Sprained ankle
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| Sprained ankle |
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A sprained ankle, also known as an ankle sprain, twisted ankle, rolled ankle, ankle injury or ankle ligament injury, is a common medical condition where one or more of the ligaments of the ankle is torn or partially torn. The anterior talofibular ligament is one of the most commonly involved ligaments. Sprains to the lateral aspect of the ankle account for 85% of ankle sprains.
Sprains happen when the foot is rolled or turned beyond motions that are considered normal for the ankle. When an ankle is placed on uneven surface or experiences a large force when landing the ligaments can be stretched into an abnormal position. The ligaments of the ankle hold the ankle bones and joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot.[1]
Most sprains occur during shifting after the foot has been planted. In most cases the ankle will roll out as the foot turns towards the inside of the body. Ligaments then stretch or tear depending on the amount of force that was placed on it. This can occur during the fast motions of sports or simply while walking on an uneven surface.
Classification
Ankle sprains are classified as grade 1, 2, and 3.[2] Some of the most common causes of ankle injuries are: lack of conditioning, lack of warming up and stretching properly, previous history of an ankle sprain, inadequate shoes, and uneven ground. [3] Depending on the amount of damage or the number of ligaments that are damaged, each sprain is classified from mild to severe. The amount of force that is placed on the ankle helps classify which Grade of sprain is suffered. A mild sprain or one that causes slight stretching with minimal damage to the fibers in the ligament is considered a Grade 1 sprain. When there is some tearing of the ligament and the ankle joint moves in abnormal ways, it is noted to be a Grade 2 sprain. The final classification is Grade 3 sprain and includes severe injuries. These are ones where complete tears or a ligament and the presence of instability is experienced.
Diagnosis
It is important to either rule out a fracture clinically or radiologically. A sudden movement or twist often when the foot rolls in can overstretch the supporting ligaments, causing ligament tears and bleeding around the joint. This is known as a sprain. This type of injury occurs most frequently in activities that require running, skipping, jumping and change of direction (such as basketball, netball, football/soccer). Some people are particularly prone to recurring ankle sprains.
Sprain, strain or break?
Sprains are stretched or torn ligaments that are injured when the ankle is twisted or rolled, but what is the difference between this and a strain or a bone fracture? With a strain, there is a twist or tear of the tendons in the ankle that connect the muscle with the bones, while a break is a complete fracture or splinter of the bone itself. Sprains are caused by trauma, strains are caused by over stretching or pulling the muscle or tendon, and breaks by excessive force to the area.
Symptoms
Knowing the symptoms that can be experienced with a sprain is important to determine that the injury is not really a break in the bone. When a sprain occurs, blood vessels will leak fluid into the tissue that surrounds the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases as well.[4] Along with this inflammation, swelling from the fluid and pain is experienced. The nerves in the area become more sensitive when the injury is suffered, so pain is felt as throbbing and will worsen if there is pressure placed on the area. Warmth and redness are also seen as blood flow is increased.
Treatment
Conservative measures
Acutely rest, ice, compression, and elevation (RICE) is often recommended.
Ice can help reduce swelling in cycles of 10–15 minutes on and 60–90 minutes off. Icing an ankle too long may cause cold injuries.[citation needed]
An ankle brace can be very helpful for the treatment of a sprained ankle injury. Braces and crutches can be used to help alleviate the pain.
Although found to be less effective than casts, compression bandages provide support and compression for sprained ankles. Wrapping is started at the ball of the foot and slowly continued up to the base of the calf muscle, pushing the swelling up toward the center of the body so that it does not gather in the foot. Bandages are kept tight, but not so tight as to cut off the circulation in the foot.[citation needed]
Immobilization
A short period of immobilization in a below-knee cast or in an Aircast leads to a faster recovery at 3 months compared to a tubular compression bandage.[5]
Rehabilitation
If an ankle sprain does not heal right, the joint may become unstable and may develop chronic pain.[6] Receiving proper treatment and performing exercises that promote ankle function is important to strengthen the ankle and prevent further injury.
It is okay to begin approved exercises not too long after the injury is suffered. The amount of therapy that a person can handle will depend on their level of pain and the grade of sprain they experienced. It is not recommended to return to sports or extreme physical activities until hoping on the ankle is achieved without pain. Wearing high-top tennis shoes may also help prevent ankle sprains if your shoes are laced snugly and if you also tape your ankle with a wide, nonelastic adhesive tape.[7]
Ankle exercises
To prevent sprains or re-injury from occurring, the following exercises can be used to strengthen the ankle. Ankle circles are performed by stretching the legs in front of the body and sliding the ankles up and down, side to side, or rotating the joint in a circle. Another common exercise is using the toes to draw the letters of the alphabet in the air. These promote flexibility and stretches the ligaments in the ankle. Flexing and pointing the toes repeatedly is also effective. Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint.[8] This includes exercises that are performed by standing on one leg and using the injured ankle to lift the body onto its toes.
Prognosis
Most people improve significantly in the first two weeks. Some however still have problems with pain and instability after one year (5–30%). Reinjury is also common.[9]
Image gallery
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Right foot, housed in an air brace, has become swollen as a result of a more severe 2nd degree sprain to the ankle. -
Right foot. A light sprain, two days after injury. Patient had trouble walking normally for 2 months.
References
- ^ Sprained Ankle - American Academy of Orthopaedic Surgeons, Retrieved on 2010-01-22.
- ^ Moreira V, Antunes F (2008). "[Ankle sprains: from diagnosis to management. the physiatric view]". Acta Med Port (in Portuguese). 21 (3): 285–92. PMID 18674420.
- ^ Ankle Sprains Symptoms and Treatment, Retrieved on 2010-01-22.
- ^ Ankle Sprains Symptoms - eMedicineHealth.com, Retrieved on 2010-01-22.
- ^ Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW (2009). "Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial". Lancet. 373 (9663): 575–81. doi:10.1016/S0140-6736(09)60206-3. PMID 19217992.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Sprained Ankle Overview - Webmd.com, Retrieved on 2010-01-22.
- ^ Ankle Sprains: Healing and Preventing Injury - Familydoctor.org, Retrieved on 2010-01-22.
- ^ Sprained Ankle: Treatment and Drugs - Mayoclinic.com, Retrieved on 2010-01-22.
- ^ Margo KL (2008). "Review: many adults still have pain and subjective instability at 1 year after acute lateral ankle sprain". Evid Based Med. 13 (6): 187. doi:10.1136/ebm.13.6.187. PMID 19043045.
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