Acute Ankle Sprain

Excerpt

Acute ankle sprains are among the most common musculoskeletal injuries, particularly in physically active individuals. These injuries occur when excessive inversion or eversion forces exceed the tensile strength of the supporting ligamentous structures, resulting in stretching, partial tearing, or complete ligament rupture. Most ankle sprains involve the lateral ligament complex, especially the anterior talofibular ligament, the weakest and most commonly injured structure. More severe injuries may also involve the calcaneofibular ligament and, rarely, the posterior talofibular ligament. Medial sprains, involving the deltoid ligament, and syndesmotic (high ankle) sprains, involving the distal tibiofibular ligaments, are less frequent but are often associated with greater morbidity. Acute sprains trigger an inflammatory response, leading to pain, swelling, and joint instability.

Intrinsic risk factors include poor proprioception, a history of previous ankle sprains, ligamentous laxity, and lower extremity malalignment. Extrinsic factors involve inadequate warm-up, improper footwear, participation in high-risk sports, and environmental hazards such as uneven surfaces. Athletes engaged in activities requiring rapid directional changes or jumping—such as basketball, soccer, and volleyball—are particularly susceptible. Evidence-based treatment follows the POLICE principle (protection, optimal loading, ice, compression, elevation). Early functional rehabilitation is preferred over prolonged immobilization, as it promotes ligamentous healing and restores joint stability.

In moderate to severe cases, short-term bracing or taping may provide additional support. Progressive weight-bearing and neuromuscular training, including balance exercises, are essential in preventing recurrent sprains. Although nonsteroidal anti-inflammatory drugs are used for pain relief, caution is advised against long-term use. Surgical intervention is reserved for cases of chronic instability or failed conservative treatment. Preventative measures, including proprioceptive training and strength conditioning, significantly reduce the risk of recurrence.