Sprains of the ankle joint are very common, and most often occur when the leg is turned inward (inversion). Usually, they are manifested by pain, swelling, tenderness on palpation, most pronounced in the front of the ankle. The diagnosis is made during a clinical assessment, and sometimes radiologically. Treatment – protection, rest, application of ice, compression, elevated position of the limb (protection, rest, ice, compression, elevation – PRICE technique); with light sprains, early loads with body weight are indicated, and with moderate and severe sprains – immobilization with subsequent therapy with physical exertion; some very severe dislocations require surgery.
The most important ligaments of the ankle are as follows:
- Deltoid ligament (strong medial ligament)
- Anterior and posterior talus peroneal (lateral ligaments)
- Calcaneofibular (lateral ligaments – Ligaments of the ankle joint)
With inversion (turning the foot inward), the lateral ligaments are damaged, especially the anterior talon-fibular ligament. Most gaps form as a result of inversion. Severe injuries of the II and III degrees sometimes lead to chronic joint instability, which predisposes to additional sprains. Inversion can also cause fractures of the dome of the talus, sometimes accompanied by sprains of the ankle.
When eversion (turning the leg out), the joint experiences a medial load. This load often leads not to a sprain, but to a tear fracture of the medial ankle, since the deltoid ligament is strong enough. However, eversion may also cause stretching. With eversion, the joint is also compressed from the side; this contraction, often combined with flexion, can lead to a fracture of the distal fibula or rupture of the syndesmosis between the tibia and fibula proximal to the ankle (the so-called high ankle sprain). Sometimes eversion forces spread up the fibula, leading to a fracture of the head of the fibula just below the knee (the so-called Mezondnev fracture).
A recurrent ankle sprain can interfere with proprioception and thus predispose to subsequent episodes of an ankle sprain. Most cases of an ankle sprain are mild (grade I and II) as recorded by the best urgent care in Los Angeles.
Stretching the ankle causes pain, swelling, and sometimes muscle cramps. The localization of pain and swelling depends on the type of injury:
- Inversion: usually maximal in front of the ankle
- Eversion: maximum over the deltoid ligament
- Meson’s fracture: over the proximal part of the fibula, as well as over the medial and sometimes lateral ankles
- Stretching III degree (complete rupture, often with damage to the medial and lateral ligaments): often diffuse (sometimes the ankle externally takes the form of an egg)
In general, pain on palpation is maximum over damaged ligaments, and not over bone; if soreness is more pronounced over the bone than over the ligaments, a fracture can be assumed.
With mild (1st degree) sprains of the ankle joint, pain and swelling are minimal, but the ankle is weakened and prone to repeated injury. Healing lasts from several hours to several days.
With moderate and severe (2nd degree) sprains of the ankle, the ankle is often swollen and bruised; walking is painful and difficult. Healing lasts from several days to several weeks.
With very severe (3rd degree) sprains of the ankle joint, the entire ankle may be swollen and bruised. The ankle is unstable and cannot support the weight. Nerves can also be damaged. Healing usually takes 6 to 8 weeks.
- Clinical assessment
- Sometimes radiography to rule out fractures
- In some cases, an MRI scan is performed.
The diagnosis of an ankle sprain is mainly clinical; Radiography is not required for every patient.
If it is impossible to assess the damage (for example, due to muscle spasm and pain), the ankle can be immobilized for several days and then re-examined after the pain and spasm subside. It is important to conduct stress testing to assess the integrity of the ligaments. However, with severe pain and swelling or spasm, the examination is usually delayed until the fracture is excluded by radiography. In addition, with edema and spasm, assessing joint stability can be difficult; thus, re-inspection after a few days is useful. An ankle joint can be immobilized until the moment when examination becomes possible.