CNY Orthopedic Sports Medicine, PC: Article: Ankle Sprains

 

Ankle Sprains
Evan Herold
ActiveLifeNetwork
Copyright 2000

What is a sprained ankle? Ankle sprains commonly occur during sports and other daily activities. Why? When we walk, run, jump, or jog, in short - move our feet, ligaments that surround and protect the ankle are stretched. And, when stretched, these ligaments are more susceptible to injury. A sprain occurs when one of these ligaments is over-stretched and damaged.

The ankle joint is made up of three bones: the tibia, fibula and talus. The tibia is the larger of the two lower leg bones. The bony protrusion located on the inside of the lower leg (tibia) is known as the medial malleolus or medial ankle bone. The fibula is the smaller of the two lower leg bones. The bony protrusion located on the outside of the lower leg (fibula) is known as the lateral malleolus or lateral ankle bone. The talus is the upper-most bone of the foot. The tibia and fibula "house" the talus by forming a wall around the talus. The tibia forms the medial or inside wall and the fibula forms the lateral or outside wall.

The ankle is the point where the lower leg bones come together with the talus. The ankle joint is connected by both medial and lateral ligaments, which connect the bones together. The ligaments help provide stability while muscles pull the bones in a specific direction. Tendons attach the muscles to the bones.

How does a sprained ankle occur? The most common cause of a sprained ankle is a twisting injury. Sprains commonly occur during sports as a result of trauma. Remember, a sprain is an injury to a ligament. There are 3 main ligaments that help provide stability to the outside of the ankle. During a sprain, the ankle is twisted either in an inward or outward fashion. Ninety five percent of the time, the ankle will be twisted inward or inverted (which means to roll over). This causes the outside edge of the foot to have to absorb all the weight of the body. As the foot rolls, the ligaments are stretched tight, much like a rubber band. Finally, the ligament cannot stretch any further and it tears. The ligament may be partially torn or completely torn.

Why does a sprained ankle hurt so much? The pain associated with a sprain is due to inflammation that occurs when ligaments are damaged. During the first 2-3 days, swelling and inflammation play an important role in the body's ability to "clean up" the injured site and allow healing. However, to decrease pain and speed up the healing process, you should control the amount of swelling as quickly as possible.

The amount of pain and swelling you have is a good indication of how severe the injury is. Reoccurring pain (when walking or doing other activities that involve putting weight on the ankle) is due to the injured ligaments. These ligaments are damaged, weak, and sensitive to motion and weight bearing. Let pain be your guide as you put weight on your ankle and gradually increase activities.

What should I do about mild to moderate pain? Pain can be classified as mild, moderate, and severe. If daily activities cause mild to moderate pain, you could be causing more damage to the ankle ligaments - which can prolong your recovery. During the first 2-3 weeks after the injury, wear a brace with all weight-bearing activities to control pain, provide stability and improve function. Early in your recovery, crutches may be needed for pain-free walking. Your physician or physical therapist can provide you with specific guidelines on how to use crutches and other rehabilitation measures. Please consult them if you have any questions.

What are the signs and symptoms of a sprained ankle? Typically, patients complain of two or more of the following:

  • Immediate pain at the time of the injury.
  • Noticeable swelling immediately after the injury.
  • Bruising over the injured bone and around the ankle joint, which may continue to get worse over the first 24-48 hours.
  • Pain with weight-bearing or any attempt at walking.
  • Decreased range of motion of the joint.

    How is a sprained ankle diagnosed? Your physician will ask you many questions about your injury. For example how did your injury occur, did your ankle swell immediately, can you move your ankle...things that will help determine the diagnosis. He will also physically examine your ankle and take several X-rays.

    How is a sprained ankle treated? Your physician will coordinate a rehab program for you based on the severity of your sprain. Immediately after your injury, initiate the PRICE (Protect, Rest, Ice, Compress, Elevate) treatment method described below. If you have not gained full function of your ankle after 2-3 weeks, you may need additional therapy. Your initial goal is to control pain, reduce inflammation and swelling, and protect the injured ankle.

    PROTECT: For the first 2-3 weeks, wear an ankle "stirrup brace" to protect the ankle when you walk and during all weight-bearing activities.

    REST: Rest means that you restrict or limit your activity always using pain as your guide. You will not be able to participate in activities that require bending, stretching or walking on the ankle for a limited amount of time. Your physician will discuss this with you and outline your restrictions.

    ICE: While resting, apply ice or cold therapy to limit the swelling and reduce the pain. This may be accomplished by using a cold pack, cold therapy device or a frozen bag of peas. Apply the ice for 20 to 30 minutes, 3-4 times a day for the first 72 hours or until the pain and swelling goes away.

    COMPRESSION: Research has determined that one of the most effective ways to reduce swelling is to apply compression to the swollen area. Apply an elastic wrap to help control the swelling. Always begin wrapping the elastic wrap at the mid foot area, continuing in an upward fashion, ending at approximately the mid calf area. This promotes circulation and helps to decrease swelling. It is important that the wrap isn't too tight. If you are uncertain if it is wrapped too tightly, loosen the wrap immediately.

    ELEVATION: Elevate your ankle by placing a pillow under your leg while resting. Raise your ankle above the level of your heart. This position allows gravity to help reduce the swelling.

    MEDICATIONS: Your physician may prescribe either an anti-inflammatory drug or pain medication depending on your injury. An NSAID (non-steroidal anti-inflammatory medication) such as Advil or ibuprofen can help reduce the pain, inflammation and swelling. Follow the instructions of your physician regarding the amount and frequency of this medication.

    Crutches may be recommended to reduce the pressure that is placed on the ankle joint during ambulation. A physical therapist or other caregiver should provide gait instruction before you attempt to use the crutches. If you experienced a moderate to severe sprain, you may need to continue with a physical therapist for a more extensive rehabilitation program. This will help you regain the motion and strength in your ankle. It is not uncommon for more severe ankle sprains to require additional therapy. Your rehabilitation program may include one or more of the activities listed below. You may need to limit activity initially, until the pain and swelling has subsided. Gradually increase activity as tolerated. Range of motion exercises will help you regain the motion in your ankle joint.

    Strengthening exercises for the muscles surrounding the ankle. Balance and proprioception exercises may be added during the final stages of your rehabilitation. Your physician may recommend some type of ankle brace be worn as you begin to increase your activity. There are braces to help alleviate swelling and braces that will help provide stability to the joint. Returning to activity to soon can cause permanent damage to your ankle. Follow

     


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