How to prevent the aftermath of a sprained ankle? Ajou University Hospital Orthopedic Surgery Prof. Park Young-wook

What is an ankle sprain?

 

An ankle sprain is when trauma damages the ligaments and muscles that contribute to the stability of the joint. Sprains of the thighs, knees, feet, Achilles tendons, and ankles can occur during lower limb injuries, but ankle sprains are very common in athletes, especially soccer players. Ankle sprains are a frequent injury that accounts for 40% of all sports injuries.

 

Bones and muscles heal well, but ligaments, tendons, and cartilage have anatomical features that make it difficult to supply blood, so it is better to prevent them as much as possible because they cannot be completely healed and cause sequelae.

 

The ligaments that are commonly injured are the anterior nasal ligament and the longitudinal ligament, and in general, when a sprain occurs in this ligament due to trauma, comorbidities occur not only in the ligaments, but also in the tendons and nerves.

 

 

Why are ankle sprains dangerous?

 

Once an ankle sprain occurs, it is dangerous because it can lead to re-injury or chronic sprain. Ligament problems can lead to ankle instability* and, as a result, cartilage damage.

 

Early treatment after early diagnosis is important. After six years of follow-up of patients with ankle sprains, 5% had to change positions and about 4% quit the sport. About 6% of non-athletes had to change careers because of sprains.

*Ankle instability: If you don't take proper care of your ankle after spraining it, or if your ankle feels unstable at the slightest stimulus.

 

How is an ankle sprain diagnosed?

 

When an ankle sprain occurs, pain, bruising, blood, and swelling occur. However, this does not mean that there is enough damage to warrant a visit to the hospital, but rather 'meaningful damage', i.e., when symptoms do not improve after three days, treatment is required. If it is difficult to diagnose based on medical findings such as pain, bruising, or swelling, several tests may be performed to diagnose a sprain. There are load radiology tests, MRIs, ultrasounds, x-rays, etc. Of these, x-rays should be taken to confirm the fracture.

 

Load radiography*, which is the most representative test for diagnosing sprains, is difficult to perform in the acute phase. If the pain is severe, it is difficult to observe the problem area with load radiological examination.

*Stress test: A test that loads stimuli such as drugs and exercise onto the human body and observes changes in motor function before and after stimulation

 

In addition, MRI and ultrasound can be used to diagnose the diagnosis. MRI is a necessary test when it is necessary to look at the cartilage located in the middle of the bone, which is difficult to see with ultrasound. However, in the case of MRI, hematomas may occur in the acute phase, which can make it difficult to make an accurate diagnosis, so it should be taken a few days after the sprain occurs.

 

Ultrasound can be performed even in the acute phase, since the hematoma is clearly visible. It is an easy to diagnose ankle instability and has the advantage of being inexpensive, so it is a diagnostic test that is often performed.

 

How is ankle sprain treated?

 

Ligaments are responsible for holding bones together and contribute greatly to joint stability, so it is very important to receive the right treatment at the earliest stage of a sprain.

 

The first stage of treatment for ankle sprains is to reduce pain, reduce swelling, and treat the acute phase. The most important of all stages of treatment is the removal of swelling. When ligaments break, it's natural for them to swell. The ligament can attach only when the swelling goes away, which is why removing the swelling is a priority.

 

To reduce swelling, remember 'RICE'.

 

Rest: Plenty of rest

Ice massage: 20~30 minutes 3~4 times

Compression: Proper compression

Elevation: Higher than the heart

 

You can also add 'Protection' to it and remember it as 'PRICE'.

 

After going through the steps to remove the swelling, the next stage of treatment depends on the case when the pain is not severe and if the ligaments are completely torn. First of all, if it is not severe, you will need to wear an assistive device. Our body also has homeostasis, and the ligaments heal on their own over time, so if the pain goes away, you can remove it, and you don't need to visit the hospital anymore.

 

However, if the ligament is severely damaged, such as a complete tear, it is necessary to immobilize it by wearing a cast. Normally, you need to fix it firmly through a cast for about ten days. The reason for this is that the inflammatory phase of the recovery phase of soft tissue injury ends around the tenth day after the trauma. If this fixation treatment is done well in the early stages, the ligaments can be attached well and the treatment can proceed smoothly in the future.

 

In the second stage of rehabilitation treatment, the next stage is to restore the range of motion of the joints and strengthen the muscles. In this step, you will learn bracket exercises, exercises that push the ligaments sideways or inward, and you will also do it on your own. If the joint range of motion and muscle strength are restored without pain as a result of repeated rehabilitation exercises, the patient will move on to stage 3.

 

In the third stage of rehabilitation, the goal is to restore motor equilibrium. Balance board workouts and resistance training, and for athletes, endurance training and discipline-specific training. Once this step is complete, the treatment of the sprain is complete.

 

Can I still experience pain after ankle sprain treatment?

 

If you continue to experience pain even after ankle sprain treatment, you may have chronic ankle instability or other comorbidities such as micro-tendon lace fractures*. Chronic ankle instability can be caused by stretched ligaments or proprioceptive receptors that have not yet healed. Diagnosis of chronic ankle instability is also the same as for ankle sprains, with examination findings, medical history, load radiography, MRI, and ultrasound.

*Tendon lace fracture: A fracture caused by a sudden contraction of a muscle that attaches to the end of a bone

Treatment options for chronic ankle instability include conservative and surgical treatments.

Conservative treatment is a three-month period of strength-building exercises with braces and exercise therapy. After 3 months of doing this, you will see an improvement of about 50%.

There are two types of surgical treatment: shortening and suturing the stretched ligament and reconstructing the missing ligament using another ligament. They are called ligament repair surgery and ligament reconstruction surgery, respectively, and rehabilitation treatment is performed after surgery. There is no particular rejection in the way other ligaments are brought in and reconstructed, because unlike other organs, ligaments and bone tissue are opposed to other tissues when they enter the body.