It is very common to find the ankle joint afflicted by injuries and the most common form is sprain. Anatomically, various ligaments that are stretched or torn surround the ankle joint when it is forced to land in varied unnatural positions.
This is of common occurrence during exercises, playing certain sports or accidentally. The usual presentation could be an individual landing his foot forcefully on an uneven surface or the foot is turned inwards suddenly with force. This force in-turn stresses the ligaments that normally help stabilize the outer part of the joint.
There might be a history of sudden snap/pop when this type of injury happens. The ankle sprain ranges in severity from grade-I to grade-III, depending on the extent of injury to the ligament. An examination of the ankle reveals swelling and discoloration due to the accumulation of blood and fluid. The X-ray is an integral part of diagnosis as it rules out the possibility of fracture. An MRI examination provides a conclusive picture of injuries to various ligaments.
Prolonged immobilization in cases of ankle sprain is a common treatment error. Early mobilization stimulates collagen bundle orientation thereby promoting healing and regaining the range of motion. Improper rehabilitation may result in instability vis-à-vis a balance deficit that increases the risk of re-injury.
Returning to activity without proper healing or inadequate rehabilitation can also lead to instability. Patients can be declared fit to return to normal activity only after taking into consideration the following points:
- When there is a full range of motion of the ankle.
- Ability to walk without a limp.
- 80-90 per cent strength when compared to normal ankle.
- Pain-free hopping possible on the affected limb.
The patients not treated adequately experience a feeling of “giving away” of the ankle. On an uneven surface, while climbing stairs, such individuals are good candidates for recurrent ankle sprains. Treatment at the initial stage aims at reducing post-injury swelling, bleeding and pain especially during the first 24 hours. Hot fomentation should be avoided as it increases swelling. Avoid Aspirin intake (as it prolongs the blood clotting time thereby increasing bleeding). Give rest to the affected joint. Keep the leg and foot elevated by placing a pillow underneath. This will reduce pain and swelling. Give ice treatment for 15-20 minutes every one or two hours.
PROTECTION OF THE ANKLE during the initial healing phase is extremely important. Taping, ankle stir-up, brace/crepe bandage and in severe cases leg cast is applied. In some cases crutches are used until pain-free weight bearing is achieved.
Once pain-free motion is attained, strengthening exercises are advised with a stretch band. Sitting on the floor/ chair, looping band over the foot with the heel on the floor, ankle is moved outwards/ inward, upward and downward. Heel/toe raises: Standing on a step with heels slightly off the step, slowly rise up on toes and then slowly bring the heel down. When this is easily done, exercise only the injured ankle in a pain-free motion.
Balance exercises: While standing, raise one foot off the floor and balance on the other foot for a count of 15. Increase the count gradually to 30. Start this exercise with your eyes open, and later on close the eyes also. Return to activity is advised when the distance travelled by patient is no longer limited by pain then patient can progress to 50 per cent walking and 50 per cent jogging.
Chronic ankle laxity treatment becomes more tedious as it requires proper rehabilitation exercises over a period of time in order to improve the range of motion, to enhance strength and bring stability. If ankle pain is managed properly and well, in time the incidence of chronic pain can be effectively reduced.
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