Sprains and Tendon Injuries
An ankle sprain is a stretching of the fibers that hold the bones of your ankle in place. Ligaments are not a part of your muscles or tendons. There are three major ligaments on the outside of your ankle named Anterior Talofibular Ligament (ATFL), the Calcanealfibular Ligament and the Posterior Talofibular Ligament (PTFL). There is a complex of ligaments along the inside of your ankle called the Deltoid Ligament. There is usually a traumatic incident in which the ankle is twisted causing a sprain. Some people will have very loose ligaments causing frequent sprains.
The symptoms of a sprained ankle usually occur after trauma. You may not be able to put any weight on your foot without severe pain. If there is a mild sprain you may be able to walk, but with a limp. Sometimes the foot becomes swollen, red, or bruised. The amount of bruising and swelling does not always tell us the amount of actual injury. The foot may also feel more floppy as the ligaments are not as strong to hold the bones together properly.
Causes of a sprained ankle are mostly traumatic from an uneven walking surface. You may be more likely to have a sprained ankle if your ligaments are loose. Some people are born with very loose ligaments or have developed this over time with repeated sprains.
The diagnosis of a sprained ankle can be more difficult than you may think. The term Sprained Ankle Syndrome is now used because there can be more damage done than just a partial tear of the ligaments. A sprained ankle may be mistaken for a bone avulsion, fracture, tendonitis, tendon rupture, capsulitis, muscle strain, subluxed peroneal tendon, Os Trigonum Syndrome or damage to the cartilage of the ankle joint called a transchondral lesion.
Prevention is aimed at mostly wearing good supportive shoes. Be aware of the surfaces that you walk or run on. If you have had frequent sprains of your ankle you may want to wear a supportive brace during heavy activity or sports. The best prevention may be to get advice from your podiatrist. If you have a bad injury keep weight off of the foot until you have had a proper examination from a physician. A commonly thought of sprained ankle can be much more serious.
Podiatric Care may include conservative treatment using RICE (Rest, Ice, Compression, and Elevation). Your doctor may prescribe an anti-inflammatory oral to reduce this swelling or pain. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and determine if there is any other problem. Sometimes during x-rays the foot will be positioned to test the ligaments, called a stress test. The doctor can then look at the position of the bones to determine how much damage is done to the ligaments, although the ligaments themselves cannot be seen on x-ray. Sometimes special tests are ordered to further evaluate the ligaments or bone structures including MRI or CT Scan. Your podiatric physician may place you in a brace, soft dressing, or a cast for a period of time. Frequently they will recommend crutches, a walker, or a wheelchair to keep weight off of the ankle. By resting and relaxing too long following a sprained ankle, sometimes you may do more harm than good causing a longer recovery. Discuss this with your podiatrist. They may refer you to a physical therapist to aid in the treatment process. Sometimes sprained ligaments will take longer to heal than an acute break in the bone. Your podiatric physician may also recommend a surgical procedure to actually fix the ligaments, especially if there is an actual ankle ligament rupture instead of a simple sprain.
Surgery to repair a severely sprained ankle or ruptured ligaments may be performed in a hospital or surgical center and commonly as an outpatient procedure. The ligament can be repaired by suturing the ends together or using a graft or other tendons to reconstruct the ligaments. The exact procedure depends on your surgeon, the number of ligaments and the actual amount of damage to those ligaments.
Post-operative Care and Risks of surgery for a repair of a severe ankle sprain depends on the exact surgical procedure. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially during the first 48 hours you should keep your leg elevated and an occasional ice pack placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know. Many times your podiatrist will send you to physical therapyfollowing repair of a sprained ankle, especially if a tendon is used as a graft to train the tendon to function properly.