| FOOT DISORDERS - Ankle Injuries |
One of the most common ankle joint injuries is
the “ankle sprain.” Ankle sprains are a very common athletic injury. In
basketball players ankle sprains account for 45% of injuries suffered. An
inversion injury of the ankle with sprain of the lateral ankle ligaments is the
single most common injury seen in sports. Because they are so common, there is a
tendency to underestimate the severity of the injury as “just an ankle sprain.”
Lateral ankle sprain:
This occurs when the foot inverts, or turns inward. A sprain denotes an injury
to a ligament. Three ligaments are commonly injured. These ligaments are (in the
order most commonly injured):
The diagnosis of lateral ankle sprain is
primarily clinical, with a history of turning in of the foot, occasionally with
a ‘pop’ heard or felt. Swelling and bruising occur shortly after the injury. It
is often difficult to bear weight immediately after, but it may be accomplished
shortly afterward. This history with careful examination of the region
determines which ligaments are injured. Ruling out other injuries is critical to
full recovery. Often the injury is severe enough to limit initial physical
examination. Repeat examination after a short period to let swelling and pain
subside may be necessary. X-rays may taken immediately to rule out a broken
bone.
A common classification applicable to all ligament injuries classifies sprains
according to degree of severity into:
Grade I ligament stretch (microscopic tear) Grade II ligament partly torn Grade III ligament completely torn
Medial ankle sprain:
This occurs when the ankle turns outward or rotates. The medial ankle ligaments
form a strong complex ligament called the deltoid ligament. These injuries are
less common, but often involve tendon or bone requiring a period of
immobilization.
Injuries related to
ankle sprains: Occult injuries
There are a number of other structures about the ankle joint that may be injured
with the same mechanism as an ankle sprain. These injuries can be a challenge to
diagnose and may be initially masked by pain from the classically involved
ligaments. When standard sprain treatments do not provide the patient with
relief, occult or hidden injury should be suspected. Other injuries that may
occur are:
Fractures
Several bones may be injured in an ankle injury. A common misconception is that
if a bone is broken one cannot bear weight. This is not true in the foot and
several fractures have been associated with ankle sprains: 5th metatarsal,
anterior process of the calcaneus, navicular, cuboid, tibia, fibula and talus.
Other ligamentous sprains
There are many ligaments that may be injured with the same mechanism either
isolated or in addition to the common structures. These structures may not
respond to regular ankle sprain treatment and may require immobilization or even
surgical management to stabilize the bones while the ligaments heal.
Tendon injuries
Tendons may also be injured in a typical sprain mechanism. They may not
completely tear, but may actually split lengthwise. This often results in a
chronic condition that requires surgical repair if it does not respond to other
treatments.
Nerve injuries
Nerve injuries can occur when the nerves stretch. This is called neuropraxia and
may result in numbness and pain. These injuries may take long periods of time to
heal
Chronic conditions as a result of ankle sprain
chronic instability of ankle or subtalar joints, osteochondral fracture,
adhesions or intra-articular hyalinized lesions as a result of intra-articular
bleeding, meniscoid lesions, synovial impingement and loose bodies, and
post-traumatic arthritis.
What Your Doctor May Do:
