Medial Ankle Sprains in Football Players

Introduction

Medial ankle sprains can occur during football games due to sudden changes in direction, collisions, or awkward landings. In this blog, we will explore the comprehensive management of medial ankle sprains in football players. We will discuss what a medial ankle sprain is, its underlying causes, the ligaments and structures involved, and the available treatment options to ensure a safe and successful return to playing football.

Understanding Medial Ankle Sprains

A medial ankle sprain refers to the injury of the ligaments on the inner side of the ankle joint. The primary structure involved in a medial ankle sprain is the deltoid ligament, a strong ligament on the inner aspect of the ankle, comprising multiple bands that provide stability to the medial side.

Ankle sprains are graded on a scale of 1 to 3, based on how much ligament damage occurred:

Grade 1 – A minor sprain where the ligament fibres have overstretched slightly or there is a very small tear. The ankle will have minor swelling and tenderness to the touch.
Grade 2 – A moderate sprain where the ligament is partially torn. There will be some swelling, instability and it will hurt to move the ankle.
Grade 3 – A severe sprain where the ligament is torn completely, with significant swelling and bruising. The ankle will be unstable, the injury is painful, and it is difficult to weight-bear.

Severe ankle sprains can result in combined injuries to one or more ligaments, as well as potential damage to the joint capsule, bones and other structures within the foot / ankle. Due to this, it is necessary to undergo assessment by a qualified healthcare professional to fully determine the potential damage caused by an ankle sprain.

Medial Ankle Sprain Symptoms

Here are some common symptoms associated with medial ankle sprains:

Pain: Football players with a medial ankle sprain often experience pain on the inner side of the ankle. The pain may be sharp, achy, or throbbing, depending on the severity of the sprain.
Swelling: Medial ankle sprains can cause swelling around the inner ankle area. The swelling may develop quickly following the injury and can lead to a visible enlargement of the ankle joint.
Bruising: In some cases, bruising may occur around the medial ankle due to the damage to blood vessels during the sprain. The bruising may appear as discoloration or darkening of the skin.
Instability: Medial ankle sprains can result in ankle instability, where the affected ankle feels weak or unstable. Football players may have difficulty bearing weight on the injured ankle or experience a sensation of the ankle giving way during movement.
Limited range of motion: Following a medial ankle sprain, football players may have difficulty moving the ankle joint through its full range of motion. They may experience stiffness or pain when attempting to bend or rotate the ankle.
Tenderness: The inner side of the ankle may be tender to the touch in individuals with a medial ankle sprain. Pressing on the affected area can elicit pain or discomfort.

If a football player experiences symptoms suggestive of a medial ankle sprain, it is important to seek appropriate medical attention. A healthcare professional can assess the injury, arrange imaging tests if necessary, and recommend the appropriate treatment plan.

Causes of Medial Ankle Sprains

Medial ankle sprains can occur due to various factors, including:

Forced eversion: Excessive inward rolling or twisting of the foot can strain or tear the medial ligaments.
Direct impact: A collision or external force applied to the inner side of the ankle can result in injury.
Overpronation: Excessive foot pronation, where the arch collapses inward, can contribute to increased stress on the medial structures.

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Ankle Sprains in Football

Assessment

Accurate assessment of medial ankle sprains is crucial for determining the extent of the injury and guiding appropriate treatment. The assessment process may involve the following steps:

Medical history: Gathering information about the player’s symptoms, mechanism of injury, previous ankle injuries, and relevant medical conditions.
Physical examination: The football physiotherapist will assess for tenderness, swelling, range of motion, stability, and specific signs of ligamentous injury on the medial side of the ankle.
Special tests: Specific tests, such as the medial stability test or ankle stress test, may be performed to assess the integrity of the medial ligaments.
Ottawa ankle rules: If there is tenderness on specific bony structures such as the medial malleolus (bony bit of the inner ankle) or an inability to weight-bear for four steps or more, an x-ray may be required to check for an avulsion fracture.
Imaging: Depending on the severity of the injury, further investigation may be needed such as x-ray or MRI imaging.

Treatment Options

The management of medial ankle sprains may include the following:

RICE (Rest, Ice, Compression, Elevation): Initial treatment to reduce pain, swelling, and inflammation.
Immobilisation: Depending on the severity of the sprain, a brace or walking boot may be used to provide support and protect the injured structures.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to alleviate pain and reduce inflammation.
Physiotherapy: A structured rehabilitation program focused on restoring ankle range of motion, strength, stability, and proprioception.
Functional exercises: Gradually reintroducing weight-bearing activities, balance exercises, and sport-specific drills to regain functional abilities.
Taping or bracing: Providing external support to the ankle during the healing and return-to-play phases.

Products that may help

Anti-inflammatory patch – Available here

The Nurofen Joint and Muscular pain relief plasters continuously releases ibuprofen over 24 hours to target pain and inflammation at the site of pain. This can be an effective option for reducing the initial swelling from the ankle sprain injury.

Ankle Cool Sleeve Ice Pack – Available here

This ankle ice pack provides cold therapy and compression for the entire ankle area, providing pain relief and helping to reduce swelling. The ice pack contains gel to ensure longer lasting cold therapy and the ankle specific design also provides compression to the injured area.

Balance Cushion – Available here

The balance cushion is a useful piece of equipment to provide challenging proprioception exercises that help to improve stability of the ankle.

Ankle Support – Available here

The aim of ankle sprain rehabilitation is to regain full function of the ankle and hopefully return to training and games without needing an ankle strapping. However, in the initial stages after an ankle sprain, or cases of chronic instability, an ankle strapping is often required. This ankle support is a high quality option for football players.

Surgical Management

In some cases, severe medial ankle sprains may require surgical intervention to repair or reconstruct the damaged ligaments. It is important to note that surgical management is typically reserved for cases with significant ligamentous damage and instability that do not respond to conservative treatment. The decision for surgical intervention should be made in consultation with an orthopaedic foot and ankle surgeon.

Rehabilitation Techniques

The rehabilitation of medial ankle sprains typically involves several phases:

Early phase:

Pain and swelling management: Utilising ice therapy, compression, and elevation.
Range of motion exercises: Gentle ankle movements and stretching to restore flexibility.
Balance and proprioception training: Enhancing joint position sense and stability through specific exercises.
Strengthening exercises: Targeting the muscles around the ankle, including the calf and intrinsic foot muscles, to improve stability and support.

Intermediate phase:

Progressive weight-bearing exercises: Gradually increasing the load on the ankle to improve strength and endurance.
Neuromuscular control exercises: Focusing on coordinated movements and stability to prevent re-injury.
Sport-specific drills: Reintroducing football-related movements, such as cutting, jumping, and change of direction.

Advanced phase:

Return-to-sport activities: Simulating match conditions, including agility drills, running, and controlled football-specific training.
Functional testing: Assessing the player’s readiness to return to competitive play through specific performance tests and criteria.

Conclusion

Medial ankle sprains are common injuries in football players and require careful management to ensure a safe and successful recovery. Understanding the anatomy, causes, and assessment of medial ankle sprains is crucial for developing an effective treatment plan. Through a combination of initial rest and immobilisation, followed by a structured rehabilitation program focusing on flexibility, strength, stability, and functional abilities, football players can regain their confidence and safely return to the pitch. Collaborating with a football physiotherapist is essential for individualised care and to minimise the risk of recurrent injuries. By following a comprehensive management approach, football players can overcome medial ankle sprains and continue to excel in their sport with reduced risk of future complications.

Disclaimer

The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.

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