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Ankle Sprains & Ankle Fractures

At our clinic we see a number of patients with ankle injuries every month. Frequently, ankle injuries have been miss-managed or left untreated.  Ankle injuries, both acute or chronic injuries, respond exceptionally well to our therapeutic approach.   With our Ankle Repair Program, we can reduce the recovery period for a sprained or broken ankle by as much as 70%.

Sprained Ankle Facts:

The most common ankle injury is an ankle sprain.  About 15% of all athletic injuries are sprained ankles.  It is estimated that there are 2,500 ankle sprains a day in Canada.   

Sprained ankles may occur as a result of walking on uneven surfaces, high heels or from playing sports.  Ankle sprains are a common injury in basketball, volleyball, soccer, modern dance, ballet, hiking or running.

The most prevalent cause of ankle sprains occurs when the foot rolls inwards (inversion). As the foot rolls in, the ligaments (fibrous bands connecting bones) stretch and tear. The lateral ankle ligament complex is the structure most commonly involved in ankle sprains, is damaged.

The most common ankle injury involves an isolated tear of the anterior talofibular ligament (ATFL).  The second most common ankle injury is a combined tear of the ATFL and the calcaneofibular ligament (CFL). 

Most patients fully recover but up to 40% of patients develop chronic symptoms of pain and instability.  It is important to see a physiotherapist after an ankle sprain in order to avoid developing a chronic problem and being susceptible to re-injury. 

In all cases of ankle injuries, an ankle fracture must be suspected.  Your doctor or physiotherapist will likely use the Ottawa Ankle Rules (OAR) to decide if an x-ray is required. Less than 15% of the patients who go to emergency with an ankle injury have a fracture.  The Ottawa Ankle Rules are used to eliminate unnecessary x-rays. 

In a recent meta-analysis regarding the effectiveness of OAR, it was found that when conducted by a physician or physiotherapist, OAR is nearly 100% effective at determining if there is a fracture.  As a result, properly interpreted OAR tests can eliminate 30% to 40% of unnecessary x-rays. 

Classification of Ankle Sprains:                                           

 Grade 1 – Mild Sprain

  • No bruising, slight swelling
  • Localized tenderness – usually on the outside of the ankle
  • No or mild limp for up to 2 days, can raise up on toes slowly
  • No joint laxity, no negative signs during stability tests and pain only at extreme range of motion.                             

Grade 2 – Moderate Sprain

  • Bruising on one side of the foot
  • More extensive swelling, the Achilles tendon contours are visible but blurred
  • Less localized tenderness, with tenderness on both sides of the ankle
  • Visible limp for 2 to 14 days, unable to raise up on toes, hop or run.
  • Slight laxity when stressed, pain with most movements, especially inversion (rolling inwards) and plantar flexion.

Grade 3 – Severe Sprain

  • Diffuse bruising and swelling on both sides of foot, the contours of the Achilles tendon are not longer visible.
  • General tenderness on both sides of the foot
  • Unable to weight bear and almost a complete loss of movement
  • Positive laxity and stability tests

The LightSpeed Physiotherapy Ankle Repair Program

Our Ankle Repair Program is an evidenced based program.  In our research and clinical observations, we have concluded that ankle injuries recover 50% to 70% faster with our four step program.  In addition, we have found that patients who complete our program heal better, have a stronger joint and achieve joint stability in a short period of time. Patients quickly resume their normal activities and are at a reduced risk of re-injury.

If you have a fracture or a severe sprain that requires a cast, try to get a removable cast or air cast so we may start your treatments immediately.  The sooner we start the treatment the faster you will recover, the bone will mend better and there will be less ligament scar tissue build up.

Our program consists of the following four steps:

Step 1 – Laser therapy to decrease pain, inflammation and bruising. 

              There are three important parameters that must be followed in order to achieve rapid healing when using laser therapy: 1) Dosimetry – approx. 200 joules per treatment applied over a 30 minute period. 2) Wavelength of the light being used – both red and infrared light must be used.  Each wavelength has a different biological affect and depth of penetration. 3) Frequency (Hz) settings.

Step 2 – Range of motion exercises.

               We will introduce pain free range of motion exercises as soon as possible.  Depending on the grade of ankle sprain, range of motion exercises may be introduced on the first day of treatment.  Patients also receive written instructions.  Ankle fracture patients will have range of motion exercises until later the program.

Step 3 – Strengthening exercises.

               As pain decreases, we begin an active exercise program.  Our goal is to increase your weight bearing capabilities while strengthening your ankle and continuing to increase your range of motion.

Step 4 – Proprioception activities.

               Proprioception is the accuracy of joint position sense or the threshold for detecting joint movement.  

              When ligament fibres are torn, deafferentation (a loss of sensory input caused by an interruption of the peripheral sensory fibres) of the joint mechano-receptors adversely alters the spinal reflex pathways to the motor nerves and muscle spindles, as well as to the cortical pathways for conscious and unconscious appreciation of proprioception. The feedback and feed-forward neuromuscular control systems need these pathways in order to dynamically stabilize joints. The feed-forward motor control system is responsible for the preparatory muscle activity that is vital in maintaining stability and preventing the development of pain in the lumbar spine, patellofemoral joint and shoulder.

               With an ankle injury, joint position sense and joint stability is reduced.  Therefore, proprioception activities play an important role in re-educating the ankle tendons and ligaments in developing a solid ankle joint and for minimizing the chance of re-injury.  It is usually a lack of proprioception that leads people to believe that they have ‘weak ankles’. 

How long will it take me to recover from my sprained ankle?

Without combined low intensity laser therapy (laser therapy) and active therapy treatment program, you can expect the following recovery times:

Grade 1 – Mild Sprain:  1 to 2 weeks

Grade 2 – Moderate Sprain:  1 to 2 months

Grade 3 – Severe Sprain:  2 to 6 months

With LightSpeed’s combined laser therapy and active therapy program, these recovery times may be reduced by 50% to 70%. 

See what people have to say about our Ankle Repair Program!  Read their testimonials


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Contact Information                                                               Clinic Hours

Telephone: 905-823-2226                                                                         Monday, Wednesday & Friday 9 am to 6 pm
FAX:           905-823-2933                                                                         Tuesday & Thursday 11 am to 7 pm
                                                                                                              Saturday 9 am to 12 pm
Location:  Sheridan Centre, 2225 Erin Mills Parkway, Mississauga, ON L5K 1T9
         One block north of the QEW on Erin Mills Parkway
         We are located in the lower level of the mall, by the library
 
E-mail info@lightspeedphysio.com
Copyright © 2008 LightSpeed Physiotherapy Inc.
Last modified: 06/16/08