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The ligaments around the ankle tear in a predictable sequence with inversion type injuries. The first ligament to experience the stress of such an injury is the Anterior Talo-Fibular Ligament ATFL , and is involved in nearly every inversion-type injury.
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This ligament is on the Anterior front Lateral outside part of the ankle. The next affected ligament is typically the Calcaneo-Fibular Ligament CFL , which is on the direct outside lateral aspect of the ankle, originating at the underside of the end of the fibula. These three ligaments make up the vast majority of the stabilizing tissue of the Lateral ankle. With higher-energy injuries, the stress of the injury may progress to the point that the Medial inside ligament complex is damaged.
This large broad ligament is called the Deltoid ligament, and it spans the entire inside of the ankle, attaching to the end of lower portion of the tibia. Finally, the last stabilizing structure of the ankle is called the Syndesmosis. This ligament actually connects the two bones of the lower leg Tibia and Fibula.
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When this ligament is injured, the discomfort is typically felt at the front of the lower leg, and may be detected by squeezing the two bones together at the mid- to lower-leg area. The presence of an injury to the syndesmosis indicates a higher level of injury which must be respected.
If this injury allows the bones of the lower leg to separate, the end result can be a long-term disaster with early osteoarthritis of the ankle joint, which is a very difficult problem to manage in an active person. Finally, the ligamentous structures of the ankle are not the only ones at risk. Some ankle injuries involve the articular cartilage structures of the joint itself.
Small or large fragments of cartilage may be sheared from the surface of the bone, and the bone itself may be damaged. These conditions are also typically due to higher-energy injuries, and must be detected early in the treatment period.
Although many ankle sprains are minor, and are treatable with Rest, Ice, Compression, and Elevation RICE , some require more advanced diagnostic accuracy and management. If an athlete has difficulty bearing weight on an ankle that has been injured, further evaluation of the injury is certainly warranted. If the athlete has discomfort with lateral movements side to side but can bear weight, it is likely that the RICE approach with possible stabilizing brace may be enough to return the athlete to normal function.
The addition of supervised Physical Therapy PT will often decrease the time to return to performance, and is generally part of our regimen for treatment of ankle sprains. When indicated, we prefer a lace-up type brace for the affected ankle, and we ask the athlete to use the brace for all weight-bearing activity for 6 weeks after the injury.
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This period corresponds to the amount of time the body takes to return the injured tissue to normal strength. Following the initial 6 weeks of brace use, the athlete is directed to use the brace for another 6 weeks for any exercise including all cheer activities. It is during these first 12 weeks after injury that the risk of re-injury is greatest.