ANKLE SPRAIN

Ankle sprains are the result of stretching or partially or completely tearing one or several of the ligaments that hold the ankle joint together. Ankle sprains occur when the ankle joint is forced to bend further than normal. The most common type of sprain occurs when the foot is turned inward and the full weight comes down on the ankle. This causes a sprain on the outside of the ankle. Almost everyone has a sprain sometime in his or her life. Almost all resolve completely without further problems.

The symptoms of a sprain include a popping or tearing sensation at the time of injury. This results in pain whenever the ankle bears weight. Usually there is fairly quick swelling at the site of injury. Bruising will often develop during the next 24 hours.

Treatment will help prevent swelling, protect the joint until it heals, and prevent unnecessary muscle weakness. Treatment also helps remove any swelling, enabling you to get moving again as quickly as possible. The initial treatment helps to prevent swelling and consists of four components. First, apply ice to the injury immediately because the swelling can start in a few minutes. The less swelling you have, the quicker you will be back to normal activity. Second, rest the joint for 1 or 2 days. This may include using crutches to rest the ankle if you have to be up and around during the first day or two. Third, compress the injured area with a compression wrap or air splint. Fourth, elevate the ankle above the level of the hip. You can remember these treatment components with the acronym RICE (Rest, Ice, Compression, and Elevation).

The next treatment is protected motion that allows the ankle to move without moving too far and further injuring the joint. This may be as simple as using a compression wrap or a splint or brace. Your doctor may prescribe physical therapy. This will keep muscles from weakening and help remove any swelling that has taken place. Sometimes your doctor may suggest heat or alternating cold and heat to try to remove swelling that is present. Do not ever use heat before 72 hours after the injury because it will nearly always cause more swelling that will slow recovery. Lastly, your doctor may recommend exercises or physical therapy after you have recovered to try to prevent future injuries. Severe injuries may require casting of the foot or even surgery. This is usually necessary when the ligaments are completely torn or if there are multiple ligaments injured.

• You should take any medicines prescribed by your doctor. Prescription pain medicines may be used for severe sprains. Over-the-counter medications may be used for less severe sprains. You should follow your instructions for RICE immediately after your injury. Your doctor may prescribe physical therapy. Use your crutches as directed. If you are an athlete, your trainer may be able to help speed your recovery. After you have recovered, you may want to consider exercises to increase the strength of the lower leg muscles. There are also exercises that may improve "proprioception" (the ability to recognize the position of your foot without looking at it). Both types of exercises may help prevent future injury.

• You should avoid activities that will increase swelling because this will slow your return to complete activity. Therefore, early application of heat, excessive activity, standing, or sitting with the ankle hanging should be avoided. If you keep a shoe on or apply a splint, brace, or compression wrap, you should watch for signs that it is getting too tight and cutting off circulation to the toes. Symptoms would include numbness or tingling in the foot or toes, blueness or duskiness of the toes, or coldness in the toes. If any of these occurs, loosen whatever is tight or contact your doctor. Although it is desirable to keep the joint moving, you must avoid a second injury before the first one heals.

• You should call if swelling is increasing or if you notice any of the above symptoms of decreased circulation to the foot. You should call if you are not noticing significant improvement within 7 to 10 days after the sprain. You should call if there is any popping, catching, or giving way of the ankle after the swelling has gone away. These may be signs of a more severe injury than was originally apparent.

Description of the injury, the ligaments involved, and treatments for severe sprains
http://www.medmedia.com/00a1/25.htm




Application of adhesive strips to immobilize the ankle. (From Rosen P [ed]: Emergency Medicine, ed 4, St Louis, 1998, Mosby.)

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