Ankle Sprain, Acute

Ankle Sprain, Acute



Description


Acute ankle sprain is the stretching or tearing of one or more ligaments in the ankle. A two-ligament sprain causes more disability than a single-ligament sprain. Sprains are classified into three grades: With a first–degree sprain, the ligament is not stretched or lengthened, but it is painful. With a second–degree sprain, the ligament is stretched but still functions. A third-degree sprain is where the ligament is torn and does not function.


image Lateral ankle sprains: The ligaments of the outer (lateral) ankle are most commonly sprained.

image Medial ankle sprains: There is one large, triangular ligament of the inner (medial) ankle that is stronger and more compact, making injuries to it less likely.

image Syndesmosis, or high ankle sprains: This affects the ligament that connects the two leg bones just above the ankle. This ligament is usually injured when the sprain to the ankle is very severe.


Frequent signs and symptoms



image Pain, tenderness, and swelling in the ankle starts at the injured side and may progress to the whole ankle and foot with time.

image A popping or tearing sensation may occur at the time of injury.

image Some bruising may appear and spread to the heel.

image Ability to walk is impaired soon after injury.


Causes


Acute ankle strain is caused by stress to the ankle that temporarily forces or pries the ankle bone (talus) out of its normal socket. The ligaments that normally hold the joint in place are stretched and/or torn, usually resulting from a twisting injury.



Factors that increase risk



image Previous ankle sprain

image Activities in which the foot may land awkwardly—such as basketball, volleyball, and soccer—or walking or running on uneven or rough surfaces

image Shoes with inadequate support to prevent sideways motion when stress occurs

image Poor physical conditioning (strength, flexibility)

image Poor balance

image Contact sports


Preventive measures



image Warm up and stretch before practice or competition.

image Appropriate conditioning includes ankle and leg flexibility, muscle strength and endurance, as well as balance-training activities.

image Coaching on proper technique is important.

image Taping, protective strapping, bracing, and/or high-top shoes may help prevent injury. Initially, tape is best, but it loses most of its supportive function in 15 minutes.

image Proper protective shoes may be helpful; high-top shoes with taping or bracing are more effective than either alone.

image Provide the ankle with support during sports and practice activities for 12 months following injury.


Expected outcome


A first-degree sprain usually heals enough in 5 to 7 days to allow modified activity and requires an average of 6 weeks to heal completely. A second-degree sprain requires 6 to 10 weeks to heal completely, and a third-degree sprain requires 12 to 16 weeks to heal. A syndesmosis sprain often takes more than 3 months to heal.



Possible complications



image Frequent recurrence of symptoms may result in a chronic, repetitive problem. Appropriately addressing the problem the first time decreases the frequency of recurrence and optimizes healing time. Severity of the initial sprain does not predict the likelihood of later instability.

image Injury to other structures (bone, cartilage, or tendon) and a chronically unstable or arthritic ankle joint with repeated sprains may be a problem.


General treatment considerations


Initial treatment consists of medication and ice to relieve the pain, a compressive elastic bandage, and elevation to help reduce swelling and discomfort. A cast, walking boot, or brace may be recommended to provide support to the joint while trying to walk with crutches for varying lengths of time, depending on the severity of the injury. Surgical treatment is rarely necessary. After the inflammation and pain are reduced, regaining motion, strength, and balance are important to return to full capacity and reduce the likelihood of recurrent injury.



Medication



image Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take within 7 days of surgery), are used to reduce inflammation. Take these as directed. Contact your doctor immediately if any bleeding, stomach upset, or allergic reaction occurs. Other minor pain relievers, such as acetaminophen, may also be used.

image Topical ointments may be of benefit.

image Pain relievers may be prescribed. Use only as directed, and take only as much as you need.


Heat and cold



image Cold is used to relieve pain and reduce inflammation for acute and chronic injuries. Cold should be applied for 20 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage. Cold compressive wraps may also be used.

image Heat may be used prior to performing prescribed stretching activities. Use a heat pack or a warm soak.


When to call your doctor



image Pain, swelling, or bruising worsens despite treatment.

image You experience pain, numbness, discoloration, or coldness in the foot or toes.

image New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
image

Figure 1


From Economou SG, Economou TS: Instructions for surgery patients, Philadelphia, 1998, W.B. Saunders, p. 41.



Range of Motion and Stretching Exercises


Acute Ankle Sprain: Phase I, Weeks 1 to 2


These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. These exercises are usually used for the first 1 to 2 weeks after a sprain. The duration will vary depending on the severity of the sprain. Please remember:


image Flexible tissue is more tolerant of the stresses placed on it during activities.

image Each stretch should be held for 20 to 30 seconds.

image A gentle stretching sensation should be felt.

image


Range of motion image active dorsiflexion/plantarflexion



1. Pull your toes and foot toward your body as far as possible, then point the foot and toes away from your body as far as possible.

2. Perform this exercise with the knee straight and then with the knee bent.

3. Hold this position for _____ seconds.
< div class='tao-gold-member'>

Related posts:

Default ThumbnailBirth Control and Sports Biceps Tendon Subluxation Default ThumbnailExercise-Induced Bronchospasm Dislocation or Subluxation Meniscal Cyst Clavicle Fracture (Distal)

Stay updated, free articles. Join our Telegram channel
Tags:
Jul 19, 2016 | Posted by in SPORT MEDICINE | Comments Off on Ankle Sprain, Acute

Full access? Get Clinical Tree
Get Clinical Tree app for offline access