Ankle Pain

ANKLE SPRAIN

An ankle sprain is one of the most common sports injury. A sprained ankle causes soft tissue damage (ligaments) around the ankle, usually caused by an inversion injury (where the ankle is twisted inwards) or an eversion injury (where the ankle is twisted outwards). Because of the position of the bones around the ankle, the inversion injury is far more common. This injury causes damage to the lateral ligaments on the outside of the ankle.

The most commonly injured ligament is the Anterior Talo-fibular (ATF) ligament The ATF joins the fibular and talus bones together. If the force to the ankle is more severe, the Calcaneo Fibular ligament (between the Calcaneus and Fibula) is also damaged. The Posterior Talo-fibular (PTF) ligament is very rarely damaged in comparison to the other two ligaments.

In an eversion injury, the damage occurs on the medial (inside) of the ankle. The ligament on the inside of the ankle is called the Deltoid ligament and is very strong. It is so strong in fact that the bone on the inside of the ankle can be pulled off (an avulsion fracture) before the ligament is damaged.

In addition to damage to the ligaments, the capsule which surrounds the ankle joint is also damaged. The damage causes bleeding within the tissues and the ankle begins to swell up and can be extremely painful.

SPRAIN CLASSIFICATIONS

1. • First degree, where only a few ligament fibres are damaged

2. • Second degree refers to more extensive damage to the ligament with    associated swelling

3. • Third degree refers to a complete rupture of the ligament with swelling and a possible joint dislocation

In more severe injuries there may be bone injury. X-rays are done to determine whether there is a fracture.

SIGNS & SYMPTOMS

With a first degree sprain there is pain when turning the foot in or out, and also pain when the damaged area is touched.

In a second degree sprain the pain is more severe, there is swelling all around the area and it is painful to walk.

With third degree sprain the pain is excruciating and walking is impossible. there is gross swelling and there may be deformity if the ankle is dislocated.

TREATMENT

In the first 2-3 days following the injury it is important to follow the PRICE protocol - protection, rest, ice, compression and elevation.Apply ice packs for a period of 15 minutes every couple of hours helps with the pain  and reduces swelling and inflammation.It is important not to put too much weight on the damaged ankle, walking should be avoided..

When a fracture is suspected an X-ray should be done..  Some hairline fractures will not show up on X-ray until about 10-14 days after the injury due to swelling and inflammation.  Treatment should be started at once to help eliminate inflammation.

With a second degree sprain, crutches should be used to allow the injured ankle to heal without further damage. Once the patient is able to put weight down on the ankle crutches are no longer necessary.  Gradual increase in activity is recommended.

Chiropractic treatments will help to reduce swelling and inflammation and restore the affected ligaments/muscles/tendons.  The CHIROPRACTOR will also assess the rest of the body structure and function to determine if there were other factors involved making the weak.  Treatment normally involves low volt current, ultrasound, laser, etc. to reduce swelling and enhance soft tissue repair.Once the patient is able to walk on the ankle, more active rehabilitation can be started.

TREATMENT & REHAB

Things you can do:

1. • Wear an ankle support for protection.  This helps speed up soft tissue repair.

2. • The Chiropractor will help relieve soft tissue damage and teach effective exercises to help strengthen the ankle and supporting structures.

3. • Continue treatment until pre-injury strength has returned

Ankle instability is characterised by ankle weakness and giving way, even though the ankle ligaments are intact and the joint is mechanically stable. It is due to an impairment of proprioception, which leads to a lack of balance and ankle joint position sense. Proprioception is the mechanism by which nerve receptors in skin, muscle, ligament and joint tissue relay information to the brain about body position sense, where this information is quickly processed and movement strategies are formulated and executed using nerve signals to muscles. This mechanism can help you ‘catch yourself” when you are about to turn your ankle.

In the unstable ankle these receptors may have been damaged directly during an ankle sprain. This impaired proprioceptive ability may, therefore, lead to a delay in protective muscle activity and the resultant loss of postural awareness and stability around a joint. This may explain why recurrent ankle sprains are so common.

Initial rehabilitation exercises depend on the degree of injury and pain suffered, but usually begin with:

1. • Improving the range of motion

2. • Non weight-bearing strengthening exercises to achieve symmetry of movement and strength

3. • Progressing to weight-bearing exercises through all ranges of motion

4. • Proprioceptive exercises from standing on one leg, progressing to use of a wobble board

A wobble board, and an ankle brace, is commonly used in the rehab of ankle instability. Wobble boards are designed to assist the re-education of the proprioceptive system by improving sensory receptor function. Wobble board training improves single leg stance ability and balance; patients with ankle instability who use a wobble experience far fewer ankle sprains..

Taping or bracing the ankle can also help to and prevent further injury.