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Ankle Sprained Clinic

We are specialized in treating Acute and Chronic Ankle Injury. Cure your Ankle Sprained Today! Call us at +65 64712744 or SMS +65 92357641 for Appointment.

A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. This can stretch or tear the tough bands of tissue (ligaments) that help hold your ankle bones together.

Ligaments help stabilize joints, preventing excessive movement. A sprained ankle occurs when the ligaments are forced beyond their normal range of motion. Most sprained ankles involve injuries to the ligaments on the outer side of the ankle.

Treatment for a sprained ankle depends on the severity of the injury. Although self-care measures and over-the-counter pain medications may be all you need, a medical evaluation might be necessary to reveal how badly you’ve sprained your ankle and to put you on the right path to recovery.

Symptoms:

Signs and symptoms of a sprained ankle include:

  • Pain, especially when you bear weight on the affected foot
  • Swelling and, sometimes, bruising
  • Restricted range of motion

Some people hear or feel a “pop” at the time of injury.

When to see a doctor

Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Self-care measures may be all you need, but talk to your doctor to discuss whether you should have your ankle evaluated. If your signs and symptoms are severe, it’s possible you may have broken a bone in your ankle or lower leg.

Ankle Sprain

Ankle Sprain

Causes Sprained Ankle

A sprain occurs when your ankle is forced to move out of its normal position, which can cause one or more of the ankle’s ligaments to stretch or tear.

Examples of situations that can result in an ankle sprain include:

  • A fall that causes your ankle to twist
  • Landing awkwardly on your foot after jumping or pivoting
  • Walking or exercising on an uneven surface

Risk Factors:

Factors that increase your risk of a sprained ankle include:

  • Sports participation. Ankle sprains are a common sports injury. Sports that require rolling or twisting your foot, such as basketball, tennis, football, soccer and trail running, can make you vulnerable to spraining your ankle, particularly if you’re overweight. Playing sports on an uneven surface also can increase your risk.
  • Prior ankle injury. Once you’ve sprained your ankle, or had another type of ankle injury, you’re more likely to sprain it again.

Complications:

If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:

  • Chronic pain
  • Chronic ankle joint instability
  • Early-onset arthritis in that joint

Many people don’t seek medical attention for mild ankle sprains. If your sprain is severe, however, your family doctor may refer you to a doctor who specializes in sports medicine or orthopedic surgery.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had, especially past ankle injuries
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

Diagnosis:

During the physical exam, your doctor will check for points of tenderness. He or she will move the joint in a variety of ways to check your range of motion and to see if any particular position or movement causes pain.

If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage:

  • X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for evaluating bones, but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
  • Computerized tomography (CT). CT scans are useful because they can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.

 Get treatment on your Sprained Ankle Today! Call us at +65 64712744 or SMS +65 92357641 for Appointment.

Achilles Tendon Rupture

Are you suffering from Achilles Injury? Not being able to walk normally and tip-toeing? You are at the Right Place. Get immediate treatment on your Achilles Injury today. Call +65 64712744 or SMS to +65 92357641 for Appointment.

A total rupture of the achilles tendon is a complete tear of the tendon and typically affects men over the age of 40 involved in recreational sport.

A complete rupture of the achilles tendon is not always recognized at the time of injury, however it is very important it is treated properly as soon as possible to increase the chances of a good recovery.

Symptoms

Symptoms include a sudden sharp pain in the achilles tendon which is often described as if being physically struck by an object or implement. A load snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt which may be less obvious later as swelling increases.

After a short while the athlete may be able to walk again but without the power to push off with the foot. There will be a significant loss of strength in the injured leg and the patient will be unable to stand on tip toes. There may be considerable swelling around the achilles tendon and a positive result for Thompson’s test can help confirm the diagnosis.

Treatment

If you suspect a total rupture of the achilles tendon then apply cold therapy and compression and seek medical attention as soon as possible. In most cases surgery is required and the sooner this takes place the higher the chances of success. If the injury is left longer than two days then the chances of a successful outcome decrease. Cold and compression can also be applied throughout the rehabilitation phase as swelling is likely to be an issue with such a serious injury.

A medical professional will take MRI scans to confirm the diagnosis and indicate the extent of the injury. Sometimes the leg is put in a cast and allowed to heal without surgery. This is generally not the preferred method, particularly for young active people. Surgery is the most common treatment for an achilles tendon rupture. 

You can expect to be out of competition for 6 to 9 months after achilles tendon surgery. This is increased to 12 months if the ankle is immobilized in plaster instead of operated on. There is also a greater risk of re-injury if you do not have the surgery.

A complete rupture of the achilles tendon is a serious injury and rehabilitation should be a very gradual process taking 6 to 9 months.

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any self treatment.

Aim of rehabilitation

  • To allow the tendon to heal, reducing pain swelling and inflammation.
  • To restore the tendon and muscles to their original flexibility and strength.
  • To gradually return to normal activity and training levels.

There are two methods of treatment; surgical and non surgical or conservative. The speed at which a patient can progress with the rehabilitation will vary and should at all times be done under the supervision of a qualified professional. The timescales indicated below are only a rough guide and you should always take the advice of your consultant.

Surgical approach

The surgical approach is usually the preferred one, especially for young and active people. Immediately following injury the principles of PRICE should be followed which are protection rest, ice, compression, elevation. Go as soon as you can to a sports medicine professional or accident and emergency unit. Surgery will usually be performed within 48 hours or as soon as possible.

Non surgical approach

This will follow a similar pattern to that of the surgical approach although will take a lot longer. A plaster cast will be applied in a plantar flexed position (toes and foot pointing down). Sometimes after four weeks this may be altered to allow less plantar flexion. After 8 weeks the tendon is usually healed.

Rehabilitation program

Week 1 to 8

  • A plaster cast is applied after surgery.
  • No stretching or exercise, just let it heal.
  • You may be able to work the upper body.
  • Try to do something positive, it will certainly help your state of mind.

Week 8 onwards

Stage 1 – range of motion and flexibility.

  • Place heel raises (1-2cm) in the shoes to take some of the pressure off the achilles tendon.
  • Sports massage techniques and ultrasound can aid in this process by helping to realign the new fibres in line with the tendon.
  • Active stretching. Pull your toes upwards to stretch the achilles tendon. Very gently at first and gradually build up.
  • If active stretches produce no pain then passive stretches can commence. This involves someone or something assisting in the stretching process.
  • When a full range of motion has returned (the ruptured leg is as flexible as the other leg) then a gradual strengthening programme can start.
  • Balance exercises should also be introduced as the sense of balance and positioning is often decreased after tendon or ligament ruptures and if not re-gained, can lead to future injuries. Wobble boards (balance boards) are great for this.

Sports massage can play a part in the rehabilitation of this injury by improving blood flow to the area, helping the muscles relax and become more supple.

Stage 2: Strengthen the achilles tendon and calf muscles.

  • Great care must be taken when commencing a strengthening programme. There is a fine line between strengthening the tendon and re-injuring it.
  • You can start strengthening exercises as soon as they can be tolerated. It may be a full month after the cast comes off before exercises can begin.
  • The athlete may feel a little pain when you first start these exercises. If the pain is intolerable then do not continue.
  • Gradually each day the pain should be less. The athlete should not attempt to increase the level of exercise until there is no pain during or after the exercises.
  • The strengthening exercises must be done after a gentle warm up and stretch. The muscles can be warmed up by raising the heels up and down on the toes while seated. Heat applied directly to the tendon for example by a hot water bottle can also help.
  • Flexibility training must be continued throughout.
  • Remember to apply cold therapy or ice after exercise, this will help keep inflammation down.
  • Avoid explosive or ballistic movements or this may lead to a re-rupture.

Return to fitness 

  • When the patient has gone at least a week without pain then they may begin to return to training.
  • If they feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.

Day 1: walk 4 minutes jog 2 minutes repeat four times

Day 2: rest

Day 3: walk 4 minutes jog 3 minutes repeat three times

Day 4: rest

Day 5: walk 3 minutes jog 4 minutes repeat 4 times

Day 6: rest

Day 7: walk 2 minutes jog 6 minutes repeat 4 times

Continue this gradual progression until you can confidently run and resume normal training.

How long until I am back to full fitness?

  • Most athletes can expect to be out of competition for 6 to 9 months after surgery.
  • This is increased to 12 months if the achilles was immobilized in plaster instead of operated on. There is also a greater risk of re injury if the athlete does not have the surgery.

CURE YOUR ACHILLES TENDON RUPTURE TODAY! CALL US AT +65 64712744 OR EMAIL TO: INFO@BONECLINIC.COM.SG FOR APPOINTMENT

Sprained Ankle Clinic

A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. This can stretch or tear the tough bands of tissue (ligaments) that help hold your ankle bones together.

Ligaments help stabilize joints, preventing excessive movement. A sprained ankle occurs when the ligaments are forced beyond their normal range of motion. Most sprained ankles involve injuries to the ligaments on the outer side of the ankle.

Treatment for a sprained ankle depends on the severity of the injury. Although self-care measures and over-the-counter pain medications may be all you need, a medical evaluation might be necessary to reveal how badly you’ve sprained your ankle and to put you on the right path to recovery.

Signs and Symptoms

Signs and symptoms of a sprained ankle include:

  • Pain, especially when you bear weight on the affected foot
  • Swelling and, sometimes, bruising
  • Restricted range of motion

Some people hear or feel a “pop” at the time of injury.

When to see a doctor

Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Self-care measures may be all you need, but talk to your doctor to discuss whether you should have your ankle evaluated. If your signs and symptoms are severe, it’s possible you may have broken a bone in your ankle or lower leg.

Causes

A sprain occurs when your ankle is forced to move out of its normal position, which can cause one or more of the ankle’s ligaments to stretch or tear.

Examples of situations that can result in an ankle sprain include:

  • A fall that causes your ankle to twist
  • Landing awkwardly on your foot after jumping or pivoting
  • Walking or exercising on an uneven surface

Rick Factors

actors that increase your risk of a sprained ankle include:

  • Sports participation. Ankle sprains are a common sports injury. Sports that require rolling or twisting your foot, such as basketball, tennis, football, soccer and trail running, can make you vulnerable to spraining your ankle, particularly if you’re overweight. Playing sports on an uneven surface also can increase your risk.
  • Prior ankle injury. Once you’ve sprained your ankle, or had another type of ankle injury, you’re more likely to sprain it again.

 Complications:

If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:

  • Chronic pain
  • Chronic ankle joint instability
  • Early-onset arthritis in that joint

Many people don’t seek medical attention for mild ankle sprains. If your sprain is severe, however, your family doctor may refer you to a doctor who specializes in sports medicine or orthopedic surgery.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had, especially past ankle injuries
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

What to expect from your doctor

Your doctor may ask some of the following questions:

  • How exactly did the injury occur?
  • Which direction did your foot turn when you injured it?
  • Can you bear weight on that foot?

Tests and Diagnosis:

During the physical exam, your doctor will check for points of tenderness. He or she will move the joint in a variety of ways to check your range of motion and to see if any particular position or movement causes pain.

If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage:

  • X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for evaluating bones, but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
  • Computerized tomography (CT). CT scans are useful because they can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.

Treatments and Drugs:

Treatment for a sprained ankle depends on the severity of your injury. Many people simply treat their injury at home.

Medications

In most cases, over-the-counter pain relievers  are enough to handle the pain caused by a sprained ankle.

Therapy

A few days after your injury, after the swelling has gone down, you may want to see a physical therapist and start performing exercises to restore your ankle’s range of motion, strength, flexibility and balance.

Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint. These exercises may involve various degrees of balance challenge, such as standing on one leg.

If you sprained your ankle while exercising or participating in a sport, talk to your doctor about when you can begin your activity again. You may need to wear an ankle brace or wrap your ankle to protect it from re-injury.

Surgical and other procedures

If your ankle joint is unstable, your doctor may refer you to a joint specialist for evaluation. You may need a cast or walking boot to immobilize your joint so that it can heal properly. In rare cases of severe ligament tears, or if you are an elite athlete, you may need surgery to repair the damage.

Lifestyle and Home Remedies

For immediate self-care of an ankle sprain, try the R.I.C.E. approach:

  • Rest. Avoid activities that cause pain, swelling or discomfort. But don’t avoid all physical activity. Instead, give yourself relative rest. With an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest. That way you still exercise three limbs and keep up your cardiovascular conditioning.
  • Ice. Even if you’re seeking medical help, ice the area immediately. Use an ice pack or slush bath for 15 to 20 minutes and repeat every two to three hours while you’re awake, for the first 48 to 72 hours. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could indicate a cold injury. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
  • Compression. To help stop swelling, compress the ankle with an elastic bandage until the swelling stops. Don’t wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, if the area becomes numb or if swelling occurs below the wrapped area.
  • Elevation. To reduce swelling, elevate your ankle above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.

Preventions:

Take the following steps to help prevent a sprained ankle:

  • Warm up before you exercise or play sports.
  • Be careful when walking, running or working on an uneven surface.
  • Wear shoes that fit well and are made for your activity.
  • Don’t wear high-heeled shoes.
  • Don’t play sports or participate in activities for which you are not conditioned.
  • Maintain good muscle strength and flexibility.
  • Practice stability training, including balance exercises.

CURE YOUR ANKLE INJURY TODAY. CALL US AT +65 64712744 or EMAIL TO: info@boneclinic.com.sg FOR APPOINTMENT

Achilles Tendon Pain

What is the Achilles tendon?

The Achilles tendon connects the calf muscle to the heel bone. It lets you rise up on your toes and push off when you walk or run.

What are common Achilles tendon problems?

The two main problems found in the Achilles tendon are:

  • Achilles tendinopathy. Achilles tendinopathy includes one of two conditions:
    • Tendinitis. This actually means “inflammation of the tendon,” but inflammation is rarely the cause of tendon pain.
    • Tendinosis. This refers to tiny tears (microtears) in the tissue in and around the tendon caused by overuse. In most cases Achilles tendon pain is the result of tendinosis, not tendinitis. Some experts now use the term tendinopathy to include both inflammation and microtears. But many doctors may still use the term tendinitis to describe a tendon injury.
  • Achilles tendon tear or rupture. An Achilles tendon also can partially tear orcompletely tear (rupture) camera. A partial tear may cause mild or no symptoms. But a complete rupture causes pain and sudden loss of strength and movement.

Problems with the Achilles tendon may seem to happen suddenly. But usually they are the result of many tiny tears to the tendon that have happened over time.

What causes Achilles tendon problems?

Achilles tendon problems are most often caused by overuse or repeated movements. These movements can happen during sports, work, or other activities. For example, if you do a lot of pushing off or stop-and-go motions when you play sports, you can get microtears in the tendon. Microtears can also happen with a change in how long, hard, or often you exercise. Microtears in the tendon may not be able to heal quickly or completely.

Being out of shape or not warming up before exercising may also cause Achilles tendon problems. So can shoes with poor arch supports or rigid heels.

An Achilles rupture is most often caused by a sudden, forceful motion that stresses the calf muscle. This can happen during an intense athletic activity or even during simple running or jumping. Middle-aged adults are especially likely to get this kind of injury.

A rupture most often occurs in sports such as basketball, racquet sports (including tennis), soccer, and softball. A tendon already weakened by overstretching, inflammation, or small tears is more likely to rupture.

What are the symptoms?

Symptoms of Achilles tendon problems include swelling in the ankle area and mild or severe pain. The pain may come on gradually or may only occur when you walk or run. You may have less strength and range of movement in the ankle.

A rupture of the Achilles tendon may cause a sudden, sharp pain. Most people feel or hear a pop at the same time. Swelling and bruising may occur, and you may not be able to point your foot down or stand on your toes.

How are Achilles tendon problems diagnosed?

Your doctor can tell if you have an Achilles tendon problem by asking questions about your past health and checking the back of your leg for pain and swelling. The doctor may ask: How much pain do you have? How did your injury happen? Have you had other injuries in the ankle area?

If your symptoms are severe or do not improve with treatment, your doctor may want you to get an X-ray, ultrasound scan, or MRI.

How are they treated?

Treatment for mild Achilles tendon problems includes rest, over-the-counter pain medicine, and stretching exercises. You may need to wear well-cushioned shoes and change the way you play sports so that you reduce stress on the tendon. Early treatment works best and can prevent more injury.

Even in mild cases, it can take weeks to months of rest for the tendon to repair itself. It’s important to be patient and not return too soon to sports and activities that stress the tendon.

Treatment for severe problems, such as a torn or ruptured tendon, may include surgery or a cast, splint, brace, walking boot, or other device that keeps the lower leg from moving. Exercise, either in physical therapy or in a rehab program, can help the lower leg get strong and flexible again. The tendon will take weeks to months to heal.

Although treatment for Achilles tendon problems takes time, it usually works. Most people can return to sports and other activities.

Cure your Achilles Tendonitis today. Call us +65 64712744 or SMS +65 92357641 to schedule for an appointment.

Achilles Tendonitis

Achilles tendinitis

Achilles tendinitis is when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It is used for walking, running, and jumping.

Causes

There are two large muscles in the calf. These muscles are important for walking. They create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.

Heel pain is most often due to overuse of the foot. Rarely it is caused by an injury.

Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.

Achilles tendinitis may be more likely to occur if:

  • Suddenly increase the amount or intensity of an activity
  • Your calf muscles are very tight (not stretched out)
  • You run on hard surfaces such as concrete
  • You run too often
  • You jump a lot (such as when playing basketball)
  • You do not have shoes with proper support
  • Your foot suddenly turns in or out

Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

Symptoms

Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning.

The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

Exams and Tests

The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.

X-rays can help diagnose bone problems.

An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.

Treatment

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.

Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb.

Changes in activity may help manage the symptoms:

  • Decrease or stop any activity that causes you pain.
  • Run or walk on smoother and softer surfaces.
  • Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon.

They may also suggest the following changes in your footwear:

  • A brace or boot or cast to keep the heel and tendon still and allow the swelling to go down
  • Heel lifts placed in the shoe under the heel
  • Shoes that are softer in the areas over and under the heel cushion

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider.

If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon.

Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Outlook (Prognosis)

Lifestyle changes usually help improve symptoms. However, symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.

Possible Complications

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair is necessary, but difficult because the tendon is not normal.

When to Contact a Medical Professional

If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.

Prevention

Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

CURE YOUR ACHILLES TENDINITIS TODAY! CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg FOR APPOINTMENT

Ligament and Muscle Damage (Managing Sprains and Strains)

Although the terms sprain and strain are used loosely and have no precise clinical definition, a sprain generally refers to an injury to a ligament – one of the tough, fibrous cords within a joint that connects the bones together – and a strain refers to muscle injury.

Sprains and strains often occur together in or near a joint, since joints absorb the stress of movement and are vulnerable to be being twisted or wrenched.  The ankle and the knee are the most common sites of such injuries.  In mild cases, the force of the injury tears a few fibres of the ligament or muscle, causing mild to moderate pain and swelling, which usually subside within a few days.  A more violent injury may completely tear a ligament or muscle and may involve bone damage such as a dislocation or fracture.

With proper care, most mild or moderate sprains and strains heal completely without complication.

The ankles are among the most vulnerable elements of the body.  These complex hinges of bone, ligament, tendon and muscle support the entire body weight and may transmit a force of impact equal to three times your weight.  Thus, ankle injuries, usually the tearing or straining of a ligament, are the most common of all joint injuries. 

The great majority of sprains are inversion sprains.  This happens when the sole of the foot turns inward, injuring the ligaments on the outside of the ankle.  Eversion injuries occur when the foot turns outward, affecting ligaments on the inner side.  Some sprains are minor and can be successfully treated at home, but many need medical attention.  An ankle sprain can put a patient at risk for another because as the injury heals, it leaves the tendon weakened and less flexible and thus more susceptible to injury.  Many sports activities place participants at risk for sprains and strains.  These injuries also often occur in normal everyday activities such as a slip on wet floors, a fall on the wrist, or jamming a finger.  Repetitive activities may also cause a sprain or strain.

Causes and Risk Factors of Sprains and Strains

Sprains and strains occur as a result of an injury, when the joint is subjected to more physical force that it can withstand.  Athletes, dancers and those who perform manual labour commonly suffer such injuries. Previous sprains may so weaken the ligaments such that recurrence is possible with only minor pressure.  The risk of sprains and strains increases with obesity and poor muscular conditioning.

Symptoms of Sprains and Strains

The symptoms of a sprain are typically pain, swelling, and bruising of the affected joint.  Symptoms will vary with the intensity of the injury; more significant ligament tears (Grade III injuries) cause an inability to use the affected joint and may lead to joint instability.   Less serious injuries (Grade I injuries) may only cause pain with movement.

Common Area of Sprains and Strains

Finger Sprain – caused by a violent overstretching of one or more ligaments that hold the finger joints together. 

Wrist Sprain – violent overstretching of one or more ligaments in the wrist joint can cause this common injury.

Knee Sprain – cause by violent stretching of one or more ligaments in the knee.  Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains.

Ankle Sprain – occurs following a sudden sideways or twisting movement of the foot.  An ankle sprain can occur during athletic events or during everyday activities.  All it takes is an awkward step or an uneven surface to cause an ankle sprain – that is why sprained ankles are among the most common orthopaedic injuries.  Orthopaedic doctors see patients for ankle sprains very often, and it is the most common foot and ankle injury.

Back Strain – commonly caused by muscle strains and lumbar sprains.  A low back muscle strain occurs when the muscle fibres are abnormally stretched or torn.  A lumbar sprain occurs when the ligaments – the tough bands of tissue that hold bones together – are torn from their attachments. Differentiating a strain from a sprain can be difficult, as both injuries will show similar symptoms.  Many doctors refer to both injuries as a category called “musculo-ligamentous injuries” of the lumbar spine.

Neck Strain – caused by injury to the muscles or tendons that attach to the vertebral column in the neck, to the skull and to the shoulder.

Groin Strain – caused by an injury to the muscles of the inner thigh.  The groin muscle, called the “adductor muscle” group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone).  These muscles pull the legs together, and also help with other movements of the hip joint.  The adductor muscles are important to many types of athletes including sprinters, swimmers, soccer players, and football players.

Hamstring (Thigh) Strain – often result from an overload of the muscles or trying to move the muscles too fast or from taking an impact at the back of the leg.

Treatment of Sprains and Strains

First aid measures for a sprain or strain can best be remembered by the acronym RICE – Rest, Ice, Compression, and Elevation:

Rest the injured area.  Try not to move or put pressure on the affected joint. A sling or splint may be recommended to immobilize the joint and allow damaged ligaments or muscles to heal.

Ice the affected area to reduce swelling.  After 24 hours, either ice or heat may be applied to reduce pain. 

Compress the joint by wrapping it in an Ace bandage to help reduce swelling and pain.

Elevate the joint to reduce swelling.

Over-the-counter pain relievers or stronger analgesics may be prescribed, depending on the severity of pain.  After the pain has subsided, a rehabilitation program may be implemented with the help of a physical therapist to help the joint regain strength and mobility.  In severe cases, surgery may be required to repair torn ligaments or muscles.

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Sprained Ankle

If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:

  • Chronic pain
  • Chronic ankle joint instability
  • Early-onset arthritis in that joint

During the physical exam, your doctor will check for points of tenderness. He or she will move the joint in a variety of ways to check your range of motion and to see if any particular position or movement causes pain.

If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage:

  • X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for evaluating bones, but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
  • Computerized tomography (CT). CT scans are useful because they can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.

Treatment for a sprained ankle depends on the severity of your injury. Many people simply treat their injury at home.

Medications
In most cases, over-the-counter pain relievers — such as ibuprofen are enough to handle the pain caused by a sprained ankle.

Therapy
A few days after your injury, after the swelling has gone down, you may want to see a physical therapist and start performing exercises to restore your ankle’s range of motion, strength, flexibility and balance.

Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint. These exercises may involve various degrees of balance challenge, such as standing on one leg.

If you sprained your ankle while exercising or participating in a sport, talk to your doctor about when you can begin your activity again. You may need to wear an ankle brace or wrap your ankle to protect it from re-injury.

Surgical and other procedures
If your ankle joint is unstable, your doctor may refer you to a joint specialist for evaluation. You may need a cast or walking boot to immobilize your joint so that it can heal properly. In rare cases of severe ligament tears, or if you are an elite athlete, you may need surgery to repair the damage.

For immediate self-care of an ankle sprain, try the R.I.C.E. approach:

  • Rest. Avoid activities that cause pain, swelling or discomfort. But don’t avoid all physical activity. Instead, give yourself relative rest. With an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest. That way you still exercise three limbs and keep up your cardiovascular conditioning.
  • Ice. Even if you’re seeking medical help, ice the area immediately. Use an ice pack or slush bath for 15 to 20 minutes and repeat every two to three hours while you’re awake, for the first 48 to 72 hours. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could indicate a cold injury. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
  • Compression. To help stop swelling, compress the ankle with an elastic bandage until the swelling stops. Don’t wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, if the area becomes numb or if swelling occurs below the wrapped area.
  • Elevation. To reduce swelling, elevate your ankle above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.

Prevention

Take the following steps to help prevent a sprained ankle:

  • Warm up before you exercise or play sports.
  • Be careful when walking, running or working on an uneven surface.
  • Wear shoes that fit well and are made for your activity.
  • Don’t wear high-heeled shoes.
  • Don’t play sports or participate in activities for which you are not conditioned.
  • Maintain good muscle strength and flexibility.
  • Practice stability training, including balance exercises.

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Patient Guide to Achilles Tendinitis

Achilles tendinitis is an overuse injury of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.

Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor’s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.

Symptoms for Achilles Tendinitis:

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur after prolonged running, stair climbing or sprinting.

You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.

When to see a doctor
If you experience persistent pain around the Achilles tendon, call your doctor. Seek immediate medical attention if the pain or disability is severe. You may have a torn (ruptured) Achilles tendon.

Causes of Achilles Tendinitis:

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes.

The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury — particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.

Risk Factors of Achilles Tendinitis:

A number of factors may increase your risk of Achilles tendinitis, including:

  • Your sex and age. Achilles tendinitis occurs most commonly in middle-aged men.
  • Physical problems. A naturally flat arch in your foot can put more strain on the Achilles tendon. Obesity and tight calf muscles also can increase tendon strain.
  • Training choices. Running in worn-out shoes can increase your risk of Achilles tendinitis. Tendon pain occurs more frequently in cold weather than in warm weather, and running on hilly terrain also can predispose you to Achilles injury.
  • Medical conditions. People who have diabetes or high blood pressure are at higher risk of developing Achilles tendinitis.
  • Medications. Certain types of antibiotics, called fluoroquinolones, have been associated with higher rates of Achilles tendinitis.

Complications of Achilles Tendinitis:

Achilles tendinitis can weaken the tendon, making it more vulnerable to a tear (rupture) — a painful injury that usually requires surgical repair.

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Patient Guide to Ankle Pain and Tendinitis (Tendonitis)

Ankle pain and tendinitis facts

  • The ankle is a “hinged” joint.
  • Ankle pain can be caused by injury or disease of the ankle joint.
  • The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair).
  • Tendinitis of the ankle can be caused by trauma or inflammatory arthritis.

The Anatomy of Ankle:

The ankle is a “hinged” joint capable of moving the foot in two primary directions: away from the body (plantar flexion) and toward the body (dorsiflexion). It is formed by the meeting of three bones. The end of the shinbone of the leg (tibia) and a small bone in the leg (fibula) meet a large bone in the foot, called the talus, to form the ankle. The end of the shinbone (tibia) forms the inner portion of the ankle, while the end of the fibula forms the outer portion of the ankle. The hard, bony knobs on each side of the ankle are called the malleoli. These provide stability to the ankle joints, which function as weight-bearing joints for the body during standing and walking.

Ligaments on each side of the ankle also provide stability by tightly strapping the outside of the ankle (lateral malleolus) with the lateral collateral ligaments and the inner portion of the ankle (medial malleolus) with the medial collateral ligaments. The ankle joint is surrounded by a fibrous joint capsule. Tendons that attach the large muscles of the leg to the foot wrap around the ankle both from the front and behind. The large tendon (Achilles tendon) of the calf muscle passes behind the ankle and attaches at the back of the heel. A large tendon of the leg muscle (posterior tibial tendon) passes behind the medial malleolus. The peroneal tendon passes behind the lateral malleolus to attach into the foot.

The normal ankle has the ability to move the foot, from the neutral right-angle position to approximately 45 degrees of plantar flexion and to approximately 20 degrees of dorsiflexion. The powerful muscles that move the ankle are located in the front and back portions of the leg. These muscles contract and relax during walking.

Ankle sprains are one of the most common musculoskeletal injuries. Sprains are injuries to the ligaments of the ankle, causing them to partially or completely tear as a result of sudden stretching. They can occur on either or both of the inner and outer portions of the ankle joint. Ankle sprains more commonly happen when there is a preexisting muscle weakness in the ankle area or a history of previous ankle injuries. The typical injury occurs when the ankle is suddenly “twisted” in a sports activity or by stepping off an uneven surface. The pain is initially severe and can be associated with a “popping” sensation. Immediate swelling over the area of injury often occurs as the injured blood vessels leak fluid into the local tissue. Examination of the area may cause severe pain when the ankle is moved. The degree of pain may not necessarily indicate the degree of damage to the ligament(s). Ligament injuries are often graded from I to III, ranging from partial to complete tears. Partial tears retain some ankle stability, whereas complete tears lose stability because the strapping ligaments no longer brace the ankle joint. After an examination, significant ankle sprains are commonly evaluated with an X-ray. X-rays can determine whether there is an accompanying break (fracture) of the bone.

Acute ankle sprains are initially treated with ice, rest, and limiting the amount of walking and weight-bearing on the injured ankle. The leg can be elevated to reduce swelling, and crutches are often recommended to avoid further trauma to the injured ligaments. Anti-inflammatory medications can be given to reduce local inflammation. Ice packs help decrease further swelling of the area and can reduce pain. Patients with severe injuries are placed in immobilization casts. Surgical repair of grade III injuries is considered, especially for those patients contemplating future athletic participation. Physical therapy programs are part of the rehabilitation process, incorporating strengthening exercises of the lower leg muscles. Broken ankles (fractures) can accompany ankle sprains or occur without sprains. Fractures are repaired with casting to immobilize the bone for healing. Depending on the severity, fractures can require orthopedic casting, surgical procedures including pinning, and open repair of the fractured bone.

Tendinitis

Tendinitis (also referred to as tendonitis) is an inflammation of the tendon. Tendinitis of the ankle can involve the Achilles tendon, the posterior tibial tendon, or the peroneal tendon. This condition usually results from trauma, such as from sudden injury in sports or overuse injury as from running but can result from underlying inflammatory diseases or illnesses such as reactive arthritis (formerly called Reiter’s syndrome), rheumatoid arthritis, and ankylosing spondylitis. All forms of tendinitis cause pain, swelling, and tenderness in the tendon area involved. The onset may be rapid, such as with an athletic injury. Immediate treatment of tendinitis involves immobilizing the area, elevation, and limiting weight-bearing, applying ice, and using nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease inflammation. NSAIDs are commonly used for this purpose. More severe inflammation can require orthopedic casting. Athletic participation should be limited when the tendon is still inflamed, as there is a significant risk of rupturing or tearing the tendon, especially in the Achilles area, with continued athletic activity. Achilles tendon more frequently occurs in patients who have had previous Achilles tendon inflammation. When the Achilles tendon ruptures, it usually requires orthopedic surgical repair.

 

Picture of the metatarsal (foot) and calcaneus (heel) bones, the plantar fascia ligament, and the Achilles tendon of the lower leg and foot

What diseases and conditions can cause ankle pain, and how are they treated?

Inflammatory types of arthritis (inflammation of the joint) that can involve the ankle area include rheumatoid arthritis, reactive arthritis, gouty arthritis, ankylosing spondylitis, and psoriatic arthritis, among others. They generally are not induced by trauma injury and often develop gradually. A thorough evaluation by a doctor with blood testing can be necessary for ultimate diagnosis. These types of arthritis are associated with pain, swelling, stiffness, redness, and warmth in the involved area. These diseases each have unique management as described elsewhere.

Other conditions of the ankle which can cause ankle pain include tarsal tunnel syndrome. This is a result of nerve compression at the ankle as the nerve passes under the normal supportive band surrounding the ankle called the flexor retinaculum. Tarsal tunnel syndrome is described elsewhere.

Infections of the ankle joint are rare. They most commonly occur as a result of bacteria being introduced into the ankle joint through puncture wounds or trauma. They also occur with a breakdown of the skin over the ankle as a result of ulcerations or abrasions. Patients with impaired immune systems such as those with AIDS, or other immune diseases, are at an increased risk of infections in the joints, including the ankle. Also, patients with diabetes or those who take cortisone medications have an increased risk for bacterial infections of the joints. Bacterial joint infections are serious and require drainage and antibiotics, usually intravenously.

It is possible to develop viral infections of the ankle joints. In an isolated joint, such as the ankle, this most commonly occurs in children and is referred to as “toxic synovitis.” It results in temporary joint inflammation and can be first noticed as subtle limping in the child. It is benign and resolves on its own with only symptomatic treatment, such as acetaminophen(Tylenol), for relief of pain.

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Don’t Ignore Ankle Sprained

Ankle sprain is a common injury in Singapore athletes as well as the active adult. Most of the time, the ankle heals with a little care (rest, taping, ice). But one rare complication of lateral ankle sprains is a condition called peroneal tendon instability.

A lateral ankle sprain means the side of the ankle away from the other leg is sprained. The two peroneal tendons go down the leg and around the back of the ankle bone. The tendons set down inside a tunnel formed by bone and connective tissue called the retromalleolar groove. A fibrous band (the superior peroneal retinaculum) goes across the tendon to hold them in the groove.

When this fibrous retinaculum is ruptured, the tendons can dislocate or pop out of the groove. The result is persistent pain along the outside aspect of the ankle bones. There may be a painful popping or snapping sensation.

Swelling may mask the symptoms of tendon displacement at first. It’s only weeks to months later when the painful symptoms don’t go away that the additional tendon damage is recognized. Early MRIs may not show peroneal tendon instability, especially if the tendon pops in and out of the groove spontaneously.

A relaxed tendon is more likely to remain in the groove. Any active movement of the ankle will force the tendon out of its protective tunnel. If the ankle is relaxed and the tendon is repositioned correctly at the time of the imaging study, then diagnosis can be delayed. Dynamic ultrasound tests are the best diagnostic tests because they will reveal the movement of the unstable tendon.

Since this problem is rare, not much is known about the best way to treat it. Conservative (nonoperative) care is only possible when the unstable tendons can reposition inside the retromalleolar groove. A cast or boot placed on the lower leg will give the tendon a chance to heal.

If conservative care is unable to achieve a stable gliding tendon or if the tendon displacement is unstable from the start, then surgery is necessary. There are several different surgical options to consider. The fibrous protective sheath (retinaculum) can be reinforced or reconstructed. The groove can be reshaped (deepened) and rebuilt. The surgeon must be careful not to destroy or disrupt the smooth gliding surface of the bone that helps form the retromalleolar groove.

The retinaculum is repaired or reconstructed depending on the severity of the damage. Incision shape, drill holes, suture type and placement, and method for protecting the groove surface are discussed. Photos of each step in the surgical procedure are provided.

In summary, traumatic displacement of the peroneal tendons is a rare but painful complication of some lateral ankle sprains. Pain and swelling may mask the presence of this problem at the time of the injury with a delayed diagnosis. A careful examination with tenderness palpated over the torn retinaculum is the best way to accurately identify the injury. Treatment is usually surgical with the surgeon’s own preferred treatment presented.

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