1. Ankle anatomy
An ankle is one of the more stable joints in the body, but due to the high stresses placed on it can be prone to injury. It takes only a small misstep and you end up with an ankle sprain. Ankle sprain is one of the most common musculoskeletal injuries and it can happen in people of all ages. Athletes, kids, elderly and even couch potatoes alike can suffer from an ankle sprain. The injury occurs when one or more of the ligaments in the ankle are over stretched or torn, causing pain, swelling, and difficulty in walking.
The most common injured ligaments in an ankle sprain are the deltoid ligament (picture 1b) & calcaneofibular ligament and anterior talofibular ligament (picture 1a). Of course the connective muscles and tendons are also affected and sometimes they can cause great pain in the ankle joint or even higher up leg.
2. Anatomy of the injury
An ankle injury is a generic term and the most common types are strains and sprains of the ankle.
2.1 Difference of sprain & strain
The main difference is where the injury happened. If the trauma stresses a joint and overstretches or even ruptures supporting ligaments, is called a sprain. This can happen from a fall, twist, or blow to the body. If, on the other hand the trauma stretch or pull a muscle or tendon it’s called a strain. Chronic strains are the result of overuse of muscles and tendons, through prolonged, repetitive movement. Not getting enough rest during intense training can cause a strain.
The basic sprains are the inversion and eversion.
Inversion sprain, which is the most common accident, happens when you roll over your ankle, injure the outside ligaments and the pain (also the bruising) is usually in the outer side of your ankle (calcaneofibular ligament and anterior talofibular ligament). Eversion sprain happens when you roll in your ankle and you sprain the inner side (medial ligament-deltoid). Bruising and pain usually occurs in the inner side of your ankle.
2.3 Grades of ankle sprain severity
After the first examination your doctor will be able to tell in which grade your injury belongs. This will help your therapist to decide and create the proper treatment for you.
There are 3 different grades:
· Grade 1 Sprain (Mild)
In grade 1 there is a slight over stretching and/or a microscopic tears in the fibers of the ligaments. There is often mild tenderness and swelling in the surround areas of the ankle.
· Grade 2 Sprain (Moderate)
In grade 2 there may be partial tearing of the ligaments with moderate tenderness and swelling.
· Grade 3 Sprain (Severe)
In this stage, we can have a complete tear of the ligament with a significant amount of tenderness and swelling.
3. First aid
It’s very important to know what to do in an ankle injury because with a quick reaction we can ensure a speedy and better recovery.
Rest your ankle by not walking on it only for the first 72 hours but avoid completely immobilisation. With gentle mobilisation (moving your ankle in circular movements) you can prevent stiffness. By resting your ankle you allow your body to proceed to the healing process without interruption.
Ice helps decrease the swelling/ inflammation, the bruising and calms down the muscle spasm and the pain. Make an ice pack by wrapping a small bag of frozen peas or some ice in a towel. Put the ice pack in the area of the pain for 10-20 minutes maximum (if you leave it longer , you may get ice burns and can damage the skin) every 3 to 4 hours for the first 3 days of the injury.
Compression can be done by wrapping your sprained ankle, with a bandage, to avoid swelling and bruising. You might need to do this for several days after your injury.
Elevate your ankle at or above the level of your hips. This helps prevent the swelling from getting worse and reduces bruising. Try to keep your ankle elevated for about 2 to 3 hours a day.
In the mean time it is important that you take regular painkillers ( if not contra-indicated, especially if you are on other medication), to reduce the pain and help you keep moving around.
3.2 How to wrap my ankle
As mentioned before, compression is a good way to ensure that the swelling goes down and to protect your ankle by reminding you that you have to be careful in the first days.
You are going to need an elastic bandage.
a) Roll up the elastic bandage if it isn’t already rolled up. Hold your ankle at about a 90-degree angle with your toes pointing up. Start in the arch of your foot by holding the loose end of the bandage there. Wrap the bandage around the arch of your foot twice, keeping it somewhat taut with a light pull.
b) After this, pull the bandage diagonally from the arch across the foot’s top and circle it around the ankle. Now bring the bandage diagonally across the top of the foot and under the arch in a figure-eight pattern.
c) Slowly wrap higher with each turn making sure that you cover the heel also. Continue around the ankle and foot in a figure eight, moving toward the heel on the bottom and toward the calf at the top of the eight.
d) The wrap should cover the entire foot and end about 7 centimetres above the ankle. Most compression wraps are self-fastening or come with clip fasteners. If not, use tape to secure the end. The wrap should be snug but should not cut off circulation to the foot. In order to check this press your big toenail and observe the colour change. If the white comes back quickly you are good to go. If not you should unwrap and do it again.
4. Functional treatment
When the swelling goes down it’s best to start a treatment therapy for a good recovery and prevention from a future sprain.
Twice a day “write” with your toes the alphabet , thus getting the ankle mobile without loading it up. Remember this exercise needs to be done when you are feeling comfortable to move your ankle after 72 hours from the injury.
5. Physical therapy
Following the initial self-administered treatment at home, it is important to follow it up with a review from your GP or physiotherapist or osteopath. The physical therapist will ensure that you get the right rehabilitation and your ankle feels back to its best.
Don’t suffer in silence, here at Woodside Clinic we can get you back on your feet faster, call us on Dunstable – 01582 608400 or Leighton Buzzard on 01525 372 447 to book an appointment with one of our physiotherapists or osteopaths or you can book online.