Dr Sachin Tapasvi: All about ankle sprains

22061319 - sport running ankle sprain. sportswoman touching painful twisted or broken ankle. athlete runner training accident.

Everyone in his or her lifespan undergoes this very common injury called an ankle sprain. A sprained ankle or a ‘rolled over’ ankle as it’s called, usually results in us tripping over an object, getting our foot stuck in a small pot hole or by missing a step which causes us to lose our balance. Suddenly the ankle rolls inwards and our unchecked body weight causes us to fall down. Though it is a very common injury, the outcomes may not be always the same.

The ankle is a strong robust joint in our body that measures roughly 4 to 5 sq cms in surface area. This small 4 to 5 sq cm joint bears our entire body weight when we are in a single-leg stance position. So 80 kilos which is the average male weight for the Indian is transmitted on a very small surface area, which means that the forces acting on the ankle joint are extremely high. The ankle joint moves in an up and down direction, which is termed as dorsiflexion and plantar flexion in medial terminology. Since it moves in a uniaxial plane, naturally, there are restraints on either side of the ankle to keep it stable and prevent from side to side movement. These supports on either side are made up of bone as well as ligaments. The bone on either side of the ankle protrudes like a small tongue and strong ligaments arise from these bony projections and bind the ankle firmly down. There are three ligaments on the outside or the lateral aspect of the ankle and two sets ligaments on the inner or the medial side of the ankle. Of both of them, the lateral or outer side ligaments are more vulnerable to an injury.

The immediate effect that one feels is that of intense pain and swelling that comes on almost instantaneously. The swelling is then followed by ecchymosis or bruising around the ankle joint. Bearing any weight may be difficult in the acute phase, and only once it settles down, would one be able to walk with a limp bearing tolerable weight. Minor degree injuries usually settle down naturally without much of a problem.

Injuries may be classified into grades. Grade I is just a strain or pulling of the ligament, a Grade II injury is a partial tear and a Grade III injury is a complete tear with a possible dislocation of the ankle. As with any acute injuries, RICE is the treatment. ‘R’ stands for rest, which means you need to rest the part, ‘I’ stands for Icing. You need to apply ice-cubes in a plastic bag for at lest 10 to 15 minutes for three times a day for decreasing the pain as well as decreasing the associated swelling. ‘C’ stands for compression. We need to apply a firm crepe bandage support to the ankle joint. This is essential to not allow the swelling to increase and also provides a support for the injured soft tissue to enable healing. ‘E’ stands for elevation. As with any other injured part in the body, once you elevate the injured part above the heart level, the swelling would track down with gravity. It is important to keep the swelling under control, since the tissue fluid (as a result of the swelling) acts like glue and this glue will lead to further stiffness. Thus the acute treatment should consist of resting or splint-age, icing, compression and elevation. As I did mention earlier, minor grade I injuries will settle down over a period of 7 to 10 days and should not pose any problems.

The Grade III or the complete dislocation will require surgical treatment since the ankle joint will be completely deranged and these torn ligaments need to be fixed so as to enable healing. The treatment of Grace II injuries is usually controversial. For the high demand athlete, we do suggest primary repairs so as to maintain the strength in the ankle and to enable faster return to work. In the non-athlete population, non-operative treatment would be the rule. In non-operative treatment, the use of air cell splints such as air cast splints are extremely useful. A good physiotherapy program is essential in all injury patterns to enable complete recovery. Proprioception or wobble board exercises are particularly useful since the ligaments contain nerve fibers, which tell the brain the position of the ankle. Once there is a ligament tear, these signals may be disrupted and hence it is essential for the brain to re-educate itself regarding the same.

So friends, don’t dismiss off the ankle injury so lightly. Definitely put some thought into it and seek attention if you find that you injury is not healing and your ankle is still sour, even a week following the injury. This will enable you to maintain and ensure complete mobility and stability.

Dr Sachin Tapasvi

Dr Sachin Tapasvi

Dr Sachin Tapasvi is one of India’s leading joint replacement surgeons. He practises in Pune and has been awarded several fellowships with experience garnered internationally as well as in India. Dr Tapasvi writes every Wednesday on Pune365.
Dr Sachin Tapasvi