Ankle Sprain

Brief Outline of Ankle Sprain

Anyone involved in athletics is susceptible to an ankle sprain, an acute injury to any or all of the ligaments that support that support the ankle structure. Tearing or stretching of the ligaments can occur when the foot is rolled either medially or laterally, or twisted forcefully. High impact sports involving jumping, sprinting or running on changing or uneven surfaces often lead to ankle sprains. Basketball, football, cross country, and hockey are a few of the sports commonly associated with ankle sprains.

Anatomy and Physiology of Ankle Sprain

Lateral ankle sprains commonly occur when stress is applied to the ankle during plantar flexion and inversion, injuring the anterior talofibular ligament. The medial malleolus may  act as a fulcrum to further invert the calcaneofibular ligament if the strain continues. The peroneal tendons may absorb some of this strain. Medial ankle sprains are less common, because of the strong deltoid ligament and bony structure of the ankle. The ligaments are stretched beyond their normal range and some tearing of the fibres may occur. Forceful twisting or rolling of the ankle, as with landing on the outside of the foot, can stretch the ligaments past their stretch point.

Cause of Ankle Sprain

Sudden twisting of the foot. Rolling or force to the foot, most common laterally.
Ankle Sprain

 

Signs and Symptoms of Ankle Sprain

First-degree sprains: Result in little or no swelling, mild pain, and stiffness in joint.

Second-degree sprains: Commonly exhibit more swelling and stiffness, moderate to severe pain, difficult with weight bearing,  and some instability in the joint.

Third-degree sprains: Result in severe swelling and pain, inability to bear weight, instability in the joint, and loss of function in the joint.

Complication if Left Ankle Sprain Unattended

Chronic pain and instability in the ankle joint may result if left unattended. Loss of strength and flexibility, and possible loss of function may also result. Re-injuring the joint is much more likely as well.

Immediate Treatment for Ankle Sprain

R.I.C.E. Second- and third-degree sprains may require immobilisation and should seek medical attention immediately.

Rehabilitation and Prevention for Ankle Sprain

Strengthening the muscles of the lower leg is important to prevent future sprains. Balance activities will help to increase proprioception (the body’s awareness of movement and position of the body), and strengthen the weakened ligaments. Flexibility exercises to reduce stiffness and improve mobility are needed also. Bracing during the initial return to activity may be needed but should not replace the strengthening and flexibility development.

Long-term Prognosis for Ankle Sprain

With proper rehabilitation and strengthening, the athlete should not experience any limitations. A slight increase in the probability of injuring that ankle may occur. Athletes who continue to experience difficulty with the ankle may need additional medical interventions, including, in rare cases, possible surgery to tighten the ligaments.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat Ankle Sprain today.

Ankle Fracture

Brief Outline of Ankle Fracture

The ankle joint is one of the most commonly injured joints in the body. The majority of athletes have experienced at least a minor sprain of the ankle. Ankle fractures are less common, but nonetheless more common than other fractures. Due to the ankles involvement in all running and jumping activities, it is very susceptible to injury. Running or jumping on uneven or changing surfaces can lead to ankle fractures. High impact sports such as football and rugby, where the possibility of forceful twisting of the ankle may occur, also have a high incidence of ankle fractures.

Anatomy and Physiology of Ankle Fracture

Ankle Fracture

The ankle joint, is a hinge joint, and comprises the tibiafibula, and talus bones. The ankle joint articulates between the distal tibia, the medial malleolus of the tibia, the lateral malleolus of the fibula and the talus. These bones are held together by a series of ligaments. In an ankle fracture, any or all of the bones and ligaments may become involved. Ankle fractures most commonly involve the ends of the tibia or fibula, or both, with some ligament stretching and tearing present as well.

Cause of Ankle Fracture

Forceful twisting or rolling of ankle can cause the end of the bones to fracture. Forceful impact to the medial or lateral side of the ankle while the foot is planted.

Signs and Symptoms of Ankle Fracture

Pain to touch. Swelling and discolouration. Inability to bear weight. Deformity may be present in the ankle joint.

Complication If Left Ankle Fracture Unattended

An ankle fracture that is left unattended can result in incorrect or incomplete healing of the bones. Continued walking or running on the injured ankle could result in further damage to the ligaments, blood vessels, and nerves that pass through the joint.

Immediate Treatment for Ankle Fracture

Stop the activity. Immobilise the joint and apply ice. Seek medical attention.

Rehabilitation and Prevention of Ankle Fracture

While the ankle is immobilised, it is important to keep conditioning levels up by using upper body exercises and weight training. When cleared for the activity with the ankle, strengthening and stretching of the muscles of the lower leg is essential for a speedy recovery. An ankle brace may be needed for support during the initial return to activity. Stronger calf and anterior muscles help support the ankle and prevent or lessen the incidence of injuries. Avoid running and jumping on uneven surfaces as much as possible.

Long-term Prognosis for Ankle Fracture

Although people who have fractured their ankle tend to have a slightly higher rate of re-injury, proper strengthening and rehabilitation usually lead to a full recovery. Compound fractures or those in misalignment may require surgical pinning to hold the bone in place while it heals.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat your Ankle Fracture today.

Brief Outline of Peroneal Tendon Subluxation

Peroneal tendon subluxation (dislocation) is most commonly a chronic condition that develops after a sprain or fracture. The tendon moves out of the groove in which it is supposed to sit due to damage to the structures designed to hold it in place. Pain on the lateral side (outside) of the ankle and a popping sensation may be signs of this condition. Running and jumping can cause repetitive stress to the tendon, especially when it is dislocating repetitively.

Anatomy and Physiology of Peroneal Tendon Subluxation

The tendons of peroneus longus and peroneus brevis run from the peroneal muscles to the foot. They pass around the lateral malleolus through a groove in the bone. They are held in this groove sheath that is reinforced by a band of ligament. When this ligament or sheath is damaged, it reduces the stability of the tendons, allowing movement out of the groove. Some people are predisposed to this injury due to a shallow, or non-existent groove where the tendons lie. Peroneal tendon subluxation may occur also if the tip of the lateral malleolus is fractured with forces dorsiflexion, or a direct blow.

Ankle Peroneal Subluxation

 

Cause of Peroneal Tendon Subluxation

Tearing or stretching of the ligaments that support the tendons, usually due to an ankle sprain or fracture. Repetitive stress to the tendons, causing inflammation and swelling, allowing the tendons to slide out of the groove.

Signs and Symptoms of Peroneal Tendon Subluxation

Pain and tenderness along the tendons. Popping or snapping sensation on the lateral side of the ankle. Swelling may be noted along the bottom of the fibula.

Complications If Left Peroneal Tendon Subluxation Unattended

The peroneal tendons become irritated when they dislocate, which causes inflammation. This inflammation an lead to tearing or complete rupture of the tendons if left untreated.

Immediate Treatment for Peroneal Tendon Subluxation

R.I.C.E. Anti-inflammatory medication. Possible immobilisation, especially with acute dislocation. Seek medical attention.

Rehabilitation and Prevention of Peroneal Tendon Subluxation

Strengthening of the muscles in the lower leg after pain subsides and normal function returns will help support the tendons. Treating ankle sprains properly will help prevent subluxation. Strong calf and shin muscles will help support the whole foot and ankle structure, preventing this condition as well.

Long-term Prognosis for Peroneal Tendon Subluxation

When treated promptly, subluxation of the peroneal tendons usually responds well to non-surgical techniques. In some cases, surgery may be required to repair the sheath and ligaments that cover the tendon to restore stability.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to see our ankle specialist regarding your Peroneal tendon Subluxation today.

An injury to the ankle will have an impact on the other muscles in the lower limb because it is a weight-bearing structure. As a result, ankle injuries usually cause weakness and muscle imbalance to the lower limb which needs to be corrected.

The ankle joint is a complex hinge joint joining the foot to the lower limb. It plays a key role in walking, running and jumping, and without a stable and pain-free ankle, these activities will be impaired. As the ankle is a weight-bearing structure, an injury to the joint or surrounding muscles and tendons will often cause an altered gait (walking) pattern. Even if this altered pattern is only for a short time, this will have an impact on the other muscles in the lower limb, often causing weakness and muscle imbalance which needs to be corrected.

Common ankle injuries include:

  • Achilles Tendonitis – inflammation of the tendon at the back of the heel and lower leg, normally worse immediately upon standing, an.d can be worse with walking, running etc.
  • Instability – weakness of the muscles and ligaments around the ankle joint making it less stable and more susceptible to injury if not treated.
  • Ligament sprain – damage to the ligamentous tissue that surrounds the joint which maintains stability.
  • Fracture – fracture of the bones around the lower leg at the ankle joint

Treatment for Ankle Injuries Include:

The Aim of the Treatment for Ankle Injuries are:

  • Reduce pain and inflammation
  • Increase range of motion
  • Improve strength, balance and proprioception of affected limb
  • Help in gait re-education
  • Allow integration of exercises into full body conditioning
  • Allow safe and efficient return to sports

 Call (+65) 6471 2674 (24 Hour) to make an appointment to treat your ankle injury today.

Ankle Sprain

Ankle sprains account for 12% of sports injuries in schools and 11% of all football injuries. While the majority of ankle sprains recover without long-term implications, up to 30% give rise to residual pain, and 20% result in an unstable ankle.

The Anatomy and Mechanics of an Ankle Sprain

Ankle Sprain

An inversion injury is the most common mechanism by which an ankle is sprained. In this situation, the ankle rolls inwards while the toes are pointed downwards towards the ground. In a mild injury, ligaments are stretched but not torn. In more severe inversion ankle sprain, the most commonly torn ligament is the anterior talofibular ligament or ATFL. In addition, the calcaneofibular ligament or CFL may also be torn.

The most commonly understood function of a ligament is to keep the joint stable (mechanical function). The ligament prevents the joint from moving in directions it is not designed to, and also keeps the range of motion of the joint within normal limits. What is less commonly appreciated is that the ligament also has a sensory function. In the example of an ankle, as the ankle starts to roll over, the ligament tightens and nerve signals are sent to the nervous system to alert it that an ankle sprain is about to occur. Nerve impulses are then sent to the appropriate muscles (peroneal muscles) to contract, in order to prevent an ankle sprain.

Unlike some ligaments of the knee which have no ability to heal, ankle ligament tears do routinely heal.

However, healing usually results in a ligament which is elongated and too lax to serve its mechanical function effectively.

The sensory function is also impaired resulting in disruption of the ligament.

Treatment for an Ankle Sprain

With an inversion as a mechanism of injury, besides an ankle ligament injury, fractures around the ankle or foot may also result. When a healthcare professional is consulted after an ankle sprain, he or she will assess for the likelihood of a fracture and if this is suspected, X-rays may be necessary.

Once it has been ascertained that the sprain has resulted only in a ligament injury, immediate treatment is with RICE therapy:

  • Rest
  • Ice
  • Compression
  • Elevation

These measures reduce swelling and inflammation at the injury site. Early return to daily activity has been found to reduce the duration of rehabilitation necessary before resumption of sports. As such, unless pain and swelling preclude walking, immobilisation in a case and the use of crutches is usually avoided.

Once initial pain and swelling has been managed, rehabilitation with physiotherapy will begin. Bearing in mind the mechanical and sensory function of ankle ligaments, physiotherapy focuses on restoring these. For the mechanical function, strengthening of the peroneal muscles allows to compensate for lax ankle ligaments. In order to restore the sensory function, balance training is insituted.

Once satisfactory rehabilitation has been achieved, return to sports with a brace or ankle taping is allows. The function of the brace or tape is two-fold. Firstly, these devices prevent the ankle from excessive range of motion which may predispose to an ankle sprain. The second role is to augment the sensory function of the ankle ligaments. Information regarding the position of the ankle is transmitted to the nervous system through the skin as the brace or tape heightens the skin’s ability so sense ankle motion as different areas tighten with different ankle positions.

Approximately 80% of people who suffer ankle sprains return to their chosen sport at the preinjury level. The remaining 20% continue to have ankle instability and suffer frequent sprains despite adequate physiotherapy. This group would benefit from ankle ligament reconstruction (ankle stabilisation).

Ankle Ligament Reconstruction

Many different methods have been described for ankle ligament reconstruction. The method usually employed is termed an “anatomic reconstruction” as it recreates the position of the native ATFL and CFL, usually using the actual ligaments themselves. This method gives the best outcome in terms of ankle stability and ability to return to sports.

Recalling how ankle ligaments heal in an elongated fashion, surgery aims to shorten the ligaments to the original length.

The stretched-out ligament is divided in the mid-portion and stitched in a shortened position with the ends overlapping each other.

After surgery, the ankle is protected first in a plaster cast then a walking boot for a total of six weeks. This is the time it takes the shortened ligament to heal. Following this, physiotherapy is started with a protocol similar to that of an ankle sprain to restore the mechanical and sensory function of the ankle. Return to sports is expected, usually, in three months.

Conclusion

The majority of ankle sprains recover without long-term consequences. Some persist to give chronic ankle instability and recurrent sprains. For this group, ankle ligament reconstruction is an effective method of stabilising the ankle to allow return to sport.

Do

  • Tape or brace an ankle that has recovered from an ankle sprain or return to sport as this reduces the risk of further injuries.
  • Seek medial attention for an ankle that is unstable or if you experience frequent ankle sprains. Recurrent ankle sprains may result in cartilage damage, which is a precursor to ankle arthritis.

Don’t

  • Ignore a severe ankle sprain especially if walking is difficult. It could be an indication of a problem more severe than a ligament tear, for example an ankle fracture.
  • Resume sports without adequate recovery and rehabilitation following an ankle sprain. This could lead to long-term problems such as pain and recurrent sprains.

Call +65 6471 2674 (24 hr) to fix an appointment to see our orthopaedic specialist for your ankle sprain today.