Ankle sprains, strains and dislocations are common injuries. However, they may be avoided and remedied by prompt and proper treatment immediately after the injury, and by tackling a specific exercise regimen to help strengthen the ankles and restore "balance" and "proprioception".
What is it?
A strain is a muscle or tendon injury due to over-exertion or stretching while a sprain is an injury to the ligaments and tissue in the region of a joint.
A joint is located where two bones come together and are bound by tissue called a joint capsule. Certain injuries may rip this capsule and allow the bones to
separate and move. When this occurs, the joint is said to be dislocated. For example, when the ankle is injured when twisting inward towards the other foot,
the anterior talofibular ligament may be stretched or torn. This is called an inversion injury. However, if the other two ankle ligaments (the posterior talofibular
ligament and the calcaneofibular ligament), on the outside of the ankle, are also injured the primary bone of the ankle, the talus, can be displaced from beneath the
tibia (the shin bone) and the ankle can "shuck" out of joint - be dislocated. The nerve supply to injured ligaments can also be affected by an ankle injury. These
nerves provide the brain and the ankle and foot, via the brain, with a sense of "position" (proprioception), an idea of where the foot is in space at a given time.
It is therefore critical to re-train the healing ligaments to regain the neural connections required for a stable ankle, during the healing process. Specific exercises can help with this.
Causes
- Any fall or misstep that twists a joint into an unnatural position can result in a sprain or strain
- Dislocations mostly result from a blow, fall or movement that forces a joint beyond its normal range of movement
Diagnosis
A careful physical examination, of the ankle joint and ligaments, by an experienced examiner,
doctor or physiotherapist can accurately grade the injury and an X-ray may be able to determine if a bone fracture has occurred with the injury.
Sprains and strains are divided into three grades:
- Grade 1 - describes a stretching of the ankle ligaments without any visible tearing.
- Grade 2 - describes a partial tearing of the fibres without a complete rupture.
- Grade 3 - is a complete rupture.
Symptoms
- Swelling, pain and discoloration at the sight of the injury.
- An obvious deformity of the joint with the bones at odd angles to each other indicates a dislocation.
Treatment - the RICE approach
For a bad sprain
- Rest - do not allow the person to put weight on the foot and ankle for at least the first 48 hours.
- Ice it - place a plastic bag filled with crushed ice, wrapped in a cloth, on the injured area. Apply ice for 15 minutes of every hour for the first 24 hours after the injury. Immediate icing diminishes the swelling and speeds up healing by decreasing swelling. Heat may be substituted for ice after the first 48 hours.
- Compress - immobilise the ankle by bandaging it firmly but not too tightly. Wrap twice around the foot and continue upwards using figure eight turns.
- Elevate - keep the injured foot elevated higher than your heart.
For a dislocation
- Immobilise and splint the joint in the position you found it - do not try to restore the bone to its joint.
- Apply cold packs and seek emergency medical help immediately - a doctor will be able to manipulate the dislocated bone back into its socket after administering a local anaesthetic.
Proprioceptive and strength training exercises
Early motion exercises of the injured ankle are required to diminish the swelling and prevent ankle stiffness. By carefully identifying which ligaments are injured, proprioceptive
and strengthening exercises may be recommended if within the safe range of motion. However, since ankle injuries occur by rolling the ankle over to the inside, any motion in the
same direction or opposite should be avoided. Straight pointing and flexing of the ankle in a pain free range of motion is recommended 7-10 times daily.
If any of these exercises cause pain, don't do them! All exercises should be performed in an ankle brace to help give support, control motion,
and most importantly to protect the ankle from rolling over again. Surgery is only recommended after trying all the above-mentioned treatment options.
Outcome
The treatment options described above when combined with the necessary strength and proprioceptive exercises usually result in total repair and recuperation.
However, surgery is highly successful for chronically unstable ankles that have not adequately responded to an exercise program. Newly designed techniques that
isolate the repair only to the ligaments and joints involved combined with careful rehabilitation exercises, immediately after surgery, and designed to be compatible
with the surgical procedure, have shown excellent success rates.