 What is it?
A "sprained ankle" is one of
the most common injuries a sports medicine physician encounters. It
is also one of the most poorly understood by lay persons and
health care providers (including physicians), and is often
under treated. A severe ankle sprain, although treated
properly, can still result in chronic instability of the ankle. Fortunately,
most are not severe and with quick and proper treatment these
injuries heal well.
Anatomy
Three
essential ligaments cross the lateral (outside) surface of
the ankle joint and are the most commonly injured with ankle
sprains.
-
Anterior Talofibular Ligament (ATFL)
-
Posterior Talofibular ligament (PTFL)
-
Calcaneo Fibular Ligament (CFL)
Much more uncommonly, however, on the medial
(inside) surface of the ankle joint, the deltoid ligament is
injured.
Mechanisms of Injury
The injury is usually the result to the
ankle turning in, commonly referred to as "going over
the ankle." In squash this can occur with sudden
pivoting or cutting movements. More often the ATFL and
CFL are involved.
Classification of Ankle Sprains
-
First Degree: Most common and often
neglected. The ligaments are stretched, not torn. There
may be minimal to mild swelling and no instability. This
patient usually treats him/herself and simply puts up
with a sore ankle for a week or so.
-
Second Degree: Ankle ligaments are
partially torn and bleeding into the surrounding soft
tissue occurs resulting in ecchymosed (bruising and discoloration). Swelling
and pain may be very minimal initially and gradually
worsen over the next few days peaking within a week. This
degree of tear requires varying degrees of immobilization
and usually 3-6 weeks before the person van resume activities.
-
Third Degree: Most severe and ominous. Represents
complete disruption of at least the ATFL and CFL and
sometimes the PTFL. The ankle is unstable. X-rays
are normal. Healing requires 8 to 10 weeks.
Treatment
In the more mild forms of sprains the best
treatment is known as R.I.C.E. This is an acronym which
stands for Rest, Ice, Compression, and Elevation. The
rest is quite self-explanatory and consists of non-weight bearing
with crutches. The ice should be applied as ice packs,
and these should be applied for the first 72 hours as much
as can be conveniently performed in order to keep the swelling
down. Compression consists of a tensor bandage which
will help to limit the swelling, although occasionally a cast
is required. Elevation must be performed to help keep
the swelling down. This period of compression and elevation
can often take up to 2-3 weeks if the sprain is bad enough. As
the pain subsides an exercise program with physiotherapy can
be started to increase the strength of the ankle and foot muscles. The
advice of physiotherapists or similar knowledgeable individuals
should be sought for proper teaching of these exercises.
Although somewhat controversial it is rare
to operate on even severely sprained ankle injuries. In
the U.S.A., immobilization involving bracing and non-weight
bearing with crutches is usually employed.
Depending upon the situation, the surgical
repair for instability, whether acute or chronic, is a viable
alternative and can be very gratifying.
Prevention
-
Perform stretching exercises.
-
Use proper footwear. Your shoe
should have good lateral support, a relatively low heel
(different from jogging shoes which have a built up heel
and poor lateral stability) and rounded contours to avoid "going
over." Shoes with a higher boot top ("high
cuts") may be indicated for those with chronic instability. Lace-up
ankle supports may be very helpful.
-
Avoid uneven surfaces which might
include anything from your opponents foot to poor court
flooring to uneven training ground.
Deciding on Surgery
If you get repeated ankle spraining easily,
you may need to have your ligaments reconstructed. This
will re-stabilize your ankle and allow you to return to sport
without constantly worrying about re-spraining your ankle. It
is a very satisfying procedure, but like all surgeries, does
carry some elements of risk to it. Discuss these risks/advantages
with your doctor.
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