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Ankle Sprains and Fractures
An ankle sprain is an injury to one or more ligaments in the ankle. Ligaments are bands of tissue, like rubber bands, that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement. Most ankle sprains occur on the outer aspect of the ankle.
Some ankle sprains are worse than others. The severity of an ankle sprain depends on whether the ligament is partially or completely torn and on the number of ligaments involved. Ankle sprains are not the same as strains which affect muscles rather than ligaments.
Nonsurgical Treatment and Rehabilitation
In the case of an ankle sprain, rehabilitation is crucial and starts early. A foot and ankle surgeon may recommend one or more of the following treatment options:
*Immobilization. Depending on the severity of the injury, a short-leg cast, walking boot, or brace will keep the ankle from moving. Crutches may also be needed.
*Early Physical Therapy. A doctor will start a rehabilitation program as soon as possible to promote healing and increase range of motion and strength.
*Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be needed to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
*Ice. Applying ice to the injured area several times a day until the pain and swelling resolves is advised. Wrap ice cubes or a bag of frozen vegetables in a thin towel. Do not put ice directly on the skin.
*Compression Wraps. To prevent further swelling, keep the ankle wrapped in an elastic bandage or stocking.
When is Surgery Needed?
In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for each patient based on the type and severity of the injury.
After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly.
High Ankle Sprain
This condition occurs when the sprain injures the large ligament above the ankle that joins the two bones of the lower leg, the tibia and fibula, together. The fibula and the tibia are joined together by the syndesmotic ligament which runs from the knee down to the ankle.
Treatment
High ankle sprains simply tend not to heal as quickly as the more common ankle sprains. An orthopaedic physician will begin treatment by first determining if the injury is stable or unstable. A stable injury is one in which the tibia and fibula do not separate from each other. These injuries can be treated in a cast or walking boot that will be worn for approximately six weeks.
When the injury is more severe and unstable, the tibia and fibula separate from each other. The treatment for this is surgical which involves placing a screw between the fibula and tibia to secure the bones in proper position while the ligament heals. This treatment is generally considered a relatively safe and trusted surgical procedure.
Ankle fractures
A fracture is a partial or complete break in a bone. In the ankle, fractures can range from the less-serious avulsion injuries (small pieces of bone that have been pulled off) to severe, shattering-type breaks of the tibia, fibula, or both.
Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and require an accurate and early diagnosis. Both can occur simultaneously.
Signs and Symptoms
An ankle fracture is accompanied by one or all of these signs and symptoms:
*Pain at the site of the fracture, which in some cases can extend from the foot to the knee.
*Significant swelling, which may occur along the length of the leg or may be more localized.
*Blisters may occur over the fractured area. These should be promptly treated by a surgeon.
*Bruising.
*Decreased ability to walk—it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured.
*Change in the appearance of the ankle so that it differs from the other ankle.
*Bone protruding through the skin—a sign that immediate care is needed! Fractures that pierce the skin require urgent attention because they can lead to severe infection and prolonged recovery.
Treatment
Elevation and ice – In most patients, swelling is often seen following an ankle fracture. An important part of proper treatment is to reduce this swelling. By limiting the amount of swelling, the pain from the ankle fracture will be decreased as well as preventing further damage to the surrounding tissue.
X-rays – A majority of ankle fracture patients are treated in an emergency room or a doctor’s office. The initial procedure is to obtain an X-ray of the damaged ankle to determine what the fracture looks like, how separated the bones are, and to find out the condition of the bone itself. The X-ray of the damaged ankle will help determine the proper course of treatment.
Splint – Applying a splint to an ankle fracture is most commonly performed in the emergency room. The splint usually remains on the leg for a few days before applying a cast. In the case of continued swelling, a splint allows for more room than a cast. If the damaged ankle is not extremely displaced, the splint may be applied immediately without moving the broken ankle. However, if there is bone separation, a “reduction” should be performed. In this case, the patient will be given anesthesia while the ankle fracture is set or aligned. Resetting the ankle bone will improve the alignment of the broken bones.
Cast – After a few days, a cast will be placed on the ankle area. However, if the swelling is minimal, it may be applied sooner. The cast is made of either fiberglass or plaster. If it is determined that the cast is needed to hold the broken bone in a specific location, then a plaster cast is usually applied since plaster molds to the skin better. A fiberglass cast is most often used if some healing has taken place or if the fracture is not unstable.
Crutches – Since most types of ankle fractures require some degree of immobilization and rest following the injury, crutches play an important part in recovery. In many cases, a patient will not be able to place any weight on the ankle for several days, weeks, or even months. The type of ankle fracture will determine whether or not the broken ankle can bear weight. This is a determination that must be made by a orthopaedic physician.
Surgery – Surgery is often required for many types of ankle fractures. The determination for surgery will largely depend on the appearance of the ankle joint on the X-ray as well as the specific type of fracture. Restoring proper alignment of the broken bone is essential to full recovery. Arthritis can occur after an ankle fracture, and the safest way to minimize this risk of arthritis is to recreate a normal ankle joint. If surgery is determined to be the best course of action to achieve this goal, a physician may recommend this. |
