Injury: Right lateral ankle ligament sprain
Patient: 19-year-old male, injured playing rugby
Date of Injury: March 2025
What Happened?
A young rugby player injured his right ankle while running during a game. He stepped into a hole on the field, causing his ankle to twist inwards – a movement known as an inversion injury. He was assisted off the field and assessed on the sideline. He experienced significant pain and noticed early swelling on the outside of his ankle.
The patient presented to the public emergency department on the day of the injury. X-rays were done, and no fracture was found. The patient was discharged with crutches and pain relief.
Initial Assessment
The patient attended his first appointment at Access Ortho 2 days after the injury, when he was still experiencing significant pain and swelling. He had previously seen the Access Ortho clinic during his commute and contacted us via our website.
On assessment, our Orthopaedic Nurse Practitioner noted:
- Swelling and bruising over the outer (lateral) ankle
- Tenderness over the ligaments and bones on both sides of the ankle
- Good strength in the ankle muscles, and no signs of peroneal tendon subluxation (slipping/abnormal movement)
- Mild laxity (looseness) in the joint, but no signs of serious instability
The X-ray taken 2 days earlier was reviewed and confirmed to show no fractures. The patient did have a history of previous ankle sprains, with some old changes seen on imaging.
Initial Treatment Plan
As the patient was having difficulty walking due to pain, a moon boot for support was fitted. He was advised to wean from his crutches as pain allowed in the coming days.
Pain relief, rest, elevation, and ice were recommended to help relieve pain and swelling. A follow-up appointment was planned in 10 days with the orthopaedic surgeon to reassess and plan the next steps.
Follow-Up Review
The patient attended the Orthopaedic specialist clinic for a 10-day review. It was pleasing to note at this time that:
- The patient had progressed to walking without crutches
- Mild tenderness remained, but swelling had significantly reduced
- He reported some clicking in both ankles but no major concerns
- The ankle was stable, and he was recovering well
Due to the decreased pain, the moon boot was swapped for a lace-up ankle brace, which provided support while allowing more natural movement.
As the patient still had some decreased movement and a past history of ankle sprains, a referral to physiotherapy was provided to rebuild strength, balance, and minimise the risk of further injury.
He was advised not to start rugby training again until the physio was happy with his progress.
A follow-up was recommended in 3 weeks if recovery didn’t progress.
The patient called and cancelled this follow-up appointment as he was progressing well, had minimal pain and swelling, and his limp had resolved. His physio was happy with his progress, and he had completed a non-contact light training session without concern.
Key Takeaways for Patients
It is important to be aware that ankle injuries can rapidly swell and cause significant bruising even in relatively minor injuries. This can make patients very concerned about a fracture or a significant ligament injury. An accurate, early assessment can help minimise the stress related to these injuries, and with orthopaedic advice, unnecessary scans can be avoided.
Bracing and physiotherapy are very effective in most ligament sprains; physiotherapy helps prevent long-term instability and repeat sprains.
Access Ortho offers support through every phase of ankle sprain recovery. Access Ortho offers rapid orthopaedic appointments for acute injuries, ensuring patients get quick answers, which will help minimise uncertainty following an injury.