In today’s post we are going to talk about ankle sprains and their 4 phases, i.e. from the moment the injury occurs until the return to sport. A tape adapted to each stage by combining different types of bandages.

What is the ankle like?

It is a hinge joint, formed by the articulation of the tibia and fibula with the talus.

The main movements are dorsiflexion (bringing the toes towards the head) and plantar flexion (bringing the toes away from the head). It is important to emphasise the inversion and eversion movements as they are the mechanism of injury in sprains, the subject of today’s blog. A forced inversion (supination plus adduction of the foot) will cause an external ankle sprain and a forced eversion (pronation plus abduction of the foot) will cause an internal sprain.

The ligaments of the ankle can be classified as internal and external.

• External: anterior peroneoastotalar (PAA), posterior peroneoastotalar (PAP) and calcaneoperoneus. They fix the tibia, fibula and talus.
• Internal: deltoid. Its bundles attach the tibia to the talus, calcaneus and scaphoid.

According to the article “Ankle sprain. Valoración en atención primaria del equipo de atención primaria de Villanueva de la Cañada, Madrid”, ankle sprains are possibly the most frequent trauma injury in the emergency department. Eighty-five per cent involve the external lateral ligament, mainly the anterior peroneoastragal ligament. And 44% of patients have some type of sequelae after one year, hence the importance of good rehabilitation. Due to its percentage of involvement, the external sprain is the one that will be dealt with in today’s post.

What is an external ankle sprain?

An ankle sprain is defined as a traumatic injury that occurs when you bend, twist or turn your ankle into an unnatural position, causing damage to the ligaments and joint capsule. Depending on the extent of the damage, it is divided into three grades:

• Grade 1: strain of the affected ligament, usually (PAA), without associated joint laxity. Less than 5% of the fibres are torn. The patient walks, there is pain and swelling but symptoms are mild.
• Grade 2: Partial ligament rupture, moderate pain with mild joint instability. Between 40% and 50% of the fibres are torn. The patient walks with difficulty and pain, there is swelling and an antalgic position is adopted.
• Grade 3: complete ligament rupture, joint laxity. The pain is intense, there is deformity and great swelling. The patient is unable to walk.

What stages does it go through? How to bandage it?

The third degree is surgical and the torn ligament must be repaired. Conservative physiotherapy treatment is not carried out before surgery, only anti-inflammatory measures. All the kinesiology tape, combined or not, which are described below, are indicated for both degrees of injury, the difference being the time. Grade I will be shorter because there is less involvement of the ligament and adjacent tissues, and grade 2 will be longer, lasting several weeks. All the bandages to be used are described for an external ankle sprain.

STAGE 1:

Acute phase. Initial rest for 48 hours and anti-inflammatory measures, using the classic RICE (Rest: rest, Ice: ice, Compression: Compression and Elevation: Elevation). Avoid support of the injured limb, therefore the use of crutches is mandatory. An octopus bandage is applied with a kinesiology tape to work on the inflammation and on top of that a bandage to help the inflammation with an elastic bandage. In the following video the complete process is described:

STAGE 2:

Healing phase. Manual physiotherapy treatment begins (manual therapy, dry needling and stretching of spasmed muscles, cyriax on ligaments, joint techniques, etc.) and the session ends with a bandage. This stage consists of helping the tissues to heal correctly and progressively achieving total support of the affected limb, i.e. the first few days there will be help from crutches and they are gradually eliminated. Grade I lasts a short time, between 7 and 10 days; grade II lasts a little longer, between 15-20 days. This is the stage with the most elaborate bandaging, consisting of a kinesiology octopus tape identical to stage 1, a layer of pretape to protect the skin, a functional bandage with tape stabilising the joint for the first supports. This bandage will be maintained between physiotherapy sessions, and these are usually 4-5 days apart. In the video is the detailed description of all the steps in each bandage:

STAGE 3:

Pre-final phase. Return to normal activity, incorporating proprioceptive exercises, strength work and finally plyometrics. The duration of this stage will depend on the work that the patient carries out at home, but it should last approximately 10 days. In the physiotherapy sessions, all the exercises are prescribed and explained and then the patient must repeat them at home to increase strength and achieve stability in the ankle joint. As in the previous stage, the bandage is maintained between sessions. The bandage in this stage will also be combined, but with several modifications: the kinesiology tape drainage is replaced by ankle stability with tibialis anterior reinforcement (provided that the inflammation has completely disappeared, otherwise the octopus is maintained), over it the layer of pretape to protect the skin and on top of it a functional bandage with adhesive bandage instead of tape, to close a cohesive bandage. As in the previous stages, the full description is given in the video:

STAGE 4:

Final phase or return to sport. Once the entire rehabilitation process has been completed in the clinic and it is necessary to introduce the patient to sport, the kinesiology ankle stability tape with reinforcement of the anterior tibial muscle is applied for the first few days of activity. In the event that the patient needs more support or is insecure, a functional bandage (both tape and adhesive bandage) can be used for the first sports practice and then removed, leaving only the kinesiology tape for the following training sessions. There is no established duration for this stage either, but the interesting thing is that the patient only needs a bandage for the first few days of activity, so a time of one week is stipulated. The description of the tape is shown in the following video:

With these 4 videos, two objectives are achieved, the first of them is to carry out a treatment with bandages for the patient with external ankle sprain from the moment of the injury to the return to sporting activity, adapting each stage to the needs of the patient. Always bearing in mind that the number of days that each stage will last will be related to the patient’s improvement and the patient’s involvement in the rehabilitation process. The second objective is to demonstrate that the combination of various materials and various types of bandaging is the optimal treatment for obtaining good results. The important thing when bandaging is the objective that you want to have with each application and from there to mix the bandages in the correct way to achieve the maximum benefit for the patient.

Carried out by the Technical Department of Calvo Izquierdo S.L.

How to cite this blog:

• Calvo Izquierdo. BLOG: evolution of an ankle sprain and how to correctly bandage it [Internet]. Calvo Izquierdo SL. 2023. Available at: https://calvoizquierdo.es/blog-evolution-of-a-sprain-ankle-and-how-to-bandage/

Bibliography:

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• Salcedo Joven, Sanchez González, Carretero, Herrero, macas, Panadero Carlavilla (2000) Ankle sprain. Assessment in primary care. Madrid
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