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Your Foot Book ANKLE SPRAINS
Ankle injures most often occur with the ankle turning inward where the sole of the foot ends up facing the opposite foot as seen in Figure 1. In this case, the ligaments on the outside of the ankle are stressed. The ligaments may me seen in Figure 2 which may be enlarged by clicking on the image. When the sprain occurs the individual may experience a sudden pain or pop which sometimes can even be heard. Swelling may occur very quickly. It is quite possible for an athlete or individual to continue in their sport of activity, however the best course of action is to stop and give basic first aid.
The acronym RICE is an easy way to remember basic first aid for basic strains, sprains and bruises. RICE stands for Rest, Ice, Compression and Elevation. Rest means get off your feet. Use crutches if necessary for as long as it hurts to stand on your foot. Ice means apply cold packs and ice the effected joint to reduce blood flow and consequent swelling. Use ice for the first three days. Don't use heat for at least three days. Compression means use a stretch bandage or other form of compression to reduce swelling and provide joint stability replace that of the torn ligaments. Provide compression for 24 to 48 hours to reduce swelling and consequent bruising. Elevation means rest with the joint elevated above your heart. If you must work or stand try to lie down for a half-hour with your foot elevated two or three times during the day. Keeping your foot elevated above your heart for two to three hours each day will reduce selling and bruising. Fortunately most ankle ligament tears are mild, but it is generally not possible for individuals to tell the exact severity, so a visit to the doctors office within a day or two is appropriate. Tears are classified or graded by physicians according to severity. A Grade I tear is a mild tear that implies a stretching of the ligament where the fibers remain in continuity. A Grade III tear is a complete disruption where the ligament no longer is capable of providing stability to the joint. Surgery is usually needed for a grade three tear. In between, a Grade II tear, is a partial tear with some fibers of the ligament being torn. A physician can usually determine the extent of the injury by physical examination alone. If the injury is mild continued elevation of the ankle and protection from further strain is appropriate. Adhesive strapping or compression sleeves may allow a person to return to normal walking, bicycling, swimming or even jogging and running. Activity that requires pivoting or twisting of the ankle such as dancing, contact sports, tennis, racquetball, etc. should be avoided for a few days to weeks depending upon severity of the injury. You should have your physician, an athletic trainer or a physical therapist strap your ankle. Never tape your ankle circumferentially or around the ankle because increased swelling could cut off circulation or cause further problems. Grade II sprains may require spending two to four weeks in a weight-bearing walking cast in order to allow the ligaments to heal. Fiberglass casts may be used in order to allow continued activity or an athlete to continue to work out and shower afterwards. Grade III tears are treated variously as there is some disagreement among physicians. An X-ray using dye to identify the tear called an arthogram or tenogram is sometimes taken. Treatment may consist of a weight-bearing cast for up to 6 weeks to allow the ligaments to heal. Other physicians are more aggressive about repairing ligaments surgically. After casting or surgery some form of exercise or rehabilitation is necessary to strengthen the ligaments. Typically exercise include isometric and isotonic exercises. Isometric exercises involve contraction of the muscle without movement such as clenching a fist. Isotonic exercises involve using the muscle with movement such as moving a weight a certain distance. In addition to exercises, one should be careful to protect the ankle by increasing stability. There are a number of wraps, compression sleeves, and even air casts that may help accomplish this. High top sneakers or other shoes may not actually prevent further injury, but do seem to help provide some sensation the body uses to tell where or in what position it is in that may reduce the chance of injury. This material does not constitute medical advice. It is intended for informational purposes only. Foot Menders will not answer medical questions via email. Please consult a physician for specific treatment recommendations. |
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