Ankle Conditions & Injuries
The injured person usually presents with a history of their ankle "turning." Sometimes a "pop" or "snap" is felt or heard. Difficulty walking follows the incident and in a short time, the ankle swells, sometimes so excessively that people are quite sure it's broken.
The typical ankle sprain results in a stretching or tearing of the small ligaments that attach bone to bone on the outside or lateral aspect of the ankle.
The physical examination almost always shows swelling and discoloration (black and blue) over the outside part of the joint. Frequently, there is instability noted on the drawer test, when we gently move the heel structures forward and back as the leg is stabilized. Another reliable sign, called the tilt test, is sometimes used by turning the heel from side to side. Range of motion in the ankle can be limited secondary to pain and swelling but strength is not usually affected.
This is certainly one area of sports medicine and orthopedic surgery when xrays are essential, including stress views. Fractures must be ruled out, as the treatment would often require surgical internal fixation.
Although the treatment of ankle sprains may vary, initially we usually use ice, NSAIDs, physical therapy and elevation. If the sprain is minor (Grade 1), these measures will suffice, although additional bracing or taping of the ankle gives much more support and allows the patient more confidence while ambulating or exercising.
The more severe sprains that have greater instability and tearing of the ligaments, should be placed in a walking support for three to six weeks to allow the injured structures to heal. These can be a non-removable fiberglass cast or a removable splint. Following this period, exercises are recommended to strengthen the ankle and reduce swelling. During this period, the ankle is often taped or braced.
Activities such as basketball, volleyball, soccer, tennis, and other sports requiring a lot of stopping, starting and twisting motions have a high incidence of ankle injuries. Beware of the uneven and pot-holed playing fields often used by soccer and baseball teams.