The most common injury that occurs to the ankle is called a sprain. Sprains in general occur when a joint is moved beyond its normal range of motion usually by body weight or some external force, causing disruption of the stabilizing soft tissues around the joint known as ligaments.
Ankle and foot sprains can be classified as mild, moderate or severe, and often referred to as Grade I, II or III. They are not as painful or injurious as fifth metatarsal fractures.
The most commonly injured ligaments are located on the outer aspect of the ankle due to the direction of twisting that occurs when an ankle is injured.
The normal injury mechanism for foot sprains is one of stepping on uneven surfaces, a hole in the ground, another person’s foot (as in landing while playing jumping sports). The typical anatomical motion is one of inversion and plantar flexion and visually the ankle is pointed down and twisted inward.
The patient experiencing a significant ankle sprain will report a "pop" in the ankle followed by immediate and significant pain with difficulty walking. The ankle will then usually swell considerably and initially this swelling is confined to the lateral malleolar (outer ankle bone) region.
It is usually feasible to recommend foot sprains be evaluated by your physician. During this evaluation, a history and exam are conducted to insure that a sprain is truly what did occur. Often times X-rays are ordered to rule out any small fifth metatarsal fractures that would be better managed with specific types of immobilization. X-Rays are not mandatory but recommended, especially in the more moderate to severe sprains.
As with most soft tissue injuries less serious than fifth metatarsal fractures, the best protocol includes rest, ice compression and elevation or R-I-C-E. Rest would include minimal to non weight bearing with crutches and possibly a brace or immobilizer depending on severity. Ice initially is best provided with a conforming bag of crushed ice directly over the injury site. Placing a foot and ankle in an ice bath is not always recommended for foot sprains early on due to the leg being in a down position, allowing the swelling to "pool" in that area. Compression should be performed with an elastic bandage beginning at the base of the toes, spiraling up the foot, ankle and calf, taking care not to provide too much compression and not leaving any skin exposed in the area of the injury or below. This allows the swelling to be pooled in the exposed area. Elevation is always recommended with the limb kept well above heart level as much as possible. In the more moderate to severe foot sprains, this program should be performed AMAP during the first week post-injury.
Physical therapy is usually recommended for either a basic home exercise program in the milder injuries and more involved in the higher severity foot sprains. PT can assist the patient in regaining all necessary range of motion, strength, body awareness and balance correction (proprioception) and progression safely back to desired activities.
The incidence of recurring ankle sprains in those instances where the initial sprain was moderate to severe can be high. The main stabilizing forces for an ankle are ligamentous. Ligaments are non-elastic stabilizing structures that become stretched and damaged in a sprain. As a result of this the inherent stability of the ankle lessens with each incidence of sprain.
Over time the ankle can become seriously unstable and limit functionality with normal activities of daily living and sports. Choices a patient may make range from limiting activities, wearing an ankle brace, or undergoing surgery.
Surgery immediately after an injury is not considered necessary as fixation is effective if repaired at a later time.
In the event that surgery is necessary to stabilize a chronically recurring ankle sprain the surgeon will repair or reconstruct those stabilizing structures that would have normally provided this stability previously. Once the ligament instability has been corrected, the patient will undergo an initial period of splinting or some form of immobilization to control swelling, pain and allow for appropriate healing of repaired structures. Weight bearing and range of motion is gradually introduced during the healing process with gradual implementation of physical therapy, strengthening, proprioceptive and flexibility training added. The results of ankle surgery are generally excellent.
For more information on how the foot sprains specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!
Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC.