What is Ankle Sprain?
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What is a Sprain?
A sprain is a overstretch or a tear of ligaments. A sprain occurs when ligaments that support the joint stretch beyond their limit. Ligaments are the connective tissue that connects two bones, stabilizing and support the joint. Symptoms of a sprain include pain, swelling, bruising, and in some cases unable to move injured joint.Ankle Sprain
Ankle sprains are one of the most common musculoskeletal injuries, and it can happen to anyone. Patients typically describe that injury happened when they roll their ankle to one side often inward, that is inversion sprain and the lateral ligament is injured. In another situation, the patients roll foot outside and the medial ligament is injured. Patients with a sprained ankle can have significant pain and swelling. A sprained ankle may often have associated redness due to the increased blood flow to this area.Anatomy of Ankle Joint
Understanding of anatomy is very important to effectively diagnose and treat patients with a sprained ankle. The bones of our lower leg and foot meet to form our ankle joint. The lower leg contains two long bones called Tibia and Fibula. These bones rest on the Talus bone in the foot, supported by the Calcaneus bone, also known as a heel bone. The Tibia is responsible for supporting about 85% of body weight, and the Fibula accepts the remaining 15%. The foot is connected to the body where the talus articulates with tibia and fibula. The prominence on the medial side of the distal tibia is known as the medial malleolus, and the distal aspect of the fibula is known as the lateral malleolus.
Strong tissues, called ligaments, connect our leg and foot bones together.
One ligament, called the Lateral Collateral Ligament (LCL), is very susceptible to an ankle sprain. The LCL is located on the lateral side of our ankle, and it contributes to balance and stability when we are standing or walking and moving. This ligament has three separate bands: The Anterior Talofibular ligament, Calcaneofibular ligament, and Posterior Talofibular ligament. These ligaments protect the ankle joint from abnormal movements, such as extreme range of motion, twisting, and rolling. The Anterior Talofibular ligament is the weakest and most commonly injured.
Another ligament called The Deltoid Ligament is a fan-shaped band of connective tissue on the medial side of the ankle. It runs from the medial malleolus down into the talus and calcaneus. The deeper branch of the ligament is securely fastened in the talus, while the more superficial aspect runs into the calcaneus. This strong ligament support and stabilize ankle joint from the medial side, and protect the joint from eversion.Mechanism of injury
Sprained ankle accompanied by swelling and pain is one of the most common sports injuries and is mainly generated during the landing or if athletes step on the foot of the other player. The Ankle is the most commonly sprained joint and occurs among people of all ages. Other causes of a sprained ankle injury can be: walking on an uneven surface, falling down, losing balance, step on the sliding surface like Ice, or wet floor, and more.Most ankle sprain injuries are minor and heal quickly, but also serious injuries of the ankle are not so rare in professional athletes, despite the use of cutting-edge footwear or protective bandages that protects joints from twisting.
Inversion ankle sprains are the most common ankle injury and appear for about 70-85% of all ankle injury. That leads to injury of the lateral ankle ligaments in the following order:
- Anterior talofibular ligament (ATF)
- Calcaneofibular ligament (CF)
- Posterior talofibular ligament (PTF)
Eversion Ankle injuries occur when the forced tightening of the joint when the foot is rotated outward (forced eversion). These injuries are very rare, however, when that happens it can be accompanying injuries with bone fractures.
Diagnosis
It is important before starting treatment to do a proper diagnose. The diagnosis of an ankle sprain injury includes history, mechanism of injury, physical examination (palpation, special tests, range of motion), and sometimes need to do imaging test (X-rays, Magnetic resonance imaging, Ultra Sound).The physical examination of an ankle sprain should be performed carefully because the exam may be painful. Palpation need to performed by gently pressing around the ankle to determine which ligaments are injured. Rane of motion is performing by moving the ankle in a different direction, however, a stiff and swollen ankle usually will not move much. Special tests should be performed to determine or exclude the laxity of the ligaments or fracture of the bones. These special tests include the anterior drawer test, Kleger’s test (external rotation test), The Talar tilt test, Squeeze, and tapping test. Visit our orthopedic clinic in Dubai for all kinds of sports injuries.
Ankle Sprains can be divided into three grade:
- Grade 1 sprain (Mild), Slight stretching and microscopic tearing of the ligament with mild tenderness and swelling around the ankle joint.
- Grade 2 sprain (Moderate) is characterized by partial tearing of the ligament followed by moderate tenderness and swelling and the joint can be a little unstable.
- Grade 3 sprain (Severe) is a complete tear of the ligament with significant tenderness and swelling and the ankle joint is completely unstable.
An inability to bear weight or tenderness in the bone (including the medial and lateral malleoli as well as the 5th metatarsal and navicular) signify a need for radiographs (as per the Ottawa Ankle Rules).Blood on the skin suggests an open fracture.
References: Musculoskeletal Medicine: Foot & Ankle, Stephen J. Pinney MD, The Codman group
Sprains and Strains. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/sprains-and-strains#tab-treatment. March 11, 2019.
American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/
Impact Orthopaedics. http://www.impactorthopaedics.com/PatientEducation/tabid/35562/ctl/View/mid/75888/Default?ContentPubID=73
The University of Rochester. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=1889
Medline Plus. https://medlineplus.gov/sprainsandstrains.html
