What is ankle sprain?
An ankle sprain is where one or more of the ligaments - tough bands of tissue that help connect or join bones - of the ankle are partially or completely torn.
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Ligaments give support to joints. A ligament can be injured, usually by being stretched during a sudden pull. The ligaments at the side of the ankle are the ones most commonly sprained.
A damaged ligament causes inflammation, swelling and bleeding (bruising) around the affected joint. Movement of the ankle joint is painful when it is sprained. Inversion ankle sprains are the most common, making up 85 per cent of all ankle sprains.
The most commonly torn ankle ligament is on the lateral aspect of the ankle. With an ankle sprain there is soft tissue damage in the ankle area, caused by the ankle twisting inwards or outwards.
The severity of a sprain is graded into:
•Grade I - mild stretching of the ligament without joint instability.
•Grade II - partial rupture (tear) of the ligament but without causing joint instability (or with mild instability of the joint).
•Grade III - complete rupture (tear) of the ligament with instability of the joint. Sometimes this is simply called a severe ankle sprain
How does it occur?
The ankle is a hinge joint between the leg and the foot, and permits up and down movement of the foot. The bones of the leg form a slot, and the bones of the foot fits between them.
The bones of the foot are held to the bones of the leg by strong bands of tissue called ligaments. Each ligament is made of many strands or fibres of a material called collagen, which is extremely tough.
The most common mechanism of injury for an ankle sprain involving the lateral aspect of the ankle is when the foot is forced into a combined inward and downward movement.
All of the body's weight is then placed on the lateral ankle ligaments causing stretch or a tear.
In this situation, the ankle would roll into an outward direction with the foot and toes moving inward toward the middle of the body.
A less common mechanism of injury may also involve a forceful outward movement at the ankle or twisting force on the ankle joint, resulting in injury. Ligaments on the outside of the ankle are those injured in a sprain.
Causes of ankle sprain
A sprained ankle may be caused by a number of different things, such as:
•an accident caused by walking on an uneven surface
•a sudden change in direction while playing sport
•landing awkwardly from a jump
You may also sprain your ankle if you have done so in the past. This may be because the ligaments didn’t heal appropriately the first time, so they are weaker.
Symptoms of ankle sprain
Ankle sprains can differ in severity, so the symptoms also vary. An individual with an ankle sprain may feel pain whenever he touches the area or turn the foot in or out. There may be some swelling in the ankle and the individual may find it a challenge to walk without feeling pain.
If the injury is really severe, the individual might not be able to walk at all due to extreme swelling.
Commonly a loud "pop" sound is heard at the time of injury. The bruising and swelling which occur are due to ruptured blood vessels from the tearing of the soft tissues.
The ankle swells as extra fluid continues to leak into the tissues over the next 24-48 hours. This will lead to a decreased ability to put your weight fully into the affected leg.
Diagnosis
You will be asked about your symptoms and your ankle will be examined for signs such as damage to the joint surface. You may be asked about your medical history and to describe exactly how you injured your ankle.
An X-ray will be taken to check if there is any damage to the bones of your ankle.
Avoid HARM for 72 hours after injury. That is, avoid:
Heat – such as, hot bath, heat packs. Heat has the opposite effect on the blood flow, it encourages blood flow. So, heat should be avoided when there is swelling.
Alcoholic drinks should also be avoided.
Running will cause further damage to the ankle joint.
Massage immediately after injury as this increases bleeding and swelling.
The writer is a Senior Physiotherapist at the 37 Military Hospital.
