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Although seen as minor injury, it’s very debilitating?By: Diandra SchonyersThe lateral malleolus is the boney protrusion on the outside of the ankle.The medial malleolus is the boney protrusion on the inside of the ankle.3495675478790Ankle injuries are one of the most common pathologies seen in sports and other recreational activities. Ankle sprains are the most commonly seen injury in the lower extremity. There are two types of ankle sprains, eversion and inversion. These sprains are more widely known as a lateral ankle sprain and a high ankle sprain. The inversion ankle sprain is the most recurring of the two; this is because the lateral malleolus sits lower than the medial malleolus. Although the lateral ankle sprain is more commonly seen, the eversion ankle sprain is more debilitating. Too many people think an ankle sprain is not a very severe injury. These injuries are classified or graded according to their severity from grade one to grade three, three being the most severe. Grade two ankle sprains are the most commonly reported because the patient begins to feel discomfort performing everyday tasks such as walking and standing. When everyday tasks are impaired a patient is more likely to become proactive and seek treatment for their injury, whether from health professionals or from their peers.315277527940Inversion Ankle Sprains The most commonly described method of injury for an inversion ankle sprain is an individual planting, cutting, and rolling their ankle inside (plantar flexion and inversion). This mechanism causes injury to the structures on the outside of the ankle. The main ligaments affected by this injury are the anterior talo-fibular ligament (ATF), the calcaneo-fibular ligament (CF) and the posterior talo-fibular ligament (PTF). The lateral ankle sprain is graded as follows:Grade OneNo sounds at the time of injury, slight discomfort over the ATF, no swelling or discoloration, no to mild pain when stretching in extreme plantar flexionGrade TwoMay have heard a pop at the time of injury, moderate swelling, discoloration, will have impaired gait (a limp), very tender over the CF and ATF, ability to move will be reduced due to pain (the ATF may be ruptured and the CF injured)Grade ThreeWill hear a pop at the time of injury, severe swelling, discoloration, very tender over all lateral structures, will not want to move their ankle because it is too painful (ATF and CF are most likely ruptured and the PTF is injured)Inversion ankle sprains are seen in any sport or activity that requires lower extremity weight bearing or activities that require repetitive jumping, landing or cutting; a few examples are football and basketball. Recently Miami Heat Guard/Forward Dwayne Wade sat out six straight games with a lateral ankle sprain. This shows that although an ankle sprain seems like a minor injury it can be very debilitating, even to professional athletes. If untreated ankle sprains can lead to injury of other structures due to compensation from the original injury, causing further injury to the ankle, and/or weakened muscles and ligaments of the ankle. While Wade sat out those six games, he went through the rehabilitation process and gave his ankle time to heal. Following his rehab he was able to return to play against the New York Knicks and scored 28 points in his first game back and played as though his ankle was not bothering him at all.3810000149860Eversion Ankle Sprains 285751457960An eversion ankle sprain occurs when someone’s foot/ankle is forced up and out (dorsiflexion and eversion). This injury is more commonly known in sports as a “high ankle sprain”. Eversion sprains are more devastating and take longer to heal because it causes injury to the deltoid ligament and/or the anterior tibiofibular joint, which is also known as the syndesmosis joint. To simplify, this “joint” is a grouping of connective tissue between the tibia and fibula. This connective tissue is responsible for holding the tibia and fibula together and dissipating the force of our everyday movements. This type of sprain causes a separation of this joint, which is very painful and greatly affects the way the patient’s gait, the way they walk. Injury to the deltoid ligament following an eversion mechanism is usually referred to as an eversion ankle sprain. An eversion mechanism that causes injury to the syndesmosis joint, and possibly the deltoid ligament, is referred to as a high ankle sprain. Injury to the syndesmosis joint causes a very unstable ankle joint. This is because the syndesmosis joint is affected by every step we take. With every step, this joint spreads a little to allow for full range of motion. This constant separation to an already injured structure causes the patient severe pain and prolongs the recovery process. Recently New England Patriots Tight End Rob Gronkowski suffered a high ankle sprain in the AFC Championship Game against the Baltimore Ravens. Due to the severity of the injury Gronkowski’s playing status for Super Bowl 46 was uncertain for much of the week leading up to the game. Although his status remained uncertain until about game day, Gronkowski played in the game. He was clearly not playing at his full ability because he was still affected by the injury.Eversion ankle sprains account for only about 10% of all ankle sprainsRehabilitation of both ankle sprainsInversion Ankle Sprains ↓-Patient is placed in walking boot or on crutches if they have a limp-As a precaution, the patient is sent for x rays to rule out any fractures -Typical progression of treatment: (Grades 1-2)1990725183515~Rest, Ice, Compression & Elevation (RICE)~Therapeutic modalities & analgesics (ex. Tylenol) to reduce pain and swelling~Mobilization using an ace wrap/ crutches may be necessary after the first 48 hours~After the first 24 hours on crutches the patient will begin weight bearing with the crutches~Strengthening exercises using a theraband~Balancing exercises1895475433705~Functional/Sport Specific Exercises~Return to sport (only granted is sport specific exercises can be completed pain free)-Typical progression of treatment (Grade 3)~For the first 6 weeks: patient goes through the normal rehab progression for Grade 1 and 2 sprains~If the patient is able to perform normal sport activities with ice, tape, a brace, and without unrelenting issues following activity the injury will not require surgery~If there is constant instability and pain, the patient will require surgery ~Following surgery the patient will follow the normal rehab progressionEversion Ankle Sprains ↓-Patient is placed in a walking boot to prevent weight bearing -As a precaution, patient is sent for x rays to rule out any fractures-Typical progression of treatment:~Rest, Ice, Compression & Elevation~Therapeutic Modalities and analgesics to reduce pain and swelling~Mobilization using an ace wrap/ crutches may be necessary after the first 48 hrs~After the first 24 hrs on crutches, the patient will begin weight bearing with the crutches~Strengthening exercises using a theraband~Balancing exercises~Functional/Sport Specific Exercises~Return to sport (only granted if sport specific exercises can be completed pain free)-Typical progression of treatment (Grade 3)~For the first 6 weeks the patient goes through the normal rehab progression for Grade 1 and 2 sprains~If the patient is able to perform their normal sport activities with ice, tape, a brace, and without unrelenting issues following activity the injury will not require surgery~If there is constant instability/pain, the patient will require reconstructive surgery of the injured deltoid ligament and the syndesmosis joint~Following surgery the patient will follow a strict rehabilitation program including the same principles as the first rehab programAlthough the progression of treatment is the same for both types of sprains, the recovery time for and eversion ankle sprain is much longer.4248150190500Why is this important?It is important to have knowledge about ankle sprains because they are the most common injury seen in professional and recreational sports. Due to this fact, many times these injuries go unreported and lead to further injury and weakened ankle structures. An ankle sprain may present in many different ways. For example there can be little to no swelling or discoloration and on the other hand, the foot and ankle may look like a ball. 66675101600The severity of an ankle sprain cannot be judged by the amount of swelling and discoloration present. There are a combination of observations and tests that are required to determine the severity of this injury. Therefore, in order to gauge the severity of the injury it is important to report the injury to a medical professional. While it is important to report these injuries, it is also essential to have some knowledge about ankle sprains.Do not underestimate the amount of discomfort an ankle injury can cause.Name of SiteURLGeneral ContentAudienceRating(1-4)Acute Ankle Injuries info about acute injuriesMedical professionals3Sports Shorts Specific info about lateral ankle sprainsMedical professionals4Sports & Spinal Physical Therapy info about lateral ankle sprainsAnyone3Sprained Ankle info about ankle sprainsAnyone2Management of ankle sprains info on ankle sprainsMedical professionals4The Physician and Sports Medicine info on ankle sprainsMedical professionals4 ................
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