A sprained ankle is very common and results from an inversion roll in plantar flexion, which is when you stand on your foot with weight off your heel and subsequently roll your ankle outwards.

Given its commonality, it’s worth knowing what you should do if either you, or someone you know, suffers an inversion ankle sprain.

Make observations

  1. Is there localised or general swelling?
    Following an inversion sprain localised swelling on and around the outside anklebone (lateral malleolus) is common. General swelling may suggest an injury to additional ligaments or bones.
  2. Is there any discolouration?
    Bruising indicates increased injury severity.
  3. Is there any obvious deformity about the lower leg, foot or ankle?
    If the ankle/foot area doesn’t look right it is probably fractured.
  4. Can the person move their foot or ankle around?
    Note their pain levels and tell them not to force any movements.
  5. Can the person weight bear or walk on the ankle?
    Whether they can put weight on their ankle only suggests the severity of the injury, not if it is broken.

The Ottawa ankle rules

These rules were established to assist clinicians to decide whether a person with a rolled ankle needs an x-ray or just standard management.

The lateral view shows the outside of the ankle and the medial view shows the inside ankle. If the person is tender in any of the yellow areas an x-ray is recommended. You can try touching these areas to see if they are tender.

Start at the base of the outside anklebone and work your way up 6cm and do the same on the inside anklebone. If the outside is very tender 5-6cm above the anklebone it may well be broken and be mindful they may still be able to walk on it! Then try touching the outside border of the foot from the heel towards the little toe, about half way down is a high fracture point.

Then what?

The standard RICER rules apply…

REST: avoid putting weight on it even if fracture is unlikely. In the first 48 hours this will avoid inflaming the ankle joint because of all the swelling around it.
ICE: be mindful that if icing for 20 minutes becomes painful this may also indicate a fracture.
COMPRESSION: use a bandage from a first aid kit to evenly wrap and compress the ankle from the foot to the lower leg.
ELEVATION: if there is a lot of swelling, rest with the ankle higher than your heart.
REFER: to your nearest physio for further management.

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