Ankle Sprains
Definition
The usual ankle injury is a sprain - the tearing or excessive stretching of the ligaments that hold the ankle bones in position.
Description
Of all the joints in the body, none is as complex as the ankle. Its intricate structure of bones, tendons, and ligaments is under the control of an equally complex group of muscles. The variety of movements performed by the ankle subject it to forces of a magnitude far out of proportion to its size. It is little wonder that ankle injuries are the most common of all joint injuries - about 1 million each year, of which approximately 85 percent are sprains. When the ligaments that stabilize the ankle are overstretched or torn, the result is a sprained ankle, one of the most common exercise-related injuries. Although the risk is greatest during workouts that involve explosive side-by-side motion, such as in tennis or basketball, you can sprain an ankle during any weight-bearing activity, including walking. Even sedentary people are vulnerable, since inactivity causes the muscles that support the ankle and protect the ligaments to lose strength and elasticity. Inversion sprains are by far the most common type. These occur when the foot abruptly turns inward, putting tremendous stress on the ligaments on the outside of the ankle. Eversion sprains, with stretching of the inside ligaments when the foot turns outward, are much less common. Mild sprains, in which the ligaments are stretched only slightly beyond their normal limits, usually require minimal attention - if the pain and swelling are so mild as to permit normal weight bearing. More severe sprains are quickly evident, with marked swelling, sharp pain, and evidence of bleeding under the skin. The worst sprain is one producing a complete tear of the ligament, putting the joint completely out of commission. Sometimes what appears to be an ankle sprain is really a fractured bone. This can be of either the end of one of the long bones of the lower leg, the fibula, or a fracture of one of the bones of the foot. Thus, care must be taken with an injured ankle to make sure exactly what is injured.
Symptoms
The symptoms of an ankle sprain are pain, tenderness, and swelling, usually occurring within the first few minutes of the injury. Sprains are graded as mild (the ligament is strained or overly stretched), moderate (partially torn ligament), or severe (a complete tear, meaning that the ligament can no longer control the ankle joint). If the swelling and pain are slight and you can put weight on the ankle, the sprain is mild and you may not need medical attention. If you heard a popping sound when you sprained your ankle, if the ankle looks abnormally bent, and/or if the swelling is severe and the skin discolored, you should suspect a severe sprain or even a fracture and see a doctor or go the emergency room as soon as possible. Not all sprained ankles need to have x-rays to determine the nature of the injury. This depends upon the symptoms and signs as determined by your doctor or other health professional.
Treatment
RICE (rest, ice, compression, and elevation) is the key to rapid healing.
Restthe ankle by reducing activities as needed. Your doctor will probably recommend avoiding weight bearing on the ankle for some time, and the use of crutches. Iceis the immediate treatment for any sprain - the sooner applied the better. The sooner the bleeding into the joint is thus controlled, the less the pain and the quicker the recovery. Apply the ice pack to the ankle 4 to 8 times a day for 20 minutes at a time (not longer due to possible cold injury and frostbite). Compressingthe ankle with tape or elastic bandage helps control the bleeding and swelling, as does Elevationof the foot.
Most sprains heal without complications, although the risk of subsequent sprains increases because of weakened and less flexible ligaments. About ten days is required for healing of a minor sprain, but full motion in the joint takes longer. Rehabilitation includes special exercises to help reduce swelling, prevent stiffness and regain flexibility, and regain strength. It is best to refrain from returning to full activity before complete healing of the ankle has occurred in order to avoid reinjury and possible complications. A moderate ankle sprain may require 3 to 6 weeks of rehabilitation before the area is fully healed, and a severe ankle sprain can take 8 to 12 months.
Prevention
Some tips for avoiding a sprained ankle are:
Before and after exercising, stretch the calf muscles. Tight muscles pull on the Achilles tendon and can reduce the range of motion of the foot.
Strengthen the ankles to avoid strains and to rehabilitate them if you have had an injury.
Try heel walking; wear flat shoes; stand on your heels and keep your toes high off the ground; walk with toes elevated for three to five minutes.
Follow a regular exercise program. Sedentary people are more likely to suffer a sprain than those with strong muscles.
When on your feet, especially if you are walking, wear stable shoes that provide support.
For active sports, most studies suggest wearing snugly laced, high-topped shoes that are protective - not floppy canvas high-tops, but the padded flexible kind worn by basketball players.
Avoid platform soles, high heels, and any shoes that throw the foot off balance. Open shoes and most sandals, which are less stable than other foot gear, are a poor choice for those trying to avoid ankle injury.
A healthy diet helps keep muscles strong.
Questions
Have the ankles been injured? Will I need x-rays to tell what has happened? What is the usual course of treatment? How do you know whether it is a serious injury? What precautions should be taken to avoid sprains? What type of shoes should be worn? Can exercise help in reducing occurrence?
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