ANKLE SPRAIN

Overview

An ankle sprain is one of the most common injuries encountered in orthopedics.

The injury occurs when accidentally we twist the ankle inward as a sudden or unexpected movement. 

Commonly seen in athletes, dancers, walking on uneven surfaces or wearing faulty footwear.

This can lead to stretch or tear of the ligaments depending on the severity of the injury.

Sprained ankles most commonly involve injuries to the ligaments on the outer side of the ankle. It can take several weeks or months for a sprained ankle to heal completely.

Movement at the Foot & Ankle Joint

Inversion (Supination):

The inversion movement is the medial border of the foot where the sole faces medially.

 

Eversion (Pronation):

The eversion movement is the lateral border of the foot where the sole faces laterally.

 

Dorsiflexion:
Dorsiflexion of the foot involves moving the top of the foot towards the shin.

 

Plantar Flexion:
Plantar flexion of the foot is the opposite movement of the Dorsiflexion otherwise known as pointing your toes down.

Mechanism of Injury

Mechanism of Injury Ligaments Affected
Inversion & Plantarflexion -Anterior talofibular ligament
-Calcaneo-fibular ligament
-Posterior talofibular ligament
Eversion -Posterior tibiotalar ligament
-Tibiocalcaneal ligament
-Ttibionavicular ligament
-Anterior tibiotalar ligament
External Rotation & Dorsiflexion          -Anterior-inferior tibiofibular ligament
-Posterior-inferior tibiofibular ligament
-Transverse tibiofibular ligament
-Interosseous membrane
-Interosseous ligament
-Inferior transverse ligament                   

Causes & Risk Factors

Any injury that stretches or traumatizes the ligaments can sprain the ankle. Some of the common causes of the sprain are:

 

Falling 

Falling can twist the ankle and the ligaments that support it. People with medical conditions like osteoporosis are more vulnerable to falls. 

 

Sedentary lifestyle 

A sedentary lifestyle does not cause sprains, but it may increase the risk of soft tissue injuries. This is because not getting enough exercise can weaken the muscles and soft tissue with time. Having weak muscles makes it easier for an injury to occur.

 

Overuse

Overuse of the ankle such as by playing competitive sports can cause tiny tears in the ligaments, tendons, or muscles. This increases the risk of injury following a fall or blow and may cause ligament damage that sprains the ankle.

 

Previous ankle sprain

An ankle sprain that does not heal correctly may cause another sprain. In some cases, a sprain changes the way a person walks, therefore increasing the risk of additional falls and injuries.

 

Uneven surfaces

Walking or running on uneven surfaces or poor field conditions may increase the risk of an ankle sprain.

 

Symptoms

  • Pain with weight-bearing (may or may not be able to bear weight)
  • Swelling & Ecchymosis (Skin Bruising)
  • Recurrent Instability
  • Stiffness
  • Catching or popping sensation may occur following recurrent sprains

Diagnosis

 

Physical Examination

  • Palpate:

The doctor will gently press around the ankle to determine which ligaments are injured.

 

  • Range of motion: 

Doctors may also move your ankle in different directions; however, a stiff, swollen ankle usually will not move much.

 

X-Ray

This test is good for ruling out bone fractures.

 

Magnetic resonance imaging (MRI)

MRIs use radio waves and a strong magnetic field to produce detailed cross-sectional or 3-D images of soft internal structures of the ankle, including ligaments.

 

 

 

CLASSIFICATION OF LOW ANKLE SPRAINS

Ligament disruption Ecchymosis and swelling Pain with weight-bearing
Grade I None Minimal Normal
Grade II Stretch without tear           Moderate Mild
Grade III         Complete tear Severe Severe

 

Treatment

The RICE protocol. Follow the RICE protocol as soon as possible after your injury:

Rest your ankle by not walking on it.

Ice should be immediately applied to keep the swelling down. It can be used for 20 to 30 minutes, three or four times daily. Do not apply ice directly to your skin.

Compression dressings, bandages or ace wraps will immobilize and support your injured ankle.

Elevate your ankle above the level of your heart as often as possible during the first 48 hours.

 

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling. 

Because they improve function by both reducing swelling and controlling pain, they are a better option for mild sprains than narcotic pain medicines.

 

Physiotherapy

Early Mobilization

-To prevent stiffness

-Range of motion exercises

-Without resistance

 

Strengthening Exercises

-Treadmill

-Hydrotherapy

-Thera-band exercises

 

*Strengthening exercises are prescribed when the patient can bear weight without an increase in pain or any other associated feature.

 

Assistive Devices

Crutches

-Walking may be difficult during the initial few days.

-Patient will be prescribed to use crutches to avoid weight-bearing

 

Air-cast

-Mild sprains may require a short period (approx. 1 week) of weight-bearing immobilization in a walking boot, air-cast or walking cast, but early mobilization facilitates a better recovery

 

Surgical Management

Surgery for sprained ankles is rarely performed. In cases when the damage is severe and not responding to the conservative management or is accompanied by instability, surgery may be required.

 Surgical options include:

  • Arthroscopy: During an arthroscopy, a surgeon looks inside the joint to see if there are any loose fragments of bone or cartilage.
  • Reconstruction: For reconstruction surgery, a surgeon will repair the torn ligament with stitches. They may also use other ligaments or tendons around the foot or ankle to repair the damaged ligaments.

The type of surgery needed will depend on the severity of the ankle sprain and the activity level. 

After surgery, rehabilitation is an important part of the recovery process. 

 

Prevention

  • Warm-up before you exercise or play sports.
  • Be careful when walking, running or working on an uneven surface.
  • Use an ankle support brace or tape on a weak or previously injured ankle.
  • Wear shoes that fit well and are made for your activity.
  • Minimize wearing high-heeled shoes.
  • Maintain good muscle strength and flexibility.
  • Practice stability training, including balance exercises.