Massage therapy · Kitchener–WaterlooEversion Sprain of the Ankle

Around 90% of ankle sprains are inversion injuries, where the foot turns inwards and the ligaments on the outside of the ankle are damaged. Eversion sprains, which injure the deltoid ligament on the inside of the ankle, are less common (American Academy of Orthopaedic Surgeons, n.d.); only about 3 to 4% of ankle ligament injuries affect the deltoid ligament alone (Koris et al., 2024). If you have sprained or torn the deltoid ligament, you are likely to have swelling, bruising and soreness, often worst on the inside of the foot and ankle.

1. Uneven surfaces. Walking, working or playing sport on uneven ground is a risk, as you may suddenly twist your ankle (American Academy of Orthopaedic Surgeons, n.d.). Deltoid injuries typically happen when landing on uneven ground (Koris et al., 2024). Fields with holes in them are also risky, as it's easy to step in a hole without seeing it.
2. Sports that involve cutting (sudden changes of direction) or jumping, such as basketball, tennis, football and soccer (American Academy of Orthopaedic Surgeons, n.d.).
3. Underlying hypermobility, where the ankle ligaments are looser than usual and stretch too much.
4. Previous ankle sprains. A previous sprain increases the risk of another one (American Academy of Orthopaedic Surgeons, n.d.); in the year after a sprain, athletes have about twice the risk of spraining it again (Hupperets, Verhagen and van Mechelen, 2009). Make sure you rehabilitate your ankle properly after a sprain.
5. Poorly fitting or unsupportive footwear (American Academy of Orthopaedic Surgeons, n.d.). Using the right footwear for your activity will help, and make sure it fits properly and is not too big.

How to Treat an Eversion Sprain of the Ankle:

Rehabilitation exercises improve flexibility, strength and balance (American Academy of Orthopaedic Surgeons, n.d.), and balance training after a sprain reduces the chance of spraining it again (Hupperets, Verhagen and van Mechelen, 2009). For a mild or moderate sprain, I can guide you through this with hands-on work, strength and balance exercises and taping; if it's severe, see your doctor first and I'll support the plan they set. See the My Approach tab for how I work.

For the first 2 to 3 days after a sprain, NHS (2024) advice is to follow PRICE:

1. Protection

Protect the injury, for example by using a support, or shoes that support your foot or ankle (NHS, 2024).

2. Rest

Stop any exercise or activities and try not to put weight on the injury (NHS, 2024). Your doctor may recommend using crutches until you can walk without pain (American Academy of Orthopaedic Surgeons, n.d.).

3. Ice

Apply an ice pack (or a bag of frozen vegetables wrapped in a tea towel) to the injury for up to 20 minutes every 2 to 3 hours (NHS, 2024). Never put ice directly on the skin. Apply it where the pain and swelling are, which is usually on the inside of the ankle.

4. Compression

Wrap a bandage around the injury to support it during the day (NHS, 2024). Avoid wrapping it too tightly. If the bandage becomes too tight, loosen it; signs that it is too tight include tingling, numbness, coolness, pain and swelling below the bandage.

5. Elevation

Keep the ankle raised on a pillow as much as possible (NHS, 2024).

To help prevent swelling, avoid heat (such as hot baths and heat packs), alcohol and massage for the first couple of days (NHS, 2024).

6. Medication

The NHS (2024) says a pharmacist can advise on the best treatment, and suggests trying paracetamol to ease pain and ibuprofen gel, mousse or spray to bring down swelling at first, with ibuprofen tablets if needed. The American Academy of Orthopaedic Surgeons (n.d.) says anti-inflammatory medicines such as ibuprofen and naproxen can help control pain and swelling. (This medicine information comes from the NHS and the American Academy of Orthopaedic Surgeons, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

7. Movement

When you can move the ankle without pain stopping you, try to keep moving it so it doesn't become stiff (NHS, 2024).

Options outside my scope

• X-rays and scans: an X-ray can rule out a broken bone, and an MRI scan may be used to check the ligaments and other soft tissues (American Academy of Orthopaedic Surgeons, n.d.; Koris et al., 2024).
• Walking boot, brace or cast: for more severe sprains, a doctor may provide a removable boot or brace, or occasionally a short leg cast (American Academy of Orthopaedic Surgeons, n.d.).
• Surgery: this is reserved for injuries that don't improve with non-surgical treatment, and for some high ankle sprains that leave the syndesmosis unstable (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

• Hands-on work for the ankle and calf as it heals
• Strength and balance exercises to lower the chance of another sprain
• Taping, brace and footwear advice for getting back to activity

I start by assessing how your ankle moves, how stable the ligaments are, your strength, balance and walking. If anything suggests a more serious injury, I'll ask you to see your doctor first.

If it's still swollen and painful well past the expected time, or keeps giving way, see your family doctor or nurse practitioner.