Lateral external sprain of the ankle

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What is a sprain?

A sprain is the stretch of a ligament that occurs when a joint is suddenly tensed, usually with a torsion.

It may be accompanied with a fracture if the torsion went beyond the limit of bone resistance, or with a tear if the tendon attachment broke without going beyond bone resistance.

It is usually due to balance loss on slippery surfaces, a spontaneous movement, or an active play phase when working out or playing sports

The ankle sprain is the stretch or tear of the external tendon of the ankle, that includes three fascicles.

It may be estimated that ankle sprains are the most frequent accident in athletes, with an incidence evaluated at 6,000 cases minimum per day!

The reason is simple : the foot, and the ankle in particular, are our "stabilisers", called proprioceptive, continuously acting to prevent loss of balance and falls. The ankle is therefore a "barrier" against balance loss.

The mechanism of sprains is typical, including uncontrolled loss of balance causing a sudden torsion mechanism in varus, i.e. towards the outside of the foot

Who never had a sprained ankle?

Doctors and emergency services regularly treat athletes or non-athletes who have a sprained ankle, with pain and visible swelling of the outer sub-malleolar section.

Classification of sprains

Mild sprains, with a simple stretch of the ligament

One of the fascicles of the lateral external ligament is stretched, but there is no break or tear. The initial pain has been replaced with a moderate pain and a small swelling, with no bruising. There is no real functional impairment; A few years ago, this condition was called a twisted ankle!

Moderate sprains with partial tear

One of the fascicles of the lateral external ligament is torn, but the ligament is not completely torn.

The pain is acute, with some swelling and bruising indicative of a bleed, and therefore a tear. There is some functional impairment due to pain

   >>Note: these first two classifications account for 90% of sprains       

Severe sprain with complete tear

Two or three fascicles of the external lateral ligament are almost completely torn, with a possibility of bone tear

The initial acute pain caused a light feeling of faintness (it is called the syncopal pain). Acute pain, swelling, diffuse bruising are the key symptoms that should lead to the performance of the required diagnostic tests.

What to do when the accident happens?

The useful reflex is to implement the following protocol as soon as it occurs: RICE : ==> Rest Ice Compression Elevation

I for Ice applied to reduce the local temperature and cause vasoconstriction to minimize bruising diffusion; ice also provides an analgesic effect.

R for rest, in order to promote the healing process.

E for elevation to reduce the bleeding and promote venous return, and therefore fight the oedema.

C for compression to stop the bleeding and also reduce the size of the oedema.

Then, without walking on the foot, see a doctor or seek emergency treatment

>>>Advice from an IRBMS (institute of sports biology and medicine) professional: At this stage, you should not massage nor use the ankle. If it is painful, while waiting to be cared for, you can take paracetamol, if you are not allergic and have no contraindication to the use of this medication

Your doctor or the emergency staff will examine you for:

  • isolated and severe pain on the outer side of the ankle
  • swelling of the outer side of the ankle
  • bruising (hematoma) along the outer side of the ankle
  • very painful movements in flexion/extension varus valgus
  • real functional impairment (impossibility to move the foot and the ankle)

Note that if the pain is bearable and the swelling not too uncomfortable, the doctor will perform a comparative examination with the other ankle to find any natural hyperlaxity by twisting the ankle (called the varus stress test)

Otherwise, and if you may suffer from a severe sprain, the doctor can also look for a muscle tear or bone tear, or even an associated fracture

How to confirm the sprain and its severity?

It is based on the physical examination, an X-ray scan and an ultrasound examination .

The doctor may also want to do an MRI to see if there is any other lesion

Sprain treatment

Several objectives:

  • relieve pain, reduce inflammation and oedema
  • promote ligament healing by immobilising the joint
  • propose early physical rehabilitation to help you go back to normal walking and eventually sports.

Care techniques

Compression and unburdening: ankle brace, strapping, tapes, orthosis and plaster cast if appropriate

Prevention of blood flow troubles and phlebitis

Painkillers and anti-inflammatory medication when necessary

Functional rehabilitation: muscle strengthening and proprioception

Exceptional indications for surgery: It will depend on the ligament tear and on the instability (abnormal joint laxity)

Conclusion

Sprains of the external lateral ligament of the ankle are common and fortunately mild most of the time

 Proper initial management combined with proprioceptive rehabilitation will help reduce recurrences.

We recommend to have a podiatric exam done after recovery to assess any foot statics problem that may contribute to ankle instabilities. The use of orthopaedic insoles may be of help  

 

Docteur Patrick Bacquaert

Médecin chef de l'IRBMS

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