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Ankle injuries are often thought of as sports injuries. But you don’t have to be an athlete or even a “weekend warrior” to turn your ankle and hurt it. Something as simple as walking on an uneven surface can cause a painful, debilitating sprain.
Ankle injuries can happen to anyone at any age. However, men between 15 and 24 years old have higher rates of ankle sprain, compared to women older than age 30 who have higher rates than men. Half of all ankle sprains occur during an athletic activity. Every day in the U.S., 25,000 people sprain their ankle. And more than 1 million people visit emergency rooms each year because of ankle injuries. The most common ankle injuries are sprains and fractures, which involve ligaments and bones in the ankle. But you can also tear or strain a tendon.
Sprains, Strains, and Fractures
Ankle injuries are defined by the kind of tissue — bone, ligament, or tendon — that’s damaged. The ankle is where three bones meet — the tibia and fibula of your lower leg with the talus of your foot. These bones are held together at the ankle joint by ligaments, which are strong elastic bands of connective tissue that keep the bones in place while allowing normal ankle motion. Tendons attach muscles to the bones to do the work of making the ankle and foot move, and help keep the joints stable.
A fracture describes a break in one or more of the bones. A sprain is the term that describes damage to ligaments when they are stretched beyond their normal range of motion. A ligament sprain can range from many microscopic tears in the fibers that comprise the ligament to a complete tear or rupture. A strain refers to damage to muscles and tendons as a result of being pulled or stretched too far.
Muscle and tendon strains are more common in the legs and lower back. In the ankle, there are two tendons that are often strained. These are the peroneal tendons, and they stabilize and protect the ankle. They can become inflamed as a result of overuse or trauma. Acute tendon tears result from a sudden trauma or force. The inflammation of a tendon is called tendinitis. Microscopic tendon tears that accumulate over time, because of being repeatedly over stretched, and don’t heal properly lead to a condition called tendinosis. Tendons can also rupture. Subluxation refers to a tendon that slips out of place.
An ankle injury occurs when the ankle joint is twisted too far out of its normal position. Most ankle injuries occur either during sports activities or while walking on an uneven surface that forces the foot and ankle into an unnatural position. The unnatural position of the ankle in high-heeled shoes or walking in unstable, loose-fitting clogs or sandals is also a factor that may contribute to ankle injuries. In addition to wearing faulty footwear, an ankle injury can happen as a result of:
The symptoms of a sprain and of a fracture are very similar. In fact, fractures can sometimes be mistaken for sprains. That’s why it’s important to have an ankle injury evaluated by a doctor as soon as possible. The signs include:
With a sprain, the ankle may also be stiff. With a fracture the area will be tender to the touch, and the ankle may also look deformed or out of place.
If the sprain is mild, the swelling and pain may be slight. But with a severe sprain, there is much swelling and the pain is typically intense.
Tendinitis and acute tears of the peroneal tendon result in both pain and swelling. In addition, the ankle area will feel warm to the touch with tendinitis. With an acute tear, there will be a weakness or instability of the foot and ankle.
Tendinosis may take years to develop. Symptoms include:
With the subluxation you will notice ankle instability or weakness. You also may notice sporadic pain behind the outside ankle bone and a “snapping” feeling around the ankle bone.
You can apply first aid for an ankle injury by remembering R.I.C.E: rest, ice, compression, elevation.
It is important not to put any weight on the ankle until after it’s been evaluated by a doctor, which should be done as soon as possible. Fractures and sprains that are ignored or aren’t treated properly can lead to long-term chronic problems with the ankle, such as repeated injury, ankle weakness, and arthritis.
The first thing a doctor will do is ask questions about how the injury occurred. Then the doctor will examine the ankle, noting the amount of swelling and bruising. The physical examination of the ankle may be painful because the doctor needs to move the ankle to evaluate the pain and swelling in order to make a proper diagnosis.
The doctor may order an ankle X-ray to determine whether there are any broken bones. In addition to an ankle X-ray, your doctor may ask for X-rays of the leg and foot to determine whether there may be other related injuries. If the doctor suspects a stress fracture, the doctor will ask for other imaging scans such as an MRI, which will show more detail about the injury. If there is a fracture, the doctor may also ask for a stress test, which is a special X-ray taken with pressure applied to the joint. This will help the doctor determine whether surgery is needed.
For most ankle injuries, pain is controlled by using an over-the-counter medication such as acetaminophen or other nonsteroidal anti-inflammatory drug such as ibuprofen. The specific treatment of the injury depends on the type of injury.
Fractures can be treated either surgically or nonsurgically. The doctor may treat the break without surgery by immobilizing the ankle if only one bone is broken, and if the bones are not out of place and the ankle is stable. Typically the doctor will do this by putting on a brace that works as a splint or by putting on a cast. If the ankle is unstable, the fracture will be treated surgically. Often, the ankle is made stable by using a metal plate and screws to hold the bones in place. Following the surgery, the ankle is protected with a splint until the swelling goes down and then with a cast.
It usually takes at least six weeks for the bones to heal. Your doctor will probably ask you to keep weight off the ankle during that time so the bones can heal in the proper alignment. Ligaments and tendons can take longer to heal after a fracture is fully mended. It can take as long as two years to completely recover full painfree motion and strength after an ankle fracture, although most people are able to resume their normal daily routine within three to four months.
After the doctor has determined it is safe for you to start moving your ankle, you may need physical therapy to provide gait training, balance, strengthening, and mobility exercises. The therapist will develop a home program that you can use to regain your previous normal function. It can take several months to return to a normal walking pattern without limping.
The treatment for sprains depends on the severity of the injury. They are graded as mild, moderate, or severe. Surgery is not usually a treatment option unless the damage is extensive, involves more than the ligaments, or when other treatment options fail.
Mild sprains — called grade 1 — are treated with the RICE approach for several days until the pain and swelling improve. With a mild sprain, you won’t need a splint or a cast. Your doctor will tell you to put weight on the ankle fairly soon — within one to three days — as long as you can tolerate it and will prescribe range of motion, stretching, and strengthening exercises.
If your sprain is classified as moderate, or grade 2, the doctor will use the RICE approach but allow more time for healing to occur. The doctor may also use a device such as a boot or a splint to immobilize the ankle. You will be given exercises to do first to improve range of motion and then to stretch and strengthen the ankle. The doctor may also prescribe physical therapy to help you regain full use of your ankle.
Grade 3 or a severe sprain involves a complete tear or rupture of a ligament and takes considerably longer to heal. It’s treated with immobilization of the joint followed by a longer period of physical therapy for range of motion, stretching, and strength building. Occasionally, especially if the sprain does not heal in a reasonable time, surgery will be considered for reconstructing the torn ligaments.
On average, the initial treatment of a sprain, includes resting, and protecting the ankle until swelling goes down for about one week. That’s followed by a period of one to two weeks of exercise to restore range of motion, strength, and flexibility. It can take several more weeks to several months to gradually return to your normal activities while you continue to exercise.
Options for treating tendon injuries are similar to options for treating sprains. They include:
The National Institute of Arthritis and Musculoskeletal and Skin Diseases recommends the following steps for reducing your risk of an ankle injury:
Originally published by www.webmd.com