Treatment for Ankle Sprain, Ankle Pain (Yonghada Clinic, Myeong-dong, Seoul)
A patient visited recently, complaining of persistent pain from an ankle ligament injury that occurred two months ago.
In most cases, mild pain and swelling subside within two weeks, but since this patient’s pain has persisted for quite some time, a focused examination was necessary. Issues were found in the posterior tibial and third fibular muscles, which play key roles in the dynamic stability of the ankle. Additionally, imbalances were detected in the core muscles, particularly the iliopsoas and gluteus medius.
For anyone suffering from prolonged pain due to an old ankle sprain, I recommend checking the balance of the surrounding ankle muscles as well as the core muscles. Today, I will discuss ankle sprains in detail.
1. Structure and Function of the Ankle
The ankle is one of the most important joints in the human body, playing a key role in supporting body weight and maintaining balance during walking and physical activity. The ankle is mainly composed of the talocrural joint, formed by the tibia, fibula, and talus, along with various ligaments connected to it.
Composition of the Ankle Joint:
Talocrural Joint: This is the joint formed where the tibia and fibula articulate with the talus, responsible for the primary movements of the ankle (dorsiflexion and plantarflexion).
Subtalar Joint: This joint between the talus and calcaneus allows rotational movements of the foot.
Main Ligamentous Structures of the Ankle:
Medial (Deltoid) Ligament: A strong ligament on the inside of the ankle, composed of the anterior tibiotalar ligament, tibionavicular ligament, and posterior tibiotalar ligament.
Lateral Ligament: This ligament supports the outer side of the ankle and is made up of the anterior talofibular ligament (ATFL), calcaneofibular ligament, and posterior talofibular ligament.
2. Ankle Stability
Ankle stability is divided into two key components: static and dynamic stability. Both play crucial roles in protecting the ankle from injury during various activities.
Static Stability:
Static stability is provided primarily by the bony and ligamentous structures surrounding the ankle joint.
Bony Structure: The anatomical structure of the ankle provides the major component of static stability. The tibia and fibula form a structure that surrounds the talus, offering anterior-posterior and medial-lateral stability to the ankle.
Ligaments: The ligaments around the ankle joint prevent excessive movement. For example, the lateral ligament prevents excessive inversion of the ankle.
Joint Capsule: The tissue surrounding the joint helps to limit movement and provides stability.
Dynamic Stability:
Dynamic stability is provided by the action of the muscles around the ankle.
Muscles and Tendons: Muscles around the ankle (such as the peroneus longus, peroneus brevis, third fibularis, tibialis anterior, and tibialis posterior) contribute to ankle stability by controlling its movements in real time.
Neuromuscular Control: Muscles are controlled by the nervous system, responding quickly to changes in the ankle’s position, which helps in continuously adjusting the joint’s stability.
3. Ankle Ligament Injuries
Ankle ligament injuries are among the most common injuries in sports activities. Ligament injuries occur when the ankle moves abnormally, and the lateral ligaments are most often affected.
Mechanism of Injury:
Inversion Injury: The most common type of injury, where the ankle inverts (turns inward), damaging the lateral ligaments, especially the ATFL.
Eversion Injury: A less common type of injury where the ankle everts (turns outward), damaging the medial ligaments.
Severity of Injury:
Grade I Injury: The ligament is slightly stretched or mildly torn, leading to mild pain and swelling.
Grade II Injury: The ligament is partially torn, causing moderate pain, swelling, bruising, and possible instability of the ankle.
Grade III Injury: The ligament is completely torn, resulting in severe pain, swelling, and significant instability of the ankle.
4. Rehabilitation and Treatment
Rehabilitation for ankle ligament injuries should be approached in phases, with the primary goals being pain management, swelling reduction, functional recovery, and prevention of recurrence.
Acute Phase Treatment:
RICE Protocol: Rest, Ice, Compression, and Elevation are the initial treatment principles applied immediately after the injury.
Use of Assistive Devices: Ankle braces or taping can help stabilize the ankle and prevent further injury.
Functional Recovery Phase:
Strengthening Exercises: Exercises to strengthen the muscles around the ankle improve dynamic stability.
Balance Training: Exercises to enhance neuromuscular control of the ankle, such as balancing on a wobble board or standing on one foot with support, are beneficial.
Flexibility Exercises: Stretching exercises are necessary to restore the normal range of motion in the ankle joint.
Pre-Return to Activity Phase:
Sports-Specific Training: Training focused on movements commonly used in the patient’s sport is essential before returning to activity.
Prevention of Recurrence: Using ankle taping, braces, and regular strengthening exercises can help prevent future injuries.
5. Treatment at Yonghada Clinic
Ankle ligament injuries often occur when the static and dynamic stability of the ankle are not in harmony. Therefore, treatment must consider not only the structural stability of the ankle but also muscle control and neuromuscular regulation. Particularly when core muscles are weakened, recurrent ankle sprains are common, so assessing the state of core muscles is essential.
Phamacoacupuncture Injection Therapy: Treatment focuses on both the injured ligaments (static stability) and the surrounding muscles (dynamic stability—such as the peroneus longus, peroneus brevis, third fibularis, tibialis anterior, and tibialis posterior) to restore stability. Phamacoacupuncture Injection sites include the ankle (ligaments), calf (muscles), and core muscles (abdomen, lower back, pelvis).
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