Ankle Sprains

Different types of ankle Injuries can occur, causing mild sprains and ligament to severe damage to the cartilage, muscles, and tendons, making it difficult to put weight on foot. Timely diagnosis, advice and treatment from a specialist become essential for the recovery of the injury.

About Ankle injuries

Ankle sprains and ligament injuries

Ankle ligaments are vital in holding the bones properly, controlling the ankle from twisting, folding, or collapsing, and stabilizing the ankle joint. An ankle sprain appears when the strong ligaments, which connect the foot bones with the lower leg bones, stretch beyond normal limits and tear.

It may be caused due to accidental falls or twists in the foot during many different activities like walking, running, exercising on an uneven surface, sports that require cutting actions such as basketball, tennis, football, etc. The ankle sprain can be mild to severe, based on how much damage is caused to the ligaments.

Home treatment for minor wounds like rest and applying ice is usually sufficient to recover any minor damage. However, consult an orthopaedic foot and ankle surgeon when the ankle is extremely swollen and painful to walk, or you cannot put weight on the ankle.

A severe sprain injury can weaken the ankle, making it prone to frequent hurts. Repeated ankle sprains may severely cause long-term problems, like chronic ankle pain, arthritis, and ongoing instability.

Different types of ankle sprains and ligament injuries and repair techniques are as follows:

 

Sprains and Ligament repair

Ligaments can usually get damaged or torn from an accidental sports injury, falls, car mishaps, a direct blow or repetitive use, which generally heal with non-operative treatments.

An injury or tear to a ligament causes pain, loss of range of motion and movement, and destabilization of the joint. Surgery is needed when the tear makes the person unfit for regular activities. Ankle ligament reconstruction is a common surgical procedure used to repair or replace a damaged ligament.

Treatment for a sprained ankle is based on the severity of the injury, where the goal is to relieve pain and swelling, promote healing of the ligament, and restore the function of the ankle. Consult a specialist doctor in severe injuries to advise you on the medication and rehabilitation method needed to retrain the ankle muscles to work together to support the joint and help prevent recurrent sprains.

Tendon injuries and pathologies

A tendon, a tough piece of tissue connecting a bone to a muscle, can be damaged caused by falling from a ladder, a long-term repetitive injury or accidents involving glass, knives, contact sport injuries, skiing tumbles, etc., when the tendons are overused.

The most common affected injuries are tendonitis and tenosynovitis, which often happen together, causing inflammation surrounding a tendon. The usually affected area is around the wrist tendon due to repetitive strain injury (RSI).

Sometimes tendon injuries may happen due to rheumatoid arthritis, causing inflammation of tendon sheaths and joints that lead to joint pains and swelling that worsen at night or during movement/activity.

Peroneal tendon disease

Peroneal tendonitis occurs due to overusing the tendons, causing inflammation in the tendons that run along the outer ankle bone and the side of the foot. This may happen due to a sudden injury such as an ankle sprain.

The condition causes pain and swelling that will usually disappear after several weeks of conservative treatments. People who play sports with many ankle movements are prone to this condition. Those who don’t stretch before physical activity or have few health conditions, like diabetes, osteoarthritis, rheumatoid arthritis or gout, are also at risk of developing it.

Get advice from an orthopaedic foot and ankle surgeon, who would do a physical exam and review your symptoms. Typically conservative treatments can help reduce tendon pain and inflammation within three to four weeks. However, recovery will be prolonged if tendonitis is caused due to another injury, like a sprain.

Surgery is required if conservative treatments don’t work well. A synovectomy procedure is done to clean out the damaged outer layers of tissue from the peroneal tendons.

Sports injuries

Sports injuries can happen while exercising or participating in a sport like fractures, joint dislocations , cartilage and ligament injury. The other conditions are overstretching or tearing the ligaments, muscles or tendons, causing a sprain and swelling.


Generally, you prevent most ankle sprains and injuries by following simple measures:

• Do warm-up before you exercise or play sports.
• Take care while walking, running or working on an uneven surface and wear well-fitted shoes suited for the activity or sport you choose.
• Use an ankle support brace or tape on a weak or previously injured ankle.
• Ensure to maintain good muscle strength and flexibility.
• Practise stability training, including balance exercise.


Cartilage injuries ( Chondral and osteochondral injuries)

Cartilage injuries are a relatively common hurt due to sudden sports injury or gradual wear and tear caused by osteoarthritis. It affects the cartilage, a tough, flexible tissue located throughout the body, shielding the surface of joints.

When there is a chondral defect, the damage happens to the articular cartilage that lines the end of the bones. For an osteochondral injury, the damage occurs to both cartilage and a piece of the underlying bone.

Cartilage becomes a shock absorber, allowing bones to slide over one another. The main symptoms of cartilage damage are joint pain, swelling, stiffness, grinding sensation and joint locking. A minor injury usually gets better within a few weeks, but it may require surgery if more severe cartilage damage occurs.

Special techniques can repair some healthy cartilage flaps, which an orthopaedic foot and ankle surgeon can advise. However, an isolated cartilage defect without any underlying bone attached to the fragment is not typically repairable. It usually needs to be removed through an arthroscopic procedure.

The standard treatment is the RICE method - rest, ice, compression and elevation that is helpful for mild sports injuries. If the sports injury looks severe, visit the doctor for consultation.

Go for emergency care when the injured joint has visible lumps, bumps, pain, severe swelling, or other deformities, popping or crunching sounds while using a joint, weakness or inability to put weight on the joint and instability.

Achilles tendon pain and rupture

When you hear a pop followed by an immediate sharp pain in the ankle and lower leg, it indicates an Achilles tendon rupture that may be a complete or partial break (or tear) in the tendon.

A pain of the Achilles tendon occurs when the area withstands a lot of stress and pressure during everyday activities and athletic and recreational play, causing it to become inflamed, swollen, and irritated, called tendonitis.

Many non-nonsurgical treatments work to heal the pain, but surgery will be needed to repair the rupture. Get a doctor’s advice if you hear a pop in the heel and can’t walk properly afterwards.

Doctors Panel of Ankle Sprains

Nazzar Tellisi

Consultant General Trauma and Orthopaedic

Arabic, English

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