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What is ankle sprain?
Ankle sprain is one of the main injuries that occur in sports. This injury causes stretching or rupture of one or more ligaments grouped in the ankle joint. Ligaments are bands of tissue that connect bones to the joint and one of their functions is to restrict their movement. This type of stretching, or rupture, can affect the tendons, the capsule or, still, the blood vessels.
Practicing physical exercises that have a lot of impact, such as football, futsal, volleyball and basketball, can cause problems and even cause injuries in which the player has to spend some time away from the courts or the lawn, whether he is a professional athlete or what he only practices for. have fun.
Classification
This injury occurs in more than 85% of cases of people who suffer from ankle injuries and, in most cases, it is small. Lesions can be separated into three degrees:
- First degree or ligamentous stretch: stretching of the ligaments, but without rupture, which can cause swelling and pain.
- Second degree or partial ligament injury: partial rupture of the ligaments and joint instability causing edema, joint stiffness, pain and swelling.
- Third degree or total ligament injury: Total rupture of the ligaments and lack of firmness in the foot when walking.
Cause
What causes the sprain is the sudden movement performed wrongly when walking, running or playing sports. This can also occur after a jump and landing on the ground, as well as after a volleyball service or throwing / kicking a ball in the hoop / goal.
With the movement caused, there is a forced turning of the ankle and, in most cases, the foot turns downwards or inwards, causing injury to the outer part of the ankle.
As there are different ways to turn the foot, we show below the three types of steps that can increase the risks of sprain.
Pronada
The foot, when touching the floor, rests on its inner side and squirms inward, using the toe to gain momentum.
Normal
When touching the floor, the foot rests on the outer side of the heel and moves inward, following in a straight line until the toe is lifted.
Supinated
The foot, when touching the ground, rests on the outer side of the heel and continues the movement using its outer side, gaining momentum in the little finger.
Risk factors
There are some risk factors that can cause predisposition to ankle sprain:
- Fall after a jump;
- Support the foot incorrectly;
- Use shoes that are inappropriate for the sport performed;
- Lack of training;
- Do not warm up when performing a sports activity.
What are the ankle ligaments?
The ankle has the important function of boosting the body and also of absorbing the impact against the ground, so it needs to be stable and flexible at the same time.
The ligaments are divided into three: anterior talofibular, posterior talofibular and calcaneofibular. The most common to be ruptured are the anterior talofibular (LTFA) and the calcaneofibular (CFL). There is hardly any rupture of the posterior talofibular ligament (LTFP).
Posterior talofibular ligament
This ligament runs medially and anteriorly from the margin of the fibular malleolus to the talus, anteriorly to its lateral articular facet.
Posterior talofibular ligament
It participates almost horizontally in the depression in the medial and posterior part of the fibular malleolus to a prominent tubercle on the posterior aspect of the stem. In addition, it also participates in the lateral part, which goes to the groove, reaching the tendon of the long flexor of the hallux.
Calcaneofibular ligament
It is a narrow and rounded cord that occurs at the apex of the fibular malleolus to a tubercle on the lateral aspect of the calcaneus.
Symptoms
The main symptoms when ankle sprain occurs are:
- Swelling in the foot and ankle;
- Pain in the lateral region of the ankle;
- Edema;
- Hematoma (red or purple color);
- Not being able to support the weight of the body on the foot.
Diagnosis
The diagnosis must be made by the orthopedist. At the consultation, the doctor will do a clinical examination, which will be based on the conversation with the patient about what happened, what the symptoms are and how long ago they appeared. The doctor must also do, before sending the patient to the x-ray , a palpation examination of the place to understand where it hurts and, thus, be able to assess the extent of the injury.
By analyzing the patient’s x-ray, the doctor can find out if there is a ligament injury and also if there is a fracture. If there is a fracture, the patient will find it very difficult to support the foot on the floor. In diagnosing the ligament injury, an MRI should be ordered by the doctor so that he can more clearly identify the type of injury and which structures are affected.
Ankle Sprain Treatment
The initial treatment should be done with rest, ice packs and elevation of the foot, so that the edema is minimized and so that the pain also decreases. In case of swelling of the ankle, some doctors may indicate the wet clay pad so that there is swelling.
Applying the ice 4 times a day, for 30 minutes, is recommended. The ice must not come into direct contact with the skin, and must contain a towel or cloth to avoid burns.
Medicines
Doctors often recommend anti-inflammatories and painkillers to patients, whether they are natural or not. The natural ones are known as arnica gel or devil’s claw ointment .
The other medications that can be used are:
- Diclofenac ;
- Ibuprofen ;
- Ketoprofen ;
- Naproxen .
Physiotherapy
Physiotherapy is indicated for:
- Reduce pain so that daily activities can be done again, such as working, driving and playing sports;
- Let the muscle regain the strength it was before, making sure there is good control of the joint;
- Re-educate the foot so that there is perfect posture and movement (proprioception).
The practice of physiotherapy consists of performing stretches with the help of devices and performing activities so that the movement returns to normal, with the strength that was before the injury.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Treatments and recovery time according to the degree of the injury
First degree injury
- A plastered splint can be used to immobilize the foot and ankle for 1 or 2 weeks.
- Elastic immobilization can work well.
- The use of anti-inflammatories, ice and elevation can alleviate the symptoms.
- Physiotherapy is indicated 2 or 3 weeks after the injury occurs.
Second degree injury
- The treatment is similar to that of the first degree, the big difference is that the immobilization time is longer, which can be up to 3 weeks.
- The recovery, healing and rehabilitation time is longer.
- Physiotherapy is important so that the treatment results are better.
Third degree injury
- The downtime can be up to 4 weeks.
- The recovery, healing and rehabilitation time is much longer compared to other cases.
- There is a possibility of lesions with late symptoms.
- Surgery can occur in athletes or in injuries with great instability.
Complications
It is believed that 90% of cases, after 6 weeks of sprain, have good results, in addition to returning to a normal life. But there are a number of patients who, even after 6 weeks, may suffer from discomfort or joint instability.
In cases of symptoms after 3 months of treatment, magnetic resonance imaging should be performed to diagnose other defects and inflammations. This test helps to diagnose late symptoms, such as joint cartilage defects, scarring and internal, painful and inflamed adhesions.
The treatment of late injuries can be done with strength, flexibility and proprioception exercises to stabilize and prevent further ankle sprains.
Living with the problem
To live with the problem, some tips are given, such as:
- Apply ice packs;
- Keep your foot elevated;
- Use crutches not to support your foot on the floor;
- Do gentle stretches;
- Move your toes to reduce swelling;
- Do strengthening exercises;
- Do proprioception exercises.
Prevention
Using ankle immobilizers can reduce the chance of sprains in the region by athletes who practice exercises with a high risk of torsion by up to 47%. Patients who have already had the problem have an even greater chance of prevention when using the immobilizer.
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