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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

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.

Treat Your Ankle Sprained today! Call +65 6471 2744 for Appointment or SMS to +65 9235 7641