What is the treatment for a torn ankle ligament?

Treatment for Torn Ankle Ligament

Functional treatment with early exercise therapy focusing on proprioception, strength, coordination, and function is the most effective approach for treating torn ankle ligaments. 1

Initial Management (First 72 Hours)

The PRICE protocol is recommended for immediate management:

• Protection: Use of a compressive device to protect the ankle
• Rest: Limited weight-bearing for up to 72 hours
• Ice: Apply cryotherapy to reduce edema and pain
• Compression: Use a compressive bandage or support
• Elevation: Keep the ankle elevated 2

Cryotherapy (ice application) helps reduce swelling and likely decreases pain and recovery time, though evidence varies on optimal timing and application methods 2.

Support Options

• Semirigid or lace-up ankle supports are recommended over immobilization for functional treatment of ankle ligament injuries 2, 1
• These supports decrease recovery time and help patients return to usual activities more quickly 2
• Elastoplast bandaging may provide better ankle function and allow earlier return to work compared to double tubigrip or no support, though differences are not statistically significant 3

Rehabilitation Protocol

A comprehensive rehabilitation program should include:

1. Early-stage exercises (begin after acute phase):

   • Ankle circles
   • Alphabet drawing with toes
   • Towel stretches for dorsiflexion
   • Gentle range of motion exercises 1

2. Progressive strengthening:

   • Resistance band exercises in all directions
   • Heel raises (progressing from bilateral to unilateral) 1

3. Proprioception training:

   • Balance exercises on stable surface, progressing to unstable surfaces
   • Single-leg stance with eyes open, then closed
   • Ankle disk or balance board exercises 1

Grading and Treatment Based on Severity

Ankle sprains are classified into three grades:

• Grade I: Ligamentous sprain without joint instability
• Grade II: Partial rupture with mild instability
• Grade III: Complete rupture with significant instability 1

Treatment intensity should match the grade of injury, with Grade III injuries potentially requiring longer rehabilitation or consideration of surgical options if conservative management fails 1.

Prevention of Recurrence

• Continue proprioceptive and strengthening exercises long-term 1
• Use semirigid or lace-up ankle supports during high-risk activities, especially for patients with history of recurrent sprains 2, 1
• Graded exercise regimens with proprioceptive elements (such as ankle disk training) help reduce risk of recurrent sprains 2

Special Considerations

• Prolonged immobilization should be avoided as it can lead to loss of proprioception and formation of inelastic scar tissue from ligamentous adhesions 4
• If pain persists beyond 6 weeks, consider other causes such as inadequate rehabilitation, impingement, occult lesions, peroneal tendon injury, or lateral instability 5
• Surgery may be considered for Grade III sprains with significant instability that fail conservative management or for persistent symptoms after 4-6 months of appropriate conservative treatment 1

Return to Activity Criteria

Return to work/sports should be based on:

• Pain-free walking
• Full range of motion
• Restored strength
• Ability to perform sport-specific movements without pain or instability 1

The evidence strongly supports functional treatment over immobilization, with early rehabilitation focusing on proprioception and strengthening exercises to promote optimal recovery and prevent recurrence.