The ankle joint is prone to injury and is the joint most likely to be affected by a sprain. It contains many ligaments that are at risk of being stretched or torn when the foot is forced to land in unnatural positions. This can occur whilst playing sports or undertaking exercise.
A sprain can occur when the foot lands on an uneven surface with force or is turned inwards suddenly. This places stress on the ligaments that normally help stabilize the outer part of the joint and causes a strain or sprain.
Ankle sprain ranges in severity from grade-I to grade-III, depending on the extent of injury to the ligament. An examination of the ankle may reveal swelling and discoloration due to the accumulation of blood and fluid within the joint. An X-ray should be undertaken to rule out the possibility of a fracture. An MRI examination should provide an idea as to the extent of damage to the ligaments.
Early mobilization stimulates collagen bundle orientation thereby promoting healing and regaining the range of motion.
Improper rehabilitation may result in instability which will place the ankle at risk of further strain. Returning to activity without proper healing or inadequate rehabilitation can also lead to instability. Patients can be declared fit to return to normal activity only after taking into consideration the following points:
1. Is there is a full range of motion of the ankle?
2. Ability to walk without a limp.
3. 80-90 per cent strength when compared to normal ankle.
4. Is pain free hopping possible on the affected limb?
If the ankle has not healed properly, the sufferer may experience a feeling that their ankle is ‘giving way’ when they try to use it again. If they try to undertake their former activities they are placing themselves at risk of further ankle sprain.
Treatment at the initial stage should reduce post-injury swelling, bleeding and pain especially during the first 24 hours. Do not use heat as it increases swelling. Avoid Aspirin intake as it prolongs the blood clotting time thereby increasing bleeding.
Rest the affected joint, and keep the leg and foot elevated to reduce pain and swelling. Place an ice pack around the joint for 15-20 minutes every one or two hours.
Protection of the ankle during the initial healing phase is extremely important. Tape, bandage or a brace can be used to protect and support the ankle. In more severe sprains a leg cast may be applied. In some cases crutches may be required until pain free weight bearing is possible.
Once pain free motion is attained, strengthening exercises are advised to help the ankle regain its former strength. Here are a couple of sample exercises;
Heel and toe raises: Stand on a step with the heels hanging slightly off the step. Slowly rise up on your toes and then slowly bring your heel down.
Balance exercises: While standing, raise one foot off the floor and balance on the other foot for a count of 15. Increase the count gradually to 30.
A gradual return to full activity is recommended, for example walking half the distance and running half, gradually increasing the amount of time spent running.
Chronic ankle injury requires proper rehabilitation exercises over a period of time in order to improve the range of motion and enhance strength and stability. If ankle pain is managed properly and well the risk of developing a chronic injury is greatly reduced.
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