On Saturday, December 7, 2024, the seventh episode of Sky Sport Doctor aired. In this episode, Francesco Della Villa, Director of our Education and Research Department, discussed ankle sprains: frequent occurrences and one of the most common injuries for football, basketball, and tennis players at all levels. Based on the abnormal movement of the ankle, different types can be identified, which may lead to ligament injuries, cartilage damage, and even fractures.
Frequent injuries in athletes. Why?
The ankle is the first “pivot,” the primary joint that absorbs (along with the foot complex) the impact with the ground. For this reason, it is subjected to significant stress, especially during landings and sudden movements.
It is a relatively stable joint, composed of the tibia and fibula (the bones of the leg), which articulate with the talus, one of the bones of the foot, forming a true “clamp”. The joint is stabilized by a series of ligaments, both laterally and medially (on the inside). The tibia and fibula are also connected by specific structures that help keep this clamp closed.
Is an ankle sprain a simple injury?
No, an ankle sprain, often underestimated, is a complex injury that can have various consequences, including ligament damage, post-traumatic cartilage defects, and even bone fractures (known as malleolar fractures). Moreover, the effects are not only mechanical but also involve neuromuscular control, which can become impaired.
Are ankle sprains always the same, or are there different types?
These injuries occur very quickly, and depending on the type of abnormal movement, they can be classified into different types:
- The most common type is the lateral sprain, where the abnormal movement is an excessive “inversion” of the ankle. The ankle moves in this way, and the injured structures are the lateral ligaments. These are the classic ankle sprains commonly seen in team sports like basketball.
- Then we have medial sprains, where the abnormal movement is an excessive “eversion” of the ankle. These injuries, which result in damage to the medial ligaments (deltoid ligament or spring ligament), are generally more severe.
Finally, often associated with medial sprains, there are high ankle sprains, injuries caused by external rotation that occur while bearing weight on the tip of the foot. These result in damage to the structures connecting the tibia and fibula, thereby widening the clamp.
How do they occur in different sports?
In sports like basketball and volleyball, these injuries almost always occur independently or due to disruptions during a landing from a jump, typically landing on a teammate’s or opponent’s foot. In football, however, the situation is quite different. Half of these injuries occur during direct-contact duels, particularly due to fouls involving lateral tackles, which result in medial injuries, or medial tackles, which lead to lateral injuries. Only about a quarter of these injuries happen completely independently.
How to assess the severity of an ankle sprain?
One of the key symptoms is swelling. If a sprain is mild, the ankle typically won’t swell much. However, if the ankle becomes significantly swollen, and especially if bruising appears, it’s important to seek medical attention as soon as possible to rule out malleolar fractures, assess the extent of ligament injuries, and determine the appropriate treatment strategy.
Diagnosis is always a key step, and to support the sports medical examination, the doctor may perform an ultrasound (including dynamic imaging) or request an X-ray, and in selected cases, an MRI.
What does the treatment involve?
Ankle sprains are treated conservatively in the vast majority of cases (treatment involves a functional recovery program, which we will cover in the next episode of Sky Sport Doctor). However, in more severe cases, where there is a complete rupture of multiple ligaments accompanied by a sense of instability, stabilization surgery may be recommended. In practice, this is more common among high-level athletes who have greater functional demands.
Why should an ankle sprain not be underestimated?
Ankle sprains are often underestimated, but this is a mistake that should not be made. Some thought-provoking numbers: 30-60% of patients will experience a recurrence, while 20% of patients with an ankle sprain develop chronic instability (one in five) over time. Due to this oversimplification, patients often return to play without fully recovering, especially when symptoms disappear (even though functional deficits are still present). This exposes patients to recurrent injuries that, over time, can lead to cartilage damage, advanced arthritis, and severe clinical conditions. Unfortunately, there have been prominent examples of this in football history.
For these reasons, it is important to properly treat the first sprain with a comprehensive functional recovery program, which significantly reduces the likelihood of a recurrence.
Therefore, it is important to emphasize: it is not “just” a simple ankle sprain.
