Ankle sprain

definition

A sprain is used in medical terminology Distortion called. This involves overstretching one or more ligaments or the joint capsule. Although the ligaments are very sturdy and serve to secure the joint, a sprained ankle is most often the result of sports injuries or an unfortunate twist of the foot.

causes

A sprain is one of the most common and uncomplicated sports injuries. It can occur particularly quickly in sports such as handball, volleyball, basketball and tennis. Fast and sudden running and jumping movements can put a lot of stress on the ligaments around the ankle, so there is a higher risk of injury and a sprained ankle.

If you get up unhappy after a jump and cannot find a stable hold, your foot most often kinks outwards. The ligaments on the outside are put under strong tension and can be overstretched. In this case it is a supination trauma. Whether or not you sprain your ankle depends most on the stability of the ligaments.

People with an existing misalignment of the foot, such as a hollow foot, can get a sprain more quickly. People who suffer from muscle weakness are also more prone to overstretching the ankle ligaments. In contrast, athletes and especially competitive athletes who expose their ankle ligaments to extreme loads are also at a higher risk of spraining the ankle.

Read more on the topic: Ligament stretch

Symptoms

A sprain is associated with massive overstretching of the ligaments at the ankle. The outside of the ankle is most commonly affected. If the sprain occurs, for example, when the foot is twisted, a sudden pulling and severe pain usually occurs. The affected people are usually no longer able to put weight on the sprained foot and have persistent severe pain. Depending on how much the foot is bent to the side as part of a supination trauma, swelling can also occur in addition to the pain. This increases slowly and can worsen the pain from the pressure on the sprained ligaments. The swelling can last for several days.

Frequent cooling and especially the immediate elevation and cooling of the sprained ankle can often prevent excessive swelling of the foot. If the ligaments are very overstretched, smaller blood vessels can also tear. This can lead to a bruise on the injured ankle after a while (Hematoma) arise.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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Classification

An ankle sprain can be divided into different degrees of severity.

  • Grade 1 represents a slight sprain, this is the most common and is certainly the most harmless. The ligaments are slightly overstretched but not torn. The ankle is still very stable and often the person affected can still walk easily despite the pain.
  • Grade 2 is a moderate sprain. The ligaments are severely overstretched and one or more ligaments may tear. In this case, the patient has much more pain and the sprained ankle is therefore also more unstable.
  • Finally, grade 3 is a more severe sprain that is often associated with severe pain. At this severity, one or more of the ligaments could be broken. The ankle joint is very unstable with this degree of injury and the affected person can often no longer put weight on the foot.

course

In the case of sprained ankles that are between Grade 1 and Grade 2 and in the best case without a torn ligament, the foot usually heals again after two weeks. Often times, the foot cannot be fully loaded, but the pain should have clearly decreased. Depending on which profession or sport the patient does, he or she is given a supporting splint or bandage for additional stabilization.

Sprains in which one or more ligaments at the ankle are also torn or even completely torn, the healing process can take significantly longer. In some cases, a torn ligament may even require surgery to treat the sprained foot. Since the ankle is always exposed to enormous loads, it can take some time before the foot can be fully loaded again. In some cases, it takes two to three years to heal completely until the ankle is as flexible as before.

Read more on the topic:

  • Torn ligament
  • Duration of a sprain

therapy

In the case of a sprain, there are some measures that can be taken immediately to relieve the pain and also to avoid excessive swelling. It is best to first treat the injury according to the PECH rule.

  • The P stands for pause. From now on, the foot should no longer be loaded in order to avoid worsening the injury. In the event of sports injuries, you should therefore immediately stop activity.
  • The E stands for ice and means to cool the sprained ankle. Various ice packs or pads can be used for this. The cooling causes the blood vessels to contract. For one thing, it causes a bruise (Hematoma), on the other hand there is less tissue fluid and swelling is not too great. Cold also slows down an inflammatory response and relieves pain.
  • The C stands for compression. A compression bandage can be applied immediately after the accident to secure the sprained ankle. The possibly unstable joint is secured by the compression. At the same time, a bandage can be used to apply a cool pack or a cooling and pain reliever ointment.
  • The H stands for high camp. The sprained ankle should be raised as often as possible. It relieves pain and at the same time promotes the outflow of tissue fluid and blood. Swelling goes back faster and the pressure in the ankle is reduced.

Most sprains subside after a few days and the foot can also be loaded normally again. In some cases in which the ligaments are severely overstretched or parts of the ligaments are torn, subsequent treatment with bandages or splints may be necessary.

Cooling and analgesic ointments can be applied to relieve pain. But pain-relieving medications, such as ibuprofen or paracetamol, can also be taken orally. In addition to bandages or splints, a third-degree sprain may also require several weeks of physiotherapy. As part of physiotherapy, the foot is kept mobile through exercises, especially when wearing splints or bandages, exercises should be performed regularly so that the foot does not get into a misalignment due to the relieving posture. Regular training under supervision also counteracts excessive muscle loss.

Read more on the topic: Sports injury

Bandages and splints

Following a sprain, depending on the severity of the injury, it may be necessary to wear a bandage or splint for several weeks until the foot has fully recovered and the ankle can be fully loaded again. Both options aim to support the ligaments and ensure the stability of the ankle.

This extra stability is often used by athletes to help them resume training and gradually increase the stress on the sprained foot. However, various bandages or splints are also used in everyday life and to promote the healing process for sprained ankles. The bandages are support bandages that are wrapped or ready-made bandages for the foot and ankle.

Another way to promote stability in sprained ankles can be achieved by putting on a kinesio tape. The kinesio tapes are also preferred for athletes so that they can resume training as early as possible. The tape strips should have a length of approx. 25 cm. They are placed in such a way that they form a double fan at the ankle and ideally cross the ankle. The tape is attached to the outstretched foot and can thus adapt very well to the bony structures. No tensile stress has to be exerted on the belt. Taping gives the sprained foot more security and restricts the patient in dangerous movements, so that the risk of re-injury is reduced.

Splints that are worn either as a complete replacement shoe or in your own shoe can also be used. They offer very good stability because they leave the sprained foot even less leeway than bandages.

Taping

With a sprained ankle, there is usually a feeling of instability in the ankle in addition to the pain. Especially in sports that require quick changes of direction, there is often a lack of security in the ankle. However, taping the ankle can help.

You have to differentiate between two different types of tape: The normal sports tape is particularly stable. It should only be worn during exercise and helps support the inner and outer ligaments of the ankle. It is an important support especially in the early phases of stress after an ankle injury. The foot is usually tapped from the ball of the toe to about five to ten centimeters above the ankle. Since the tape sticks extremely well, you should depilate or shave this area beforehand if necessary. The tape dressing should not be applied in complete rounds, as this can quickly lead to constrictions with reduced blood flow. Instead, short strips of tape are used that only extend halfway around the foot.

In contrast to this is the more modern kinesio tape. It is not only intended for stabilization, but rather designed to support the muscles. The tape strips are attached in such a way that they apply tension along muscle strands. This increases the natural function of the muscle. The kinesiotape can stay on the ankle until it falls off by itself.

plaster

In the case of a severe sprain with possibly torn ligaments, it may also be necessary in some cases that the sprained foot has to be immobilized for optimal healing. In this case, the patient is given a fitted cast or a cast boot. In addition, if the plaster of paris should not be stressed either, the patient is also given forearm crutches. The plaster of paris protects the sprained ankle and does not put any strain on it. How long the cast has to be worn depends on the severity of the injury. Usually the duration is about 3 to 4 weeks. After wearing a cast, walking and the strain on the foot can be very unfamiliar at first. In addition, the muscle mass can also be reduced. In order to avoid another accident, physiotherapy can also be carried out after a plaster treatment. It is used to train the muscles and strengthen the ligaments and tendons.

Home remedies

The main universal remedy for a sprained ankle is the PECH scheme. This anagram stands for pause, ice, compression, and elevation. Many home remedies are to be seen as supportive measures for cooling. The easiest way to cool the ankle is with a cold pack. However, it is important to ensure that the cool pack does not come into direct contact with the skin, as this could otherwise be damaged. It is best to wrap a towel around the cold pack so that it can also be tied directly to the ankle. Alternative methods of cooling are curd or cabbage wraps. Both refrigeration applications are simple natural products that can be found in any supermarket. If they come straight out of the refrigerator, a good cooling effect is achieved. The quark also cools due to its moisture and the cabbage leaves can also release liquid by folding them several times.

If the sprain has been a few days or weeks ago, Franzbrand wine can also be used. This initially has a cooling effect, but it also stimulates blood circulation, which accelerates the healing process. Pineapple juice is also cool because it is liquid and it also contains anti-inflammatory substances. Occasionally, the application of heat also helps in the subsequent healing process. This is especially the case when the actual injury has healed, but the muscles are still a bit weak or the ankle is still stiff.

ointment

Ointments are used to cool the sprained ankle, relieve pain and reduce inflammation. Leading the way are the pain ointments Voltaren®, which contains the active ingredient Diclofenac®, and Docsalbe®, which contains ibuprofen®. Alternatively, Doc-Arnica-Salbe®, which is based on herbal active ingredients, can be used. It is important that no circulatory ointments are used immediately after the injury. You can start doing this after a week at the earliest (and only if the ointment is good) to promote healing.

Also read: Arnica ointment

Duration

The worst phase with a sprained ankle is usually over after a few days. After that there is a noticeable improvement every day. After two to three weeks at the latest, the foot can be loaded with full body weight again. With sufficient physiotherapy, it is usually possible to return to running easily after about six weeks.Stop-and-go sports in particular, but also sports with rapid changes of direction or uneven ground should be avoided at the beginning.

After individual consultation with the attending doctor and physiotherapist, fitness for sport can be further developed. The sick leave is usually based on when someone can return to normal. Therefore, the ability to work is given after three weeks at the latest. Only those who work hard physically or who are on their feet all day can be given longer sick leave. Generally, the length of time a sprained ankle lasts depends on how severe the sprain is. A distinction must be made between a sprain with and without a torn ligament. With torn ligaments, recovery is expected to take longer and the age of the affected person plays a decisive role. In addition, performing stability exercises can improve recovery.

prophylaxis

To prevent a sprain, many athletes wear bandages and splints, for example. They protect against a new injury and give a previously sprained ankle stability again. Strengthening exercises and coordination exercises for the muscles around the ankle joint can give the foot more stability in the long term. Especially if a patient has had to take a long break in sports due to an injury such as a sprained ankle, it is very important to build up the muscles first. Such training includes, for example, exercises on a balance board. Targeted training guided by a physiotherapist can also strengthen the muscles in the ankle.

When resuming training, bandages or splints can be worn as a preventative measure. As a result, the foot is initially restricted in its range of motion and the risk of buckling to the side is significantly reduced. As in everyday life, but also in sports, you should also pay attention to correctly fitting and suitable footwear. If you have damaged joints, you should largely avoid high-heeled shoes, as they pose an increased risk of injury.

Read more on the topic: physical therapy

diagnosis

As part of the anamnesis, the doctor asks how the accident happened. In order to better narrow down what type of injury it is, he will examine the patient and ask exactly about the pain. During the physical exam, he feels his way from the knee down to the ankle. The head of the fibula is often felt on the knee because it is at risk of tearing off if the malleoli fracture. On the ankle itself, he will feel the lateral ligaments and test them for pressure and movement sensitivity. To do this, the doctor tests to what extent he can still move the foot in all directions. Of course, he takes the patient's pain information into account.

The doctor can then request a conventional X-ray of the sprained foot. With this X-ray, he can assess the bony structures and rule out a broken bone. Using magnetic resonance imaging, the ligaments and other soft tissue structures in the vicinity of the sprained ankle can be viewed more closely. Which procedures the doctor uses to make a diagnosis usually depends on the circumstances of the accident and the information about the patient's pain. Therapy will then be initiated accordingly.

Which doctor treats this?

If you have a sprained ankle you can first see a family doctor, but they will likely refer the affected person to an orthopedic surgeon, ideally a sports orthopedic surgeon. Both orthopedics and physiotherapy then play a role in the treatment team. Since medical laypeople cannot distinguish a simple overstretching from a rupture of the ligaments, a doctor should always be consulted. Especially if after a week it is still not possible to exercise with full body weight.

Sprained ankle in the child

Children play and romp and if they are not quite sure how to walk for the first time, children can quickly twist an ankle and pull a sprain on their ankle. When children fall, they get frightened very quickly and often do not even understand what happened. Often it is best to calm down the children first and possibly explain to them what happened. If the child continues to cry and is already reporting exact pain in the foot, it may be a sprained ankle. In this case, the parents should explain to the child to keep the leg still.

Since it is often difficult for parents to find out what the pain means in children, they should consult a doctor for evaluation to rule out a worse injury. Until then, the foot can be observed and, as a precaution, also be cooled. The cool packs should always be wrapped in a protective towel so that the skin does not get frostbitten. The child's possibly sprained foot should be immobilized and elevated to prevent swelling. If swelling occurs after a while, this can be an indication of a sprain on the ankle.

The child is examined by the doctor. Since children are often afraid of doctors and do not always provide an answer to questions, it is helpful for the doctor to have a parent with them during the examination. Last but not least, the child then feels more comfortable and the mother or father can also calm the child down. If the doctor finally diagnoses an ankle sprain, it may be necessary to immobilize your foot. A bandage or bandage may be sufficient to support the foot. Children can often judge for themselves whether they can put pressure on the foot without pain or not. In addition, cooling and pain relieving ointments suitable for children can be applied to the sprained ankle daily.

A splint may sometimes be necessary for more severe injuries. As a rule, children take the accident very well, and they also tolerate the examination and treatment of the ankle very well. They often recover from such an injury much faster than adults and can put weight back on the foot more quickly. To prevent such injuries, children should always wear suitable, sturdy shoes. Shoes that extend beyond the ankle offer good support, especially when running, playing and when walking unsteadily.

Read more interesting information on the topic at: Bruise in the child