Introduction

After an ankle sprain, have you experienced symptoms such as “The pain has subsided, but there’s still numbness in the top or outer side of my foot” or “The skin sensation remains dull and hasn’t returned to normal”?

These post-sprain sensory abnormalities are commonly experienced by many patients, yet often become chronic due to inadequate management and treatment approaches.

From my clinical experience as a physical therapist, I can say that these symptoms are frequently caused not only by ligament damage but also by peripheral nerve dysfunction, which can be significantly improved with proper evaluation and treatment.

Today, I will explain the neurological symptoms following ankle sprains from anatomical and physiological perspectives, incorporating osteopathic approaches as well.

Classification of Ankle Sprains and Neural Impact

Sprain Severity Classification

Ankle sprains are generally classified into three grades:

Grade I (Mild)

• Microscopic ligament damage (stretching)
• Mild pain with minimal functional impairment
• Neurological symptoms are relatively rare

Grade II (Moderate)

• Partial ligament rupture
• Moderate pain, swelling, and walking difficulties
• Increased frequency of neurological symptom onset

Grade III (Severe)

• Complete ligament rupture with joint instability
• Severe pain and marked swelling
• Nerve dysfunction occurrence rate reaches up to 86%

Why Do Neurological Symptoms Occur?

During a sprain, nerves are damaged simultaneously with ligament injury through the following mechanisms:

1. Direct Traction Injury

• Excessive nerve stretching due to forced inversion and plantar flexion
• Damage to myelin sheath and axons

2. Secondary Compression Disorder

• Physical compression from hematoma and edema
• Decreased nerve function due to inflammatory cytokines

3. Chronic Adhesion and Fibrosis

• Scar tissue formation during the repair process
• Restriction of neural gliding mobility

Major Neural Dysfunction Patterns

Superficial Peroneal Nerve

Anatomical Pathway

• Runs from the lateral compartment of the lower leg to the medial dorsum of the foot
• Provides sensory innervation to the dorsum of the foot (excluding the first web space)

Injury Mechanism

• Traction stress during inversion sprain
• Secondary injury associated with anterior talofibular ligament damage

Symptoms

• Sensory dullness and abnormal sensation on the foot dorsum
• Discomfort around the extensor hallucis longus tendon

Sural Nerve

Anatomical Pathway

• From posterior to the lateral malleolus to the lateral border of the foot dorsum
• Sensory innervation to the lateral aspect of the 5th toe

Injury Mechanism

• Compression from hematoma around the lateral malleolus
• Adhesion associated with peroneus brevis tendinitis

Symptoms

• Sensory abnormalities from posterior lateral malleolus to lateral foot dorsum
• Discomfort when shoes make contact

Posterior Tibial Nerve Branches

Anatomical Pathway

• Branches from posterior medial malleolus to the plantar surface
• Plantar sensory innervation

Injury Mechanism

• Compression from swelling around the medial malleolus
• Thickening of the flexor retinaculum

Symptoms

• Plantar sensory dullness
• Plantar discomfort during walking

Osteopathic Evaluation and Treatment Approach

Importance of Whole-Body Assessment

Based on the fundamental osteopathic principle that “the body is a unit,” we conduct comprehensive whole-body evaluations even for localized symptoms.

Spinal and Pelvic Assessment

• Functional evaluation of L4-S1 nerve roots
• Sacroiliac joint mobility assessment
• Lumbar lordosis status confirmation

Lower Extremity Kinetic Chain

• Compensatory patterns in hip and knee joints
• Evaluation of fascial continuity
• Identification of kinetic chain dysfunction points

Manual Therapy Approaches for the Nervous System

Neural Mobilization

• Improvement of neural mechanical interface
• Graduated approach based on neural tension tests
• Recovery of neural gliding and sliding mobility

Myofascial Release

• Release of lower leg fascial adhesions
• Improvement of soft tissue flexibility around the ankle
• Liberation of fascial restrictions

Craniosacral Approach

• Central nervous system optimization
• Autonomic nervous system balance adjustment
• Normalization of primary respiratory mechanism

Exercise Instruction and Self-Care

Graduated Exercise Program

Phase 1: Tissue Repair Phase

• Gentle range of motion exercises
• Elevation and compression for edema reduction
• Joint range of motion maintenance within pain-free range

Phase 2: Functional Recovery Phase

• Proprioceptive training
• Balance training on unstable surfaces
• Calf muscle strengthening

Phase 3: Functional Integration Phase

• Sport-specific movement patterns
• Graduated plyometric exercises
• Injury prevention education

Daily Life Guidance

• Appropriate footwear selection
• Walking pattern modification
• Environmental adjustments for recurrence prevention

Objective Assessment with Connect AI Posture Analysis

At our clinic, we use the Connect AI Posture Analysis System to objectively evaluate postural changes following sprains.

Post-sprain assessment includes:

• Changes in weight-bearing patterns
• Visualization of postural compensation
• Numerical confirmation of treatment effectiveness

This data allows us to confirm improvement not only subjectively through symptoms but also objectively through measurable outcomes.

Functional Assessment with Foot Look Plantar Measurement

Detailed Foot Pressure Distribution Analysis

• Asymmetry in loading patterns
• Dysfunction during push-off phase
• Balance strategy evaluation

These measurement results serve as important objective indicators of neural function recovery progress.

Evidence-Based Treatment Approach

Our clinic’s approach integrates the research perspective gained as a Master of Health Sciences with osteopathic philosophy.

Evidence-Based Practice

• Clinical application of latest research findings
• Utilization of objective assessment indicators
• Continuous monitoring of treatment effectiveness

Osteopathic Principles

• Maximization of the body’s natural healing capacity
• Emphasis on structure-function interrelationship
• Holistic approach to patient care

Conclusion

Sensory abnormalities and numbness following ankle sprains are frequently caused by mechanical and chemical dysfunction of peripheral nerves, and significant improvement can be expected with appropriate evaluation and treatment.

The key is to maintain a whole-body perspective even when addressing localized symptoms, aiming for integrated neural system functional recovery.

At our clinic, we combine anatomical and physiological knowledge as physical therapists with osteopathy’s holistic approach to provide treatment focused on fundamental functional improvement.

“My sprain should be healed, but the discomfort remains” “The sensation hasn’t returned” “I continue to feel unstable when walking”

If you are experiencing these symptoms, please don’t hesitate to consult with us.

We will support your functional recovery through scientifically evidence-based evaluation and individualized treatment programs.

---

---

#Kyoto #KyotoOsteopathyCenter #Osteopathy #Chiropractic #Pain #Numbness #Paralysis #Posture #Walking #AnkleSprain #PeripheralNerve #NerveDysfunction #PhysicalTherapist #EvidenceBased #FunctionalImprovement