Ankle Injuries

Since the ankles support the entire weight of the body, the ankles are particularly susceptible to injury. An estimated 2 million people are treated for ankle injuires / sprains annually, and ankle fractures are among the most common injuries treated by orthopedists.

Anyone, from the best-conditioned athlete to the most sedentary office worker, can incur an ankle injury. Usually, the cause is accidental-- jogger steps in a pothole; a pregnant woman slips getting out of her car; a weekend rugby player slides awkwardly into a try. Overweight people and women who wear high-heeled shoes are at particular risk for ankle injuries.

Typical ankle injury involves a sudden, usually unexpected, loss of balance, resulting in a sharp twist of the ankle. A strain is when a muscle or tendon becomes over-stretched. A sprain is more serious and involves ligaments (the strong connective tissue that connects one bone to another) that become over-stretched. In some cases a ligament may tear and even pull a fragment of bone with it. When a piece of bone is pulled off the main bone, it is known as an avulsion fracture and must be treated like all other fractures even though the piece of bone is a small portion.

Sprains & Strains

Most ankle sprains and strains are inversion injuries in which the foot twists inward, damaging the lateral ligaments on the outside of the foot. Less common are pronation injuries to the medial ligaments on the inside of the foot, caused by twisting the foot outward.

Sprains are graded on a scale of 1 to 3 - mild, moderate or severe - reflecting the relative amount of tearing to the ligaments. In evaluating such injuries, the physician typically will prescribe X-rays to rule out the possibility of a fracture or dislocation. Treatment usually involves the R.I.C.E approach - rest, ice, compression and elevation:

  • Rest means keeping off the injured ankle as much as possible. Crutches will enable the patient to move about when necessary without placing undue weight on the injury. An air cast or splint may be applied to the ankle for support. Severe sprains occasionally require the application of a hard cast.
  • Applying ice on the injury reduces swelling. The usual routine is to apply ice packs for 20 minutes at a time every hour or so for the first day after the injury, and thereafter as long as swelling persists. 
  • Compression means supporting the ankle and foot with a firmly (but not tightly!) wrapped elastic bandage, compression stocking or gel wrap. If swelling causes the bandage to become tight, it should be loosened immediately. 
  • Elevating the foot above the level of the heart minimizes blood pooling and swelling in the affected area. This should be done as much as possible during the first 48 hours after the injury. 

The physician also may prescribe a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, to reduce pain, swelling and inflammation. Some people experience prolonged swelling. This usually is caused by the formation of excessive scar tissue. The physician may request X-rays to check for small, previously undetected bone fragments or damage to the joints.

With proper treatment, most ankle strains and sprains heal within 2 to 6 weeks. The most severe, such as those requiring the use of a cast may take as long as 12 weeks. A carefully monitored program of physical therapy may be required to restore full muscle balance and strength. This can involve stretching of the Achilles tendon, as well as coordination and speed exercises. During this time, taping or bracing the ankle may be prescribed to give it support until full function is regained.

It is important to note that persons who have experienced an ankle injury are at particular risk of another. This is true not only during the recovery period, but for the rest of their lives. An injured ankle, even though healed, may be unstable and therefore prone to recurrent injury. For this reason, persons who have sustained an ankle injury should take precautions thereafter. Good-quality shoes that provide plenty of stability and support are a prudent investment, and supplemental bracing, such as with a specially fitted elastic wrap, may be recommended.

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