given crutches, gradually try and decrease their use over the next few days. Any unaffected parts of your leg may still be exercised.

Ice

Applying ice or cold water to the injured area can help reduce swelling and bruising. Ice should only be applied if you have full sensation around the area. Application of ice can be repeated regularly - every 2 hours in the first 24 hours. It must be done carefully, as it is possible to get an ice burn.

Technique for the application of ice treatment at home

1. Use either a bag of frozen peas or a plastic bag with ice cubes.

2. Cover the area to be treated with a damp tea towel or damp cloth.

3. Place the ice pack over the area and hold in position with a towel or bandage.

4. Leave for 10 to 15 minutes on bony areas. 20 to 25 minutes over more fleshy or muscular areas.

5. Check the skin every 5 minutes and if it becomes white, blue or blotchy or painful, numb or tingles, remove the ice pack.

Elevation

Wherever possible support the injured leg in a raised position a little height above the level of your heart is best for your foot. This will help the blood flow and reduce the swelling in the injured area.

After 48 hours - if the pain is easing, follow the steps below. 

Movement 

It is normal to experience some discomfort when you begin moving your ankle, but you should attempt the exercise below regularly and start to walk as normally as possible within your pain limits. You may still require crutches or a walking stick.

Lie on your back with your legs straight. Briskly bend and straighten your ankles regularly through the day within the limits of pain.

Wiggle your toes on both feet and bend and straighten both ankles regularly.