Ankle sprains are common during land based activities. Many shrug off a sprained ankle, calling it their “stubborn” ankle or referring to it as a “rolled” ankle, but this injury/injuries can accumulate and become a stubborn, recurrent issue. I’ve worked with many patients who report spraining their ankle hundreds of times throughout their life! This is unacceptable, as there are methods for preventing ankle re-injuries. Unfortunately, our society relies too much on passive treatment, instead of being a proactive member for prevention and recovery!

If you are someone with a history of ankle sprains, there are simple, at home exercises/treatments at your disposal. If you’ve had an ankle sprain, I highly recommend seeing a physical therapist for individualized rehabilitation and prevention. However, if you are looking for a few tips and tricks, or simply want prevention give these a try!

COR Ankle Sprain Solution

Muscle Length

Length of the muscles are impaired after any injury. Whether you sprain your ankle or injury your back, you hobble around, compensating for the injury. This compensation creates a cascade of tight (shortened) and long (elongated and weak) muscles. Muscle length works on improving the tight muscles around the ankle. There are a lot of other muscles which may need addressing (sometimes those at the hips and low back), but the peroneals, posterior tibials, calf, and plantarfascia often yield the biggest improvement. Here are the muscles and exact location, for all you anatomy nerds in the bunch!

We suggest self myofascial release (SMR) for improving muscle length. When doing self myofascial release, start gently, and slowly. Stop on any tender spot and hold for 1 – 3 minutes. Here is an example of the plantarfascia:



MUSCLE ORIGIN INSERTION ACTION INNERVATION
Tibialis Anterior
(1)
Lat tibia
(upper 2/3)
(IO membrane)
Med cuneiform (med surf)
(Base of 1st MT)
DF ankle
Invert IT (STJ)
Deep fibular nerve
Extensor digitorum longus
(2)
Ant fibula
(Lat tibial condyle)
(IO membrane)
Base of middle
& distal phalanges 2-5
(dorsal aponeuroses)
DF ankle
Evert IT (STJ)
Ext MTP/IP 2-5
Deep fibular nerve
Extensor hallucis longus
(3)
Med fibula
(IO membrane)
Base 1st distal phalanx
(Dorsal aponeurosis)
DF ankle
Evert/Invert IT (STJ)
Ext MTP/IP 1
Deep fibular nerve
Fibularis (peroneus) longus
(1)
Prox 2/3 lat fibula
(Head of fibula)
Med cuneiform
(Base 1st MT)
PF ankle
Evert IT (STJ)
Superficial fibular nerve
Fibularis (peroneus) brevis
(2)
Distal 1/2 lat fibula
(IO membrane)
Base 5th MT PF ankle
Evert IT (STJ)
Superficial fibular nerve
Fibularis (peroneus) tertius
(3)
Distal ant fibula
(w/ EDL)
Base of 5th MT DF ankle
Evert IT (STJ)
Deep fibular nerve
Extensor digitorum brevis Dorsal surface calcaneus Base middle phalange 2-4
(Dorsal aponeuroses 2-4)
Ext MTP 2-4
Ext PIP 2-4
Deep fibular nerve
Extensor hallucis brevis Dorsal surface calcaneus Base prox phalanx 1
(Dorsal aponeurosis 1)
Ext MTP 1 Deep fibular nerve
Abductor hallucis Med calcaneal tuberosity
(Plantar aponeurosis)
Base prox phalanx 1
(via med sesamoid)
Abd MTP 1
(Flex MTP 1)
Med plantar nerve
Flexor hallucis brevis
(med head)
Med cuneiform Base prox phalanx 1
(via med sesamoid)
Flex MPT 1 Med plantar nerve
Flexor hallucis brevis
(lat head)
Intermediate cuneiform
(Plantar calcaneocuboid lig)
Base prox phalanx 1
(via lat sesamoid)
Flex MPT 1 Lat plantar nerve
Adductor hallucis
(oblique head)
Base MTs 2-4
(Cuboid)
(Lat cuneiform)
Base prox phalanx 1
(via lat sesamoid)
Add MTP 1
Flex MTP 1
Lat plantar nerve
Adductor hallucis
(transverse head)
Deep transverse MT lig
(MTP 3-5)
Base prox phalanx 1
(via lat sesamoid)
Add MTP 1
(Supports transverse arch)
Lat plantar nerve
Abductor digiti minimi Lat calcaneal tuberosity
(Plantar aponeurosis)
Base prox phalanx 5
(Tuberosity MT 5)
Abd MTP 5
(Flex MTP 5)
Lat plantar nerve
Flexor digiti minimi (brevis) Base MT 5
(Long plantar lig)
Base prox phalanx 5 Flex MTP 5 Lat plantar nerve
Flexor digitorum brevis Calcaneal tuberosity
(Plantar aponeurosis)
(Side) middle phalanges 2-5 Flex MTP 2-5
Flex PIP 2-5
Med plantar nerve
Quadratus plantae Calcaneal tuberosity Lat border FDL tendon Redirects and augments pull of FDL Lat plantar nerve
Lumbricals
(1-4)
Med border FDL tendons Dorsal aponeuroses 2-5 Flex MTP 2-5
Ext IP 2-5
Add MTP 2-5
1st Lumbrical:
Med plantar nerve
Lumbricals 2-4:
Lat plantar nerve
Plantar interossei
(1-3)
Med border MT 3-5 Med base prox phalanx 3-5 Add MT 3-5 Lat plantar nerve
Dorsal interossei
(1-4)
Two heads from opposing sides MT 1-5 First interosseus:
Med base prox phalanx 2
2-4 interossei:
Lat base prox phalanges 2-4
(Dorsal aponeurosis)
Abd MTP 2-4 Lat plantar nerve
Soleus Soleal line tibia
(Head/neck fibula)
Calcaneal tuberosity
via Achilles tendon
PF ankle
Invert IT (STJ)
Tibial nerve
Gastrocnemius Med epicondyle femur
Lat epicondyle femur
Calcaneal tuberosity
via Achilles tendon
PF ankle
Invert IT (STJ)
Flex knee
Tibial nerve
Plantaris Lat epicondyle femur
(Prox to lat head gastroc)
Calcaneal tuberosity
via Achilles tendon
Small Contributor
PF ankle
Invert IT (STJ)
Flex knee
Tibial nerve
Tibialis post Post Tibia
IO membrane
Post Fibula
Navicular (tuberosity)
Med cuneiform
(mid & lat cuneiforms)
(Base MT 2-4)
PF ankle
Invert IT (STJ)
Tibial nerve
Flexor digitorum longus Post tibia
(middle 1/3)
Base distal phalanges 2-5 PF ankle
Inv IT (STJ)
Flex MTP
Flex IP 2-5
Tibial nerve
Flexor hallucis longus Post fibula
(distal 2/3)
Base distal phalanx 1 PF ankle
Inv IT (STJ)
Flex MTP 1
Flex IP 1
Tibial nerve

Muscle Strength

Another component of prevention and rehabilitation is muscle strength.  Typical ankle sprains elongate ligaments in the ankle. This damage takes a while to recover and sometimes doesn’t ever reach the pre-injury strength. This makes ankle strengthening essential, as strength provides extra support around the damaged ligaments. Proper strength ankle the foot is a combination of strength in the feet and around the ankle. In society, many people have flat feet or pronated feet, which is exacerbated from wearing flip flops. This condition impairs stability at the foot, by stretching out the passive (ligaments) structures. Therefore, creating active (muscle, tendons) support is mandatory for preventing future sprains.

Strengthening the ankle requires arch strengthening, see below.


Strengthening around the ankle joint is also essential. Simple strengthening to the tibialis posterior is possible by moving the ankle actively through supination (remember, supination is like holding a bowl of soup). Once you can actively move the ankle through supination, strengthening it with the foot on the group is essential. For this, a simple exercise is the multi-directional single leg partial squat.
On top of this, performing multi-directional foot movements, side-steps, karaoke, etc. can help strengthen the foot and ankle.

Muscle Timing

Once again, after an ankle sprain, the ligaments are impaired. This infarct at the ligaments doesn’t just create strength impairments, but also sensory impairments. At the cellular level, ankle sprains damage the neurological structures (golgi tendon organs and muscle spindles) which help the ankle sense its position in space. More or less, an ankle sprain makes the ankle dizzy. Like general dizziness, ankle dizziness decreases the ankles ability to stabilize itself without injury itself further. Luckily, proprioception exercises help strengthen these impaired neurological structures and make the joint more aware of its positioning.

Improving muscle timing works on many facets, but for now we’ll show you a few simple tricks for improving ankle muscle timing.

  • Single leg balance: Balancing on one leg help is essential for ankle injury prevention. This re-teaches the ankle its position, as well as strengthens the active structures around the joint.
  • Single leg balance with eyes closed: Removing the eyes further challenges the proprioception of the ankle, forcing you to rely on the joint’s sense of position, not vision.
  • Single leg balance, eyes closed, and on an unstable surface: Further challenging proprioception involves standing on one leg on an unstable surface, while closing your eyes. The addition of an unstable surface forces the ankle to stabilize and improve its positional awareness.

This is only one progression for improving muscle timing. Other alternatives and progressions are single leg squats and single leg multi-directional squats with the same progressions.

How to Improve Stubborn Ankle Sprains Summary

Once again, if you have had an ankle sprain, you can improve it and prevent it from coming back. Be a positive advocate for your improvement, by taking responsibility. If you have had an injury, I always suggest seeing a physical therapist, but if you want to try improving it on your own, improve your muscle length, strength, and timing.

Written by Dr. G. John Mullen, DPT, CSCS