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Lateral Ankle Sprains in Football Players

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Introduction

Lateral ankle sprains are one of the most common injuries among football players. The rapid changes in direction, sudden stops, and high-impact collisions involved in the sport make the ankle vulnerable to injury.

In this blog, we will discuss the management of lateral ankle sprains in football players. We will cover what a lateral ankle sprain is, the assessment process, and the importance of a structured approach for optimal recovery.

Understanding Lateral Ankle Sprains

A lateral ankle sprain occurs when the ligaments on the outer side of the ankle are stretched or torn due to excessive inversion (rolling inward) of the foot. The main ligaments involved in a lateral ankle sprain include the:

  • Anterior Talofibular Ligament (ATFL): Connects the talus bone to the fibula and is often the most commonly injured ligament.
  • Calcaneofibular Ligament (CFL): Connects the calcaneus bone to the fibula and provides additional stability to the ankle joint.
  • Posterior Talofibular Ligament (PTFL): Connects the talus bone to the fibula and is less commonly injured.

Ankle Sprain in Football

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.

Symptoms of Lateral Ankle Sprains

Here are some of the symptoms associated with a lateral ankle sprain:

  • Pain and tenderness: Football players may experience pain and tenderness on the outside of the ankle, specifically along the lateral ligaments. The intensity of the pain can vary depending on the severity of the sprain.
  • Swelling: Ankle sprains often lead to swelling around the injured area. The swelling may occur immediately after the injury or develop gradually over a few hours.
  • Bruising: In some cases, bruising or discoloration may be visible around the ankle. This typically occurs due to bleeding under the skin as a result of the injury.
  • Instability: Lateral ankle sprains can cause a sense of instability or a feeling that the ankle is “giving way.” This instability may make it difficult for football players to bear weight on the affected foot.
  • Reduced range of motion: Football players with a sprained ankle may experience limited movement in the joint. They may find it challenging to flex or extend the ankle fully.
  • Difficulty walking or running: Ankle sprains can affect the normal gait pattern, making it painful or uncomfortable to walk or run. Players may experience a limp or altered movement due to the pain and instability.

It is important for football players to seek appropriate medical attention if they suspect a lateral ankle sprain. The severity of the injury can range from mild to severe, and proper diagnosis and treatment can help facilitate recovery and prevent long-term complications

Causes of Lateral Ankle Sprains

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

  • Sudden change in direction: Swift pivoting or cutting movements can place excessive stress on the ankle ligaments.
  • Uneven surfaces: Playing on uneven or unstable surfaces can increase the risk of ankle sprains.
  • Poor footwear: Inadequate footwear that doesn’t have the appropriate level of grip for the playing surface can contribute to ankle instability.
  • Previous ankle injuries: A history of ankle sprains or insufficient rehabilitation increases the likelihood of re-injury.
  • Contact mechanisms: Forceful impacts that are sustained when the foot is already in an inverted position can increase the level of stress and damage to the ankle ligaments.

Read Also

Ankle Sprains in Football

Assessment of Lateral Ankle Sprains

Accurate assessment of lateral ankle sprains is crucial for determining the severity of the injury and developing an appropriate treatment plan. The assessment may involve the following:

  • Medical history: Gathering information about the player’s symptoms, mechanism of injury, previous ankle injuries, and any relevant medical conditions.
  • Physical examination: The football physiotherapist will evaluate the ankle for tenderness, swelling, range of motion, stability, and specific signs of ligamentous injury.
  • Special tests: Specific tests, such as the anterior drawer test or talar tilt test, may be performed to assess the stability and integrity of the ankle ligaments.
  • Ottawa ankle rules: If there is tenderness on specific bony structures such as the lateral malleolus (bony bit of the outer 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 for Lateral Ankle Sprains

The management of lateral ankle sprains may include:

  • RICE (Rest, Ice, Compression, Elevation): Immediate treatment to reduce pain, swelling, and inflammation.
  • Immobilisation: Depending on the severity of the sprain, a walking boot, or ankle taping may be used to provide support and immobilise the ankle during the initial healing phase.
  • Early mobilisation: Gradually reintroducing range of motion exercises and weight-bearing activities as pain and swelling decrease.
  • Rehab Programme: A structured rehabilitation program involving various exercises to restore ankle strength, flexibility, proprioception, and balance.
  • Functional exercises: Incorporating sport-specific movements and activities to prepare the player for a safe return to football.

Surgical Management

In certain cases, severe lateral ankle sprains that do not respond to conservative treatment may require surgical intervention. It is important to note that surgical management is typically considered when conservative treatments fail to provide adequate stability and symptom relief. The decision for surgical intervention should be made in consultation with an orthopaedic foot and ankle specialist.

After undergoing surgery, a comprehensive rehabilitation program will be crucial for a successful recovery. The program will be tailored to the individual’s specific surgical procedure, the extent of the injury, and their healing capacity. The rehabilitation process will focus on protecting the surgical site, promoting healing, restoring ankle range of motion, strengthening the ankle, improving proprioception, and gradually reintroducing weight-bearing activities.

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.

Rehabilitation for Lateral Ankle Sprains

The rehabilitation of lateral ankle sprains typically involves several phases:

Early phase:

  • Range of motion exercises: Gentle movements to maintain or improve ankle mobility.
  • Strengthening exercises: Focusing on the muscles around the ankle, including the calf, to provide stability and support.
  • Balance and proprioception training: Enhancing joint position sense and stability through specific exercises.
  • Modified Cardiovascular Training: Maintaining fitness levels through low impact activities such as the exercises bike and cross trainer.

Intermediate phase:

  • Progressive weight-bearing exercises: Gradually increasing the load on the ankle to improve strength and stability.
  • Return to running: Gradually building running distances and speeds, initially starting in straight lines and then progressing to some change of direction.
  • Plyometric exercises: Incorporating controlled jumping and landing to improve power and dynamic stability.
  • Sport-specific drills: Reintroducing football-related movements, such as high speed running, cutting and change of direction.

Advanced phase:

  • Training Load Management: Ensuring the player has covered the appropriate volume in total distance, change of direction loading and high speed running, in comparison to the rest of the squad and what is required for their position.
  • Return-to-sport activities: Completing position specific agility drills, technical work and a controlled integration back in to football training.
  • Functional testing: Assessing the player’s readiness to return to competitive play through specific performance tests and criteria.

Conclusion

Lateral ankle sprains are common injuries among football players. Proper management, including accurate assessment, early treatment, and a structured rehabilitation program, is essential for optimal recovery and reducing the risk of re-injury.

Collaborating with a football physiotherapist can help players regain ankle stability, strength, and functional abilities, enabling them to return to the pitch with confidence.

By following a comprehensive management plan and emphasising injury prevention strategies, football players can continue to pursue their passion while minimising the impact of lateral ankle sprains on their performance.

Further Reading

D’Hooghe et al, (2020) – Return to Play After a Lateral Ligament Ankle Sprain

Smith et al, (2019) – Establishing return to play criteria after acute lateral ankle sprain injuries

Nery et al, (2016) – Foot and ankle injuries in professional soccer players: diagnosis, treatment, and expectations

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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