By: Michael Daigle, Canadian Certified Pedorthist

It has been my experience as a clinical pedorthist that most people who are active in a running or racquet sport will twist their ankle; this is called an ankle inversion sprain. It is a rolling out of the ankle while the foot twists inward. How many ligaments are strained depends on the grade of the sprain with 3 classifications to the degree of damage.

There is much confusion surrounding proper care and treatment of this injury; in fact it is a polemic area of medical treatment. In the acute stage, rest, ice, compression, elevation or the acronym RICE is the way to go. Put your leg up, wrap the injured ankle tightly and ice it to keep the swelling down. What most patients don’t do is continue to compress the joint for months after the trauma, and this is so important.

Let me explain what happens to the ankle when this event occurs; but first we need a brief anatomy lesson. The lateral ankle or malleolus is the distal end of the fibula bone; the smaller bone in the outside lower leg-from the knee. It is not a weight bearing bone but exists to house muscle and balance the tibia, which is the larger bone, known as the shin bone. Holding these bones to your foot are two sets of ligaments, one on the inside, medial or tibial, known together as the deltoid ligament, and on the outside, the lateral collateral ligaments. This group consists of the anterior and posterior talofibular ligaments and the calcaneofibular ligaments. All three join the fibula to the talus in the front, the talus in the back and the heel bone (calcaneus); hence the word fibular in their names.

When an ankle twist occurs the anterior (talofibular) ligament is the first to suffer and our foot is usually in a plantarflexed and inverted position, which is the least stable ankle position. Imagine the uninjured ligament as your hands tightly laced together. When we suffer a sprain your hands open up, spread apart and return only part way. Unless we compress the joint by wrapping it with a strap, the ligament will not shorten again and there is an 80% chance of twisting it again. Within the ligaments are nerve endings called proprioceptors which respond to position and movement. They automatically tell your brain where your foot is in space. When these nerve endings are damaged, the information isn’t immediate like electricity, so by the time your brain realizes what is about to happen, it’s too late; the foot is already twisting.

Anyone playing soccer or volleyball, who has twisted their ankle, is advised to wear an ASO brace for support. This has opposing straps that wrap your ankles firmly to prevent injury while playing. A strap that compresses the ankle joint should be worn while doing any activity like walking for months after the event.

See your physiotherapist for treatment. See your pedorthist for advice on orthotics and shoes. Lace up!