The ankle joint holds a significant value in terms of locomotion and movement during routine and athletic activities. The joint is stabilized by various structures, which, if severed, give rise to an ankle sprain. Ankle sprains are classified into three grades depending on the severity of ligament damage and the presenting signs and symptoms. The grade of the ankle sprain determines the prognosis and treatment suitable for ankle sprain pain.  

Anatomy of Ankle Joint 

The ankle joint is the point of articulation of three bones – talus, tibia, and fibula. It is a hinged synovial joint and allows movements including plantarflexion, dorsiflexion, inversion, and eversion. Various muscles of the leg such as gastrocnemius, soleus, and peroneus muscles are responsible for these movements at the ankle joint. The joint is stabilized by ligaments present at both the lateral and medial sides of the joint. The deltoid ligament is present on the medial aspect of the ankle joint whereas three ligaments are responsible for stabilization at the lateral side. These are anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL). Out of these ligaments, AFTL is the weakest and more prone to injury. [1]

What is Ankle Sprain? 

An ankle sprain is referred to as over-stretching and tearing of ligaments associated with the ankle joint. This is one of the most prevalent injuries in sports. An ankle sprain usually occurs when excess inversion of the ankle occurs, affecting the lateral ligaments of the ankle joint. ATFL is involved in approximately 70% of the inversion ankle sprains. On the contrary, the deltoid ligament on the medial aspect of the ankle joint is the strongest and usually damaged in conjunction with other ligaments during eversion of the ankle. High-grade ankle sprains are relatively more common in competitive athletes such as soccer players and involve greater damage to the ligament system. [2]

Symptoms of Ankle Sprain

Signs and symptoms of ankle sprain include the following. [3]

1. Localized pain when movement occurs at the joint
2. Swelling and/or bruising at the involved site
3. Tenderness at the involved site
4. Instability and stiffness at the ankle joint
5. Limited range of movement at the ankle joint

Causes and Risk Factors of Ankle Sprain 

Causes, internal, and external predisposing factors of an ankle sprain are listed below. [3, 4] 

1. Inappropriate shoe type
2. Lack of ankle bracing 
3. Previous history of ankle sprains 
4. Abnormal foot anatomy including crus varum and pes cavo-varus 
5. Ligament hyperlaxity syndrome 
6. Muscle tightness 
7. Walking on an uneven surface 
8. Lack of stability
9. Exaggerated movements at the ankle during athletic activities 

Ankle Sprain Evaluation 

Physicians classify the ankle sprains into any of three grades, based on the physical evaluation. [5]

Normal Healing Cycle 

The normal healing cycle comprises the following stages. [6] 

1. The inflammation stage involves the activity of inflammatory mediators in repose to tissue injury. Inflammation involves the recruitment of immune cells and exudation of fluid into the tissue spaces. The primary goal of this process is to eliminate the cause of inflammation. 
2. The proliferation stage is characterized by the formation of scar tissue, which serves as a scaffold for further healing processes. Fibroblasts deposit collagen fibers, new blood vessels form, and reepithelization takes place. 
3. During the maturation stage, wound contraction occurs and excess matrix substances undergo degradation. The maturation stage is marked by the completion of the healing cycle.

Ineffective Treatment of Ankle Sprain

Following therapeutic techniques are commonly followed, however, these do not target the underlying pathology and are ineffective for resolving ankle sprain pain. 

1. Heat and ice therapy
2. Electrical stimulation
3. Massage and use of foam roller
4. Joint mobilization and stretching
5. Muscle-strengthening exercises during inflammation stage 

Effective Treatment for Ankle Sprain Pain

Following techniques are beneficial for effective reduction in ankle sprain pain. These therapeutic techniques target the inflammation and proliferation stages simultaneously, hence, stimulating the healing cycle to proceed to the maturation stage. 

1. Adequate rest
2. Avoid athletic activities and joint mobilization during the healing process
3. Resolve muscle tightness
4. Appropriate shoes that provide sufficient stability to the joint
5. Normal gait and walking on an even surface 
6. Normal foot anatomy 

7. Resolution of inflammation stage 

   1. MagnaHeal devices – MagnaHeal is made of a neodymium magnet which is coated in anti-inflammatory ingredients. Magnetic fields and the presence of anti-inflammatory substances accelerate the healing process and resolve inflammation. MagnaHeal 1 has a magnetic force length of 2 inches whereas MagnaHeal 2 is more powerful with a magnetic force length of 3 inches. MagnaHeal 2 is part of more aggressive therapy for grade II and III ankle sprains. [7] 
   2. Anti-inflammatory diet – this plays a crucial role in suppressing inflammation and inflammatory mediators. This diet lacks pro-inflammatory foods such as alcohol, caffeine, red meat, refined carbohydrates, and sugary beverages. The anti-inflammatory diet is rich in un-refined and plant-based food items that are rich in essential fatty acids and phytonutrients to minimize inflammation. [8]
   3. Anti-inflammatory supplements – nutrient deficiencies may give rise to an abnormal healing cycle. Intake of these supplements will eventually promote a healthy state and prevent excess inflammation. One can complete the evaluation offered by the AskASTR program to determine the nutrient deficiencies and choose from a wide range of supplements. 

8. Resolution of proliferation stage 

   1. Scar tissue release – superficial and deep excessive scar tissue can be released by using A3 and A5 ASTR tools respectively. 
   2. Fascia release – fascia adhesions during the proliferation stage may be responsible for delayed healing and exacerbation of symptoms. A1 tool is used for releasing superficial and aponeurotic fascia restrictions whereas the A5 tool releases epimysium, perimysium, and endomysium fascia restrictions. [9]
   3. Trigger point release – trigger points or knots may develop in the muscles of the lower limb. A3 and A5 tools are used for releasing these trigger points. 

Conclusion

Ankle sprain pain is an immense challenge in terms of mobility, quality of life, and hospital visits. Despite being prevalent in the country, people and practicing physicians don’t follow effective management and treatment techniques. This prolongs recovery and increases the risk for recurrence. Effective treatment regimens include dietary and lifestyle modifications and the use of ASTR tools and MagnaHeal devices to resolve inflammation and proliferation simultaneously.  

References

1. https://www.ncbi.nlm.nih.gov/books/NBK545158/  
2. https://www.ncbi.nlm.nih.gov/books/NBK459212/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907605/  
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3781861/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780668/  
6. https://www.ncbi.nlm.nih.gov/books/NBK470443/
7. https://advancedsofttissuerelease.com/astr-healthcare-provider-course/
8. https://pubmed.ncbi.nlm.nih.gov/28350517/   
9. https://pubmed.ncbi.nlm.nih.gov/30252294/