By: Svetlana Marianer, Reg. Physiotherapist, MSc. Pht
Even though ankle sprains are common, they are not always minor injuries. Repeated or severe sprains can lead to further problems such as long-term joint pain, weakness and ultimately even arthritis. The healing time depends on the degree of damage to the ligament as well as your age and past history of injury.
During the first 3 to 5 days following an ankle injury the appropriate treatment protocol can be summarized with the acronym POLICE:
P: Protection, immobilize the affected joint
OL: Optimal Load ie. weight bearing as tolerated with crutches or cane
I: Ice the affected area; 10 to 15 minutes every two hours (use a damp cloth between the ice and the skin to avoid burning)
C: Compression; apply pressure on the swollen area. Ie. wrap an elastic bandage up to 10 cm above the affected area.
E: Elevation; raise the affected area above the level of the heart for as long as possible.
The ankle joint is composed of three bones; the tibia and fibula, making up the lower leg, and the talus, base of foot. The three come together and are joined by ligaments. These strong elastic bands function to stabilize the ankle and keep the bones in place while allowing normal ankle motion. Lastly, tendons are cord-like bands that attach the muscle to the bone. These bands move the ankle and foot.
These injuries are defined by the kind of tissue, bones, ligaments or tendons you have damaged.
1. Ankle sprain:
Sprains are the most common ankle injury. They are typically caused by a rapid shifting movement with the foot planted in the ground (such as in soccer) or a “wrong movement”/twist of the foot (such as missing a step). The foot rolls one way and the ankle turns the opposite way, causing the ligaments to either stretch or tear.
Depending on the severity of the injury and on how much damage the ligament suffered, an ankle sprain can range from mild to severe. The most commonly used classification is as follows:
v Grade I: ligament stretch but no rupture; usually presents with tenderness upon touch, swelling, and stiffness but feels stable. Little pain with walking.
v Grade II: Partial ligament rupture; commonly presents with redness, warmth, swelling and significant pain with walking. May or may not bruise.
v Grade III: complete ligament rupture; may hear a crack or “pop” of the ligament, ankle feels unstable or “wobbly”, walking is difficult and painful. Usually bruising and severe swelling occurs almost immediately.
Healing and Prevention
Treatment by a physical therapist can help to speed the healing process and prevent complications and ongoing ankle problems.
2. Ankle tendonitis/ Tendon rupture
Tendonitis refers to the inflammation of a tendon. These injuries are usually the result of gradual wear and tear from overuse or aging. In other words, tendons are commonly injured when we repeatedly make the same motion; either at work, during sports or throughout our daily activity. The inflammation is caused little by little and is a slow process
However, tendon injuries can also occur rapidly and suddenly, usually following a direct blow or trauma. If the trauma is either severe or the tendon is very weak, the tendon can rupture. This injury is similar to ligaments and can either be partial or complete (depending on how many fibers have been torn).
Symptoms of tendonitis are:
- Pain during activity
- Stiffness of the ankle
- Loss of strength
- Tenderness to touch
- Redness, warmth and swelling.
Symptoms of an ankle tendon rupture are:
- Pain at rest
- Discoloration of the ankle region
- An audible pop at the time of injury
- Pain and difficulty with walking
- Ankle stiffness as well as the feeling of instability of “giving out” of the foot.
Healing and Prevention
The key to a successful outcome for a rupture of any of the ankle tendons is early diagnosis and proper treatment. In the case where the diagnosis or the treatment is delayed, the integrity of the healing tissue may be compromised as a result of scarring and decreased blood flow. These complications prolong the recovery time and increase the risk of complications.
For a complete tendon tear the treatment of choice may be surgical repair followed by structured and aggressive physical therapy. For partial tears a conservative physical therapy treatment without surgery is often the best option.
An ankle fracture can consist of a break in one or more of the three bones (tibia, fibula or talus). This type of injury typically results from a fall, an automobile accident or some other traumatic event.
Often with fractures other tissues can be injured. Ligaments may be severely sprained and can mask the symptoms of a broken ankle. An examination by a physiotherapist and/or your physician can help to determine if you need more investigation.
Symptoms of a broken ankle include:
- Immediate and severe pain
- Tenderness when touched
- Inability to put any weight on the injured foot
- Deformity, particularly if there is a dislocation as well as a fracture
Greenberg, G et al. (1994). Implementations of the Ottawa Ankle Rules. http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf