The ‘ankle’ is the joint between the foot and the rest of the body. Two leg bones and a foot bone meet here to form this joint. To allow the whole body weight carried through to the foot, these bones are tied together with strong ropes called ligaments. To give our body a stable platform to stand, ankle joint has less freedom of movement. Hence any external force pushing the joint in any direction other than the allowed direction will put excessive stress on the connecting ropes-(ligaments) resulting in strain- damage to the muscle and tendon units, sprain- damage to the ligaments. The injury can be a minor stretch to a complete tear. Sometimes the same force instead of damaging these soft structures may break the leg bones close to the joint.Sprains and starins are so common and on the face of it they appear very simple injuries. But they can produce significant long term disability. One may be surprised to know that once you had a an ankle sprain you stand more chance of re-spraining again. These repeated sprains are thought to be due to injury to our nerves in these ligaments and we cannot control our posture well and we fall again with little imbalance when we walk. A sprain results in residual symptoms in 33% and some long term changes in about 2/3rds of cases. They also lead to weakness of the calf muscles.
Ankle injuries are most commonly seen in people involved in sport activities, but they can also occur to anyone at any age by simply twisting the foot on uneven surface. Wearing of faulty footwear or high heels increase the risk of injury by reducing the stability of foot on the ground allowing it to twist easily.
·Pain at the point of ligament injury or around the ankle if the damage is more.
·Swelling or bruising of the ankle and foot.
·Unable to stand on the foot
·Deformity or mis shape of the ankle
·Some times one or other of the bones may pierce the skin and come out with bleeding.
·Sports: Participating in sports that require rolling or twisting the foot, such as basketball, tennis, football etc.
·Prior ankle injury:There is an increased risk of injuring the ankle which has already been injured before.
·Other factors: These include overweight, walking or running on uneven surfaces.
·People with ‘double joints’ or stretchable joints where there is an abnormal elasticity of soft structures of the joints allowing excessive movement at the joints.
The type of injury and a physical examination can confirm the severity of ankle injury. How ever the degree and type of injury to the bones will become clear with x-ray. When the injury appears to be severe but the x-ray does not show any injury, it is indicative of ligament injury. This can be ascertained by modalities like MRI though we do not routinely do the scan in acute situations. ACT scan can be useful to delineate the fracture shape in some cases when needed. When there is any doubt we always compare with the opposite ankle for the shape, movement and looseness in any direction.
Depending on the severity of the injury the treatment varies. Immediately following the injury PRICE treatment, Protection-Rest-Ice-Compression-Elevation- is followed. Tablets to reduce pain and swelling are given. To avoid any movement at the injured ankle, a splint is given which in itself helps to reduce the pain. A short term splint or plaster for 10-14 days helps in healing of the ligaments in mild and moderate injuries. But in severe injuries of the ligaments, i.e. complete tear of the ligament then surgery may be required to stitch the ligament back. If a fracture is ruled out then as the symptoms improve the ankle is moved in a graduated fashion to allow the healing but to regain movements and strength. But it is quite common for patients to start experiencing instability of the ankle joint several weeks or months after a minor or moderately severe sprain which was treated with splinting. Some of these patients may need surgery to re-create the ligament which may have got completely wasted. For this, we need to use some other tendon of the body or a donor tendon to build torn ligament. When a fracture is found on the x-ray, then either a plaster cast is applied under anaesthesia or the broken bones are fixed with plates and screws.
The following measures should be followed to help prevent an ankle injury.
·Warm up before doing exercise or playing sports.
·Be careful when walking, running or working on an uneven surface.
·Don't play sports or participate in activities for which you are not conditioned
·Wear shoes that fit well and are made for your activity.
·Due care when wearing high-heeled shoes.
·Maintain good muscle strength and flexibility.
Long term results and Rehabilitation:
Complete recovery from minor and intermediate degree injuries may occur even though some of these injuries may still lead to a feeling of instability of ankle joint in some people. With severe injuries, which may need long duration splinting or surgery, may end up stiff and may go on to develop early arthritis due to damage to the joint cartilage with the original injury perhaps not recognised at that time. One need to look for damage to the adjacent joints while treating these injuries. Individuals who are prone to recurrent injury and sports personnel need to have structured rehabilitation programme not only to improve the ligament and muscle strength but also to improve their sense of position and balance.