Ankle Injuries Essay, Research Paper

Ankle Injuries

Yes, if we did not have it or if it is broken, fractured, sprained, etc, life can be a little difficult. The ankle is a very important tool in the art of walking, running, even standing. The average ankle consists of bones such as the Talus and Calcaneus. The thickened portion of the fibula called the medial malleolus forms the ankle joint or talocrural joint sometimes-called ankle mortise. The ankle joint allows two motions: plantarflexion and dorsiflexion. Stretching, strengthening of key muscles, improving neuromuscular control, proper footwear, and proper taping or bracing can prevent many ankle injuries.

Since the ankles support the entire weight of the body, the ankles are particularly susceptible to injury. An estimated two million people are treated for ankle sprains and strains annually, and ankle fractures are among the most common injuries treated by orthopedists.

The most common type of ankle injury is a sprain and usually results when the ankle is twisted, or inverted. The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. On the lateral side of the ankle there are three ligaments that make up the lateral ligament complex. These include the anterior talofibular ligament (ATF), the calcanerfibular ligament (CF) and the posterior talofibular ligament (PTF). The very common inversion injury to the ankle usually injures the anterior talofibular ligament and the calcaneofibular ligament. The ATF ligament keeps the ankle from sliding forward and the CF ligament keeps the ankle from rolling over on its side.

The ankle is a hinge joint that connects the lower leg bones with the foot through many tough fiber cords called ligaments. Because of these ligament “bridges,” the ankle is quite strong and able to handle a lot of force and movement. If an ankle is twisted, it often can result in an injury to these ligaments. An ankle strain occurs when the ligaments are stretched beyond their normal limit. An ankle sprain occurs when the ligaments are partially or completely torn.

Anyone, from the best-conditioned athlete to the most sedentary office worker, can incur an ankle injury. Usually, the cause is accidental–jogger steps in a pothole; a pregnant woman slips getting out of her car; a weekend softball player slides awkwardly into a base. Overweight people and women who wear high-heeled shows are at particular risk for ankle injuries. A ligament is made up of multiple strands of tissue– similar to nylon rope. A sprain results in tearing of the ligaments. The tear can be a complete tear of all the strands of the ligament or a partial tear, where portions of the strands of the ligament are torn. The ligament is weakened by the injury– how much depends on the degree of the tear. The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. An inversion simply means that the ankle tilts over to the outside edge of the foot. This causes the ligaments on the outside of the ankle to stretch and possible tear. An eversion ankle sprain is less common than inversion sprains mainly because of the bony and ligamentous anatomy. Eversion injuries may involve an avulsion fracture of the tibia before the deltoid ligament tears. Even though Eversion sprains are less common than Inversion sprains they may take longer to heal. A Dorsiflexion sprain is when the anterior and posterior tibiofibular ligaments are torn with forced dorsiflexion and are often injured in conjunction with severe sprain of the medial and lateral ligament complexes. These sprains often take months to heal. Sprains are graded on a scale of 1 to 3 – mild, moderate or severe – reflecting the relative amount of tearing to the ligaments.

Initially the ankle is swollen, painful, and may turn eccyhmotic (bruised). The bruising, and the initial swelling, is due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. This initial swelling due to bleeding then increases due to edema fluid leaking into the tissues as well over the next 24 hours. In a grade 1 sprain, there is some stretching or perhaps tearing of the ligamentous fibers with little or no joint instability. Mild pain occurs with also swelling. With a grade 2 sprain, there is also some tearing and separation of the ligamentous fibers and moderate instability to the joint. Moderate – to- severe pain, swelling and joint stiffness is expected. Grade 3 sprains involve total rupture of the ligament, manifested primarily by gross stability of the joint. Severe pain may present initially, followed by swelling profusely. Surgical repair or reconstruction may be necessary to correct instability. If an ankle injury occurs, a first concern is to determine if a fracture has occurred. Indications of a possible fracture include swelling, discoloration (black and blue), and a joint that is deformed or bent in an odd way. If a fracture is suspected, the ankle should be kept immobilized, applying ice to the injured area and seeking medical attention immediately is necessary.

Most ankle injuries are not fractures or severe sprains, and can be treated using the self-care procedures. The diagnosis of an ankle sprain is usually made by examination of the ankle and x-rays to make sure that there is no fracture of the ankle. If there is a complete rupture of the ligaments suspected a doctor may order stress x-rays as well. These x-rays are taken when someone twists or stresses the ligaments.

Treatment begins initially by * controlling swelling

+ evelation

+ gentle compression and ice controlling pain

+ mild pain relievers

+ Controlling weight bearing / crutches.

Casts have fallen out of favor, and as treatment progresses, early weight bearing has been shown to be beneficial. Braces that can be worn to support the ankle–but still allow weight bearings are the most popular treatment method today. Healing of the ligaments usually takes about 6 weeks. The swelling may present the several months. A physical therapist may be suggested to help regain full function of the injured ankle. Treatment also involves the so- called RICE approach -rest, ice, compression and elevation:

+ Rest means keeping off the injured ankle as much as possible. Crutches will enable the patient to move about when necessary without placing undue weight on the injury. An air cast or splint may be applied to the ankle for support.

+ Icing the injury reduces swelling. The usual routine is to apply ice packs for 20 minutes at a time every hour or so for the first day after the injury and thereafter as long as swelling persists.

+ Compression means supporting the ankle and foot with a firmly (but not tightly!) wrapped elastic bandage, compression stocking or gel wrap. If swelling causes the bandage to become tight, it should be loosened immediately.

+ Elevating the foot above the level of the heart minimizes blood pooling and swelling in the affected area. This should be done as much as possible during the first 48 hours after the injury.

In the initial 24 hours, it is very important to avoid things, which might increase swelling.

Avoid 1. Hot showers 2. Heat rubs (methylsalicylate counterirritants such as “Ben Gay” etc.

3. Hot packs 4. Drinking alcohol 5. Aspirin – prolongs the clotting time of blood and may cause more bleeding into the ankle. (Tylenol or Ibuprofen may be taken to help with pain, but will not speed up the healing process). Some people experience prolonged swelling. This usually is caused by the formation of excessive scar tissue. The physician may request X-rays to check for small, previously undetected bone fragments or damage to the joints. With proper treatment, most ankle sprains heal within 2 to 6 weeks. The most severe, such as those requiring the use of a cast may take as long as 12 weeks. A carefully monitored program of physical therapy may be required to restore full muscle balance and strength. This can involve stretching of the Achilles tendon, as well as coordination and speed exercises. During this time, taping or bracings the ankle may be prescribed to give it support until full function is regained.

In a small number of cases, the ligaments will not heal back as strong as normal. This results in an ankle that is unstable and ahs tendency to give away, or twist again very easily. Ankle instability can lead to an ankle that is sore and painful, sometimes swollen, and untrustworthy on rough terrain. Once the initial pain and swelling begins to resolve, physical therapy will probably be initiated to regain as much of the normal range of motion as possible. Once of the problems that tearing the ligaments around the ankle causes, is that small proprioceptive nerve endings in the ligaments are torn as well. These nerves function to give the brain information about where the body is in 3D space. For instance, these nerves are what make it possible for one to touch the nose with the eyes closed. The joints rely on good physical therapy program will help retrain these nerves as they repair themselves, and will strengthen certain muscles that will take over some of the functions of stabilizing the ankle joint from the loss of ligaments. If all these simple measures fail, surgery may be suggested to reconstruct the ligaments that have been torn. Surgery involves making an incision on the side of the ankle. A portion of the tendon called the peroneus brevis is used to reconstruct the lateral ligaments. A drill hole is made in the fibula, near the attachment the original ligament.

A second drill hole is made in the area where the ligaments attached to the talus. The tendon graft is then woven into these holes to recreate the ligament complex. After surgery, the patient would be put in a cast or brace for about 6 weeks to allow the tendon reconstruction to heal. Following removal of the cast, physical therapy will be required to regain full use of the ankle.

It is important to note that persons who have experienced an ankle injury are at particular risk of another. This is true not only during the recovery period, but for the rest of their lives. An injured ankle, even though healed, may be unstable and therefore prone to recurrent injury. For this reason, persons who have sustained an ankle injury should take precautions thereafter. Good-quality shoes that provide plenty of stability and support are a prudent investment, and supplemental bracing, such as with a specially fitted elastic wrap, may be recommending.