Sprained Ankle

What is Sprained Ankle?

Sprained ankle is a medical condition that occurs when tough bands of tissues or ligaments tear or stretch resulting to pain and injury. Ligaments are tissues around joints that attach bones together to support and stabilize for movement.

Ankle sprain or sprained ankle can occur when the ligaments are used beyond its capacity causing a momentary stretch usually that happen during physical activity or sudden movement. It is the most common form of orthopedic and soft tissue injury caused by even the simple daily activities such as walking and engaging in competitive, contact sports.

People might interchange the terms ankle sprain and ankle strain, but these terms are entirely different. Ligaments are affected in ankle sprain while muscles are inflicted in ankle strain.

Types

Types of ankle sprain should be known in order to apply the necessary treatment for each, though it is possible that a person canhave a combination of one or more sprains in multiple locations of the ligaments.

Inversion

Inversion also known as lateral sprain and this is the most common type and approximately 90% of the cases have this type. This occurs when the foot is inverted too much causing too much stretch on the lateral ligaments affecting the outside of the foot. This is without joint instability. The majority of the swelling will be mainly around outside the ankles and the location and amount of bruising can be varied.

Eversion

Eversion also known as medial sprain and occurs when there is too much stretch on the medial ligament of the foot. This is without joint instability. This injury is common among high activity and contact sports like hockey, football and basketball. The amount of swelling are not marked though in this case, it can be located inside or near the back of the ankle and causing moderate pain.

High ankle sprain

High ankle sprain medically referred s syndesmotic or syndemosis ligament sprain which occurs when the ligaments that attach tibia and fibula (the two long bones of the lower leg) are injured due to forceful outward twisting of the foot. This type of sprain will took a long time to heal, because of the severity and complexity of the injury. Surgery may be required to help restore and repair the affected ligaments before a thorough rehab program is done.

Classification

There are three classifications of ankle sprain, namely Grade 1, 2 and 3. This is depending on the severity of the damage that the ligaments sustained and the force that is applied to the ankle causing the injury.

Grade 1 – Grade 1 occurs as a mild sprain causing little damage and minor stretching on the ligaments.

Grade 2 – In this grade 2 there is minor tearing of the ligament and the ankle joint is moved awkwardly.

Grade 3 – In Grade 3 there is major tearing of ligament present, presence of instability is felt.

Risk Factors

1. Participating in sports can cause ankle sprain as much as the body can be vulnerable to intense force and stretching of ligaments especially those are overweight. Unhealthy playing conditions such as uneven surfaces can also increase the risk of sustaining ankle sprain.
2. Past ankle injuries can also pose a factor increasing the vulnerability of the person to sustain another ankle injury.

Causes

Ligaments can be injured when too much force is used to them and when it is moved beyond its normal range or motion. These are the usual causes of ankle sprain:

1. Poor ankle flexibility
2. Weak tendons that cross along the ankle joint
3. Lax ligaments; can be hereditary or due to overstretching ligaments because of repetitive ankle sprains
4. Didn’t perform a warm up before physical activities
5. Failed proprioception on the joints
6. Slow neuron response to an off-balance postion
7. Planting the foot on an uneven surface causing the ankle to twist
8. Losing balance while wearing high heels
9. Inadequate heel support
10. When playing contact sports, in the event that one player steps on another causing ankle sprain

Symptoms & Signs

The signs and symptoms of inflammation that will occur on ankle sprain are:

1. Swelling of the ankles brought about shifting of fluids from inside the tissues.
2. Pain around the injured area that can be triggered when the affected foot is moved and pressure is exerted on it due to sensitivity of the nerves around the affected area.
3. The area becomes inflamed and warm due to blood pooling on the affected area.
4. Decreased or loss of motion

Diagnosis

Diagnosis can be made through complete medical history including the onset of the symptoms. A physical exam will be performed to confirm signs and symptoms. There will be checking for tenderness and the affected area will be tested for different ranges of motion.

When injuries are severe, the physician may request for some diagnostic tests to evaluate more the injury. These diagnostic tests are:

1. X-ray –  X-ray is the use of small amount of radiation that will pass through your body in order to view the internal structures. This test is good for evaluating presence of fractures or cracks, but less effective in visualizing soft tissue injuries.
2. Bone scan – Bone scan involves injecting a radioactive material intravenously that will enhance viewing and detecting stress fractures.
3. Computerized Tomography –  Computerized Tomography scans are effective since it can reveal more detail on injuries because viewing can be made at different angles and can make cross-sectional images of the body’s internal structures.
4. Magnetic Resonance Imaging – Magnetic Resonance Imaginguses waves and strong magnetic field and is used to visualize soft tissue injuries.

Treatment

Aim of Treatment: To reduce further injury to the ligaments by reducing and keeping swelling, pain and inflammation into a minimum. Sprained ankle management is based on the severity of the injury.

First aid management

For first aid management, it is best to keep the affected area immobilized to prevent further harm to the injured ligaments. A bandage or ankle support may be used to help in immobilization. After immobilization, rest the affected area for 48-72 hours following injury.

Ice applications

Ice applications are also advised 10-30 minutes after injury. Application of less than 10 minutes will have no effect and exceeding 30 minute ice application can damage the skin. It is important to wrap the ice pack in a plastic bag or towel to prevent ice burn. Gentle pressing to the affected part will help reduce blood flow thus limiting pain and inflammation to the site. After the first application, physicians recommend re-applying of cold packs for 15 minutes every two hours for the first 48-72 hours of injury to achieve the maximum desired effect.

Compression with the use of a bandage

Compression with the use of a bandage will help limit swelling. It is important that mild pressure is applied that is to not to impede the blood flow.  Before going to sleep, it is important to remove the bandage. After 48 hours following injury, it is indicated to remove the bandage because it may limit the movement of which the ankle should be moving freely and free from pain. However, there are people who keep their bandages longer to keep their joint more comfortable and decrease further swelling.

Elevation is done to limit swelling. It is advised to keep foot up on a chair at hip level when sitting and when lying on bed, a pillow can be placed under the affected area.

Contraindications

Application of heat within 72 hours after injury would increase the blood flow to the affected area when presently inflammation is developing, so it must be avoided. However, application of heat after 72 hours following injury, heat can be soothing to the affected area.

Ingestion of alcoholic drinks are also must be avoided because this will increase bleeding and swelling thus decreases fast healing.

Further movement may also aggravate the condition and massage within the 72 hours of injury can increase swelling. However, as with heat, massages can be soothing to the area affected.

Other Treatments

Wearing of ankle support while doing daily activities until symptoms are gone can be used to support the healing ligaments. Physicians also suggest that to keep all of the weight on your ankle, use of crutches and walkers can be considered. It also advised to refrain from sports 3-4 weeks after the injury to promote further healing of the torn ligaments.

Uses of medications like over the counter pain relievers such NSAIDs or nonsteroidal anti-inflammatory drugs can relieve pain and limit swelling and inflammation. It is also important to watch out for side-effects of these drugs such as stomach pain and bleeding pain. That is why these medications should be taken after meals to avoid gastrointestinal irritation. Some doctors say that they don’t recommend taking anti-inflammatory painkillers for the first 48 hours because this may delay healing. They implicate that inflammation is a part of the healing process and taking in these painkillers might disrupt it. Use of topical anti-inflammatory painkillers can also be used in treating sprains and there is less risk for side-effects.

Rehabilitation

Rehabilitation exercises for ankle sprains can be done and performed at home to prevent chronic pain and promote healing. An individual can perform stretching exercises before and after physical and vigorous exercises to prevent re-injury.

Ranges of motion exercises are also important for rehabilitation. This involves performing a set of exercises with repetition of 10-30 times and this set is done 3 to 5 times a day. An example of which, is tracing the alphabet with your toe which encourages all directions of ankle movement. Another is sitting on a chair with foot flat on the floor and moving the knee side to side slowly while maintaining the foot flat.

Towel curls can also be performed. This is done by placing a hand towel on a smooth floor and curling the toes around the towel to grab it and continuing to scrunch the entire length of the towel.

Strengthening exercises can be performed when an individual is able to stand without feeling of increased pain. These exercises should be held for at least 3 to 5 seconds with 15-20 repetitions once or twice a day for 2 to 4 weeks. It is done by starting sitting on the floor with fool flat on it and pushing it outward against an immovable object such as a wall.

Complications

If sprained ankle is left untreated or if an individual engaged in an activity, one may experience the following complications:

1. Chronic pain
2. Early onset arthritis
3. Chronic ankle joint instability

Prevention

In order to prevent occurrence or sprained ankle, these are the following steps:

1. Warm up before engaging in exercise and playing sports
2. Be cautious in walking, running on an uneven surfaces
3. Use footwear that are comfortable and made for your activity
4. Be careful when wearing high heels
5. If you are not fit or conditioned for a certain type of sport, don’t engage in it.
6. Practice balancing exercises – Perform exercises that promote muscle strength and flexibility.

Pictures

Pictures of Sprained Ankle

Image of Clinical presentation of Sprained Ankle

Photo of Swelling and redness in Sprained Ankle

Support band pic in Sprained Ankle