Ligaments help stabilize the ankle joint and prevent excess motion. Ankle injuries occur when ligaments are stretched beyond their normal range of motion and the ankle moves in an awkward motion beyond the normal range of that joint. The most common mechanism of ankle sprain is a combination of plantarflexion and inversion, or a downward-inward motion of the foot about the ankle. When this takes place, the 3 main outer ankle ligaments stretch or tear depending on the severity. With severe ankle injuries, fractures and joint displacement can occur.
Ankle sprains are graded based on the severity and degree of ligamentous injury.
Grade 1: Partial tear of a ligament
Grade 2: Incomplete tear of a ligament with moderate functional impairment
Grade 3: Complete tear and loss of integrity of a ligament
Ankle sprains present with pain to the outer ankle area. Redness and swelling may occur. There will be pain and tenderness on palpation, weight bearing, and joint motion. Range of motion of the ankle and foot will also be limited.
Ankle sprains are evaluated with a careful history and thorough physical exam. In conjunction with a good history and physical, there are other in-office diagnostic modalities in which we can further evaluate ankle sprains. Digital X-Rays are done in-office to rule out any bone injury and can instantly be reviewed with the patient. An in-office Sonogram evaluation of the ligaments and tendons allows for visualization of any soft tissue pathology. For severe ankle trauma, or when conservative therapy is not effective, a CT or MRI scan will allow for proper visualization of both bone and soft tissue allowing for the proper treatment course to be implemented.
At Gotham Footcare, we examine all ankle trauma with a 12 step approach which starts at the knee and works its way down to the ankle and foot. A high spiral fracture of the fibula should not be missed.
Treatment of ankle injuries depends on the extent of the injury. This is where a proper grading of the injury dictates the best treatment course of action.
Physical therapy along with muscle strengthening and range of motion exercises will aid in the treatment of ankle sprains and assist in restoring full function after an injury.
It is almost impossible to prevent all types of injuries but with proper precautions, we can help limit the risks. Proper supportive shoe gear is very important. A lace up shoe or sneaker is recommended. Avoid slip-on types of shoes, wedge or high heel type shoes, and shoe that allow for excess movement of the foot inside the shoe. Always be cognizant of your surroundings. Avoid uneven surfaces especially the curbs when crossing the street. When exercising, allow for proper warm-up and stretching and avoid overuse. Timely treatment of an acute ankle sprain decreases the risk for chronic ankle instability.