Ankle Sprain – the common source of morbidity in the athletic population

Health
Tuesday, 03 November 2015 1088 Views 0 Comments
Ankle Sprain – the common source of morbidity in the athletic population

By Shailja Kaushik

Ankle injuries are a common source of morbidity in the general and athletic population, with an estimated 25,000 ankle sprains requiring medical care in the United States, every day. Males (50.3%) are more susceptible to ankle sprains as compared to females (49.7%).[i] Ankle sprains are the most common athletic injury. They make up 45% of all injuries in basketball, 31% in soccer and 25% in volleyball.[ii]

What are ankle sprains?

An ankle sprain is what we colloquially refer to as a twisted ankle. It is a very common injury that may affect people of any age group and those involved in any kind of activity. The tearing of the ankle ligaments is known as ankle sprain and commonly, it affects the outside or lateral part of the ankle. It is mentioned in the book Essentials of Physical Medicine and Rehabilitation that 85% of all ankle sprains occur on the lateral aspect of the ankle. Sprains may affect the cartilage, blood vessels and tendons of the ankle and surrounding areas. If not cared for, it may result in a fracture of the ankle.

Causes

  • Inversion or twisting of the ankle at the base of the leg is the most common cause of ankle sprains. This may happen unexpectedly during physical activities such as jumping, running or playing sports
  • Certain conditions such as hindfoot varus, in which the heels are naturally turned inside, or weak peroneal muscles (those found outside of the ankle) increase the chances of getting ankle sprains
  • Those who sprained their ankles in the past may twist or turn it again because of their instability during walking or any other activity
  • Running on uneven surfaces
  • Wearing improper shoes.

Symptoms

  • A sprained ankle is characterised by pain, swelling and tenderness over the injured ligament
  • A ‘pop’ sound is reported by some patients at the time of injury
  • Depending on the intensity of pain, a person experiences reduction in function and range of mobility, along with instability
  • Some people also complain of ecchymosis (i.e. discoloration of skin) during the first 24-48 hours
  • Inability to bear weight on the affected foot and stiffness are the other symptoms experienced by those with ankle sprains.

Prevention

  • Co-ordination training on ankle disks
  • Use of orthosis, such as taping and bracing, have been known to decrease the risk of ankle sprain by 50-70% in those who have history of ankle sprains.[iii]

Treatment

PRICE – protection, rest, ice, compression and elevation are considered to be the basis of initial treatment. These should be followed on immediate basis. Other early treatment measures are as follows:

  • Avoid putting weight on the affected area
  • Use a bandage to wrap the ankle
  • Wear a brace or use crutches if weight bearing is painful
  • Rest as much as possible and take off any pressure from your ankle
  • Immediately after injury, apply ice packs locally for 20-30 minutes, at least three to four times a day. This helps to reduce pain and swelling
  • Put pillows under your foot and keep it in a raised position. This will help to reduce swelling and tenderness
  • Avoid heat and contrast baths (alternating immersion in hot/cold water) as this may lead to swelling and bleeding.

The doctor may advise you to take non-steroidal anti-inflammatory (NSAIDs) medication such as Ibuprofen or Acetaminophen to manage inflammation. As highlighted in the book Essentials of Physical Medicine and Rehabilitation, other treatment modalities such as electrotherapy, use of ultrasound waves and diathermy have not been shown to be effective. Surgery is rarely required for correcting ankle sprains except in cases where severe ligament damage is present.

If you return to work or start physical activities before being completely healed, then this may lead to chronic pain and total instability in the injured area. Though most ankle sprains will recover within a week to 10 days but few more severe ones will take few months. It is estimated that 20-40% of ankle sprains may result in chronic sequelae.[iii] In case an ankle sprain does not heal, further investigations should be done to look for other causes.

References

Hans Tropp; Carl Askling and Jan Gillquist. Prevention of Ankle Sprains. The American Journal of Sports Medicine. 1985.

Lap Ki Chan; Patrick Yung; Kai Ming-Chan; Daniel Fung and Youlian Hang. A Systematic Review on Ankle Injury and Ankle Sprain in Sports. Sports Medicine. 2007.

M.S. Yeung; Kai-Ming Chan and W.Y. Yuan. An epidemiological Survey on Ankle Sprain. British Journal of Sports Medicine. 1994; 28(2)

[i] Walter R. Frontera; Julie K. Silver; Thomas D. Rizzo. Essentials of Physical Medicine and Rehabilitation. Elsevier Health Sciences. 2014.
[ii] Robert C. Ward. Foundations for Osteopathic Medicine. American Osteopathic Association. 2002.
[iii] Walter R. Frontera; Julie K. Silver; Thomas D. Rizzo. Essentials of Physical Medicine and Rehabilitation. Elsevier Health Sciences. 2014.

(Dr. Rohan Habbu is an Orthopedic Hand, Nerve & upper Extremity Surgeon. He has done Fellowship in Arthroscopy & Sports Surgery and is an avid runner. To know more, reach out to him on rohanhabbu@gmail.com or +91 982017 13941)

Print Friendly, PDF & Email