An ankle sprain is one of the most common orthopedic injuries. So, what are the ankle sprain risk factors? Most people will suffer a sprained ankle at some point in their life. Often, you’re doing something active when suddenly your ankle rolls inward. You experience a marked pain on the outside of your ankle follow by noticeable swelling. The ligaments supporting the outside of your ankle are torn. If you’re lucky, you’ll be able to limp home and recovery in a week or two. However, for more severe ankle sprains the recovery time can be much longer –and chronic symptoms including ankle looseness is common. So, who sprains their ankle? The chance of suffering an ankle sprain is not random. Some people are at high risk for ankle sprains.
While the majority of people have suffered an ankle sprain at some point in their life, a small minority (~10–20%) will suffer numerous ankle sprains during their lifetime. What is it about these people that makes them more likely to sprain their ankle? It turns out there are predictable risk factors. These include:
- Participation in a high-risk activity (ex. basketball, volleyball, soccer, etc.)
- An ankle with notably more inward motion (inversion) than outward motion (eversion)
- Loose ligaments (ligamentous laxity)
- A history of multiple previous ankle sprains (chronic ankle instability)
Ankle Sprains Increase in High Risk Activities
Participation in activities that are more likely to lead to an ankle sprain is a big risk factor. Sporting activities, where athletes are jumping and landing (basketball, volleyball, etc.), or suddenly changing direction (soccer, pickleball, etc) are associated with increased rates of ankle sprains. It’s common for athletes in these sports to tape their ankle or use an ankle brace for extra support. However, other activities, such as hiking on uneven terrain may also increase the risk of suffering an ankle sprain.
Increased Ankle Inversion
Increased ankle inversion is also a risk factor for an ankle sprain. An ankle with increased inward motion (inversion) will also considerably increase the chance of that person suffering an ankle sprain. The type of ankle that has increased inversion is often seen in association with a higher arched foot shape. When the foot lands during walking or following a jump, it may roll inwards initially. Individuals who have excessive inversion will often not realize their foot is in a “at risk” position until it’s too late. The foot continues to roll inwards. There is marked force through the ligaments on the outside of the ankle, and these lateral ankle ligaments tear.
Loose Ankle Ligaments make an Ankle Sprain more likely
Ligamentous laxity is another risk factor for suffering an ankle sprain. Some individuals are just more flexible than others. This includes younger athletes who tend to have more flexibility than older individuals. There is also a condition called ligamentous laxity where individuals have excessively loose ligaments supporting their joints. These individuals can often bend their fingers backwards more than 90 degrees and can noticeable hyperextend their elbows. Due to their lax ankle ligaments their foot can roll excessively inwards before their brain realizes the ankle is in a position from which it cannot recover. The end result is tearing of the lateral ankle ligaments, which may heal in a further lengthened position. This may exacerbates the looseness in their ankle potentially leading to chronic ankle instability.
A History of Multiple Ankle Sprains
Not surprisingly, if a person has had multiple ankle sprains they are much more likely to suffer an ankle sprain in the future. Often, they have one or more of the above risk factors. In addition, previous ankle sprains often lead to further stretching out of the ligaments on the outside of the ankle. This can lead to ankle laxity and predisposes patient to recurrent ankle sprains. Physical therapy can be helpful. Treatment includes strengthening the protective muscles on the outside of the lower leg (the peroneal muscles) as well as improving the inherent balance from muscular control (proprioception). However, some patients with recurrent ankle instability will require surgery to stabilize the stretched-out ankle ligaments.
If someone is at high risk for suffering an ankle sprain there are a variety of things they can do to minimize the possibility of an ankle sprain. These include appropriate muscle strengthening and balance exercises; activity modification to avoid “at risk” sports; and ankle taping or bracing. When an ankle sprain does occur, early icing, elevation, and immobilization can help with symptoms. During the recovery period there is a critical need for optimal rehabilitation as failing to completely regain baseline lower leg strength and balance (proprioception) can also increase the risk of another ankle sprain. For more information on ankle sprains and rehabilitation strategies check out our webpage on ankle sprains.
March 3rd 2024