Conditions and Treatments
Ankle Injuries
OVERVIEW
The ankles support the entire weight of the body and are particularly susceptible to injury. An estimated 2 million patients are treated for ankle sprains and strains annually, and ankle fractures are one of the most common injuries treated by orthopedists.
CAUSES
Anyone, from the best-conditioned athlete to the most sedentary person, can incur an ankle injury. Usually, the cause is accidental (e.g., a jogger steps in a pothole, a pregnant woman slips getting out of the car, a softball player slides awkwardly into a base). Overweight people and women who wear high-heeled shoes are at increased risk for ankle injuries.
An ankle injury usually involves a sudden, unexpected, loss of balance, resulting in a sharp twist of the ankle. A strain occurs when a muscle or tendon becomes overstretched. A sprain is more serious and occurs when ligaments (the strong connective tissue that connects one bone to another) become overstretched. In some cases, a ligament tears and may pull a fragment of bone with it. When a piece of bone is pulled away, it is known as an avulsion fracture. This type of injury is treated in the same way as other fractures, even though the piece of bone is small.
SIGNS & SYMPTOMS
Most ankle sprains and strains are inversion injuries in which the foot twists inward, damaging the lateral ligaments on the outside of the foot. Pronation injuries to the medial ligaments on the inside of the foot, caused by twisting the foot outward, are less common.
Sprains are graded on a scale of 1 to 3 (mild, moderate, or severe), reflecting the amount of tearing to the ligaments. In evaluating these injuries, the physician usually orders x-rays to rule out a fracture or dislocation. Treatment usually involves the RICE approach - rest, ice, compression, and elevation:
- Rest means keeping off the injured ankle as much as possible. Crutches enable the patient to move about when necessary without placing weight on the injury. An air cast or splint may be applied to the ankle for support and severe sprains occasionally require a hard cast.
- Icing the injury reduces swelling. Ice packs are usually applied for 20 minutes at a time every hour as long as swelling persists.
- Compression means supporting the ankle and foot with a firmly (not tightly) wrapped elastic bandage, compression stocking, or gel wrap. If swelling causes the bandage to become tight, it should be loosened immediately.
- Elevating the foot above heart level minimizes bruising and swelling. This should be done as often as possible during the first 48 hours.
- The physician also may prescribe a nonsteroidal antiinflammatory drug (NSAID), such as ibuprofen, to reduce pain, swelling, and inflammation. Some patients experience prolonged swelling caused by the formation of excessive scar tissue. The physician may request x-rays to check for small, previously undetected bone fragments or damage to the joints.
With proper treatment, most ankle strains and sprains heal within 2 to 6 weeks. Severe injuries may take as long as 12 weeks. A carefully monitored program of physical therapy may be required to restore full muscle balance and strength. This can involve stretching the Achilles tendon as well as coordination and speed exercises. During this time, taping or bracing the ankle may be prescribed to provide support until full function is regained.
Patients who have experienced an ankle injury are at risk for another during the recovery period and thereafter. An injured ankle, even though healed, may be unstable and prone to recurrent injury. For this reason, patients who have sustained an ankle injury should take precautions. Shoes that provide stability and support are a prudent investment, and supplemental bracing with a specially fitted elastic wrap may be recommended.
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