Sprained Ankle
There is a wide spectrum of injuries and degenerative diseases that can affect the ankle joint. Like the knee, it must support the load of the entire body. The capsules and ligaments are most commonly affected, typically by injuries involving twisting or turning the ankle on uneven surfaces, and during high-risk sports like soccer and tennis.
The ankle joint connects the shin (tibia) to the foot via two joint structures:
the upper ankle, or talocrural joint (tibia, fibula, talus)
the subtalar joint (talus, calcaneus, tarsal bones).
The upper ankle joint is stabilized by strong ligaments on either side, as well as by the capsule.
There are three important ligaments on the outer side of the ankle, a fan-shaped ligament on the inner side, and a strong ligament connecting the tibula to the fibula (the so-called syndesmosis).
Further information about the ankle joint can be found on the following pages.
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as of: august 2010
Symptoms
After twisting an ankle, there is usually extreme painfulness on the either the outer or inner side of the ankle accompanied by swelling, which does not necessarily relate to the degree of injury.
Weight bearing is often painful and mobility is limited.
Bruising and discoloration can often be seen after several hours, and in rare cases there are open superficial wounds.
as of: august 2010
Diagnosis
The mechanism of injury and the intensity of direct or indirect force can help to indicate which structures have been injured.
An in-depth clinical examination and special tests of ligaments, tendons, and so forth allow physicans to make a fairly precise initial diagnosis.
An x-ray examination is necessary to exclude the possibility of broken bones. Controlled x-rays are usually not a good idea for freshly ruptured ligaments, since muscular tension is so high that dependable results are only possible under local anesthesia. In addition, controlled x-rays may increase the damage.
An ultrasound examination, and sometimes an MRI exam, can help evaluate the ligaments, capsule, tendons, and possible hemorrhaging more precisely.
This allows the severity of the injury to be determined.
as of: august 2010
Treatment
During the acute phase directly after injury, it is best to treat according to the RICE principle (Rest, Ice, Compression, Elevation).
Further treatment addresses instability, tissue damage, and possible secondary injuries (e.g. cartilage/bone).
Indications for surgery are:
significant instability
rupture of the syndesmosis
injuries to cartilage/bone
massive soft tissue damage
open wounds
chronic instability (for example following insufficient treatment)
The goal of surgery is to create an anatomically correct reconstruction of the ligaments through:
stitching of the ligament (Bandnaht)
periosteal flaps (Periostlappen)
rarely tendon grafts may be required
However, surgery is rarely necessary, and most injuries can be treated conservatively.
as of: august 2010
Follow-Up Treatment
Immobilization always requires some form of outer stabilization, the duration of which depends on the degree of instability, tissue damage, and on the type of surgery that was carried out. Two to six weeks of stabilization are recommended using an ankle brace or athletic tape (after the swelling goes down), depending on the severity of the injury.
Proprioceptive and prontation training is also necessary to help the body the repaired ankle. This means strengthening and limbering of the muscles that surround and protect the ankle joint.
as of: august 2010
