Ankle joint injuries

Sprains (distortions) and ligament injuries of the ankle are among the most frequent of all injuries. Based on data from comparable countries, it can be assumed that more than 1 million people suffer an ankle injury in Germany each year alone. The exterior ligament complex of the ankle is affected in 85% of all cases.



Causes

Ligaments in the ankle joint can be overextended or may even rupture due to twisting the foot, with or without the application of external force. Such injuries often occur during sports activities. Acute ankle injuries are the most frequent here. They account for approximately 15 to 20% of sport injuries. Sports with frequent, rapid changes of direction, jumps and contact with opposing players are especially risky for the ankle ligament structures. Sports with an especially high incidence of acute ankle injuries include football, basketball and volleyball.

The risk of a renewed ankle injury is elevated, especially among athletes. Approximately one-third of patients suffer another ankle injury within 3 years; among athletes, this figure is as high as 73% of all cases. Later on, many patients also complain about minor yielding of the ankle, pain while walking and running, slight swelling and slight instability of the ankle joint.

Type of ligament injury

85% of injuries to the upper ankle ligamentous apparatus affect the lateral ligaments, with the anterior lateral ligament in turn being the most frequently affected. Injuries of the lower ankle may also occur. While isolated injuries of the lower ankle are rare, estimates indicate that 10% of patients with chronic lateral instability of the upper ankle also suffer from instability of the lower ankle.

Severity of the injury and its symptoms

Ankle ligament injuries are separated into 3 degrees of severity:

Grade I (slight):

Ligament elongation without macroscopic rupture, slight swelling and/or sensitivity of the affected structures. No or minimal loss of function, usually no bruising, no mechanical ankle instability, no weight bearing problems.

Grade II (moderate):

Partial macroscopic rupture with moderate pain, swelling and sensitivity of the affected structures. Slight to moderate impairment of function and slight to moderate ankle instability; frequently bruising and weight bearing problems.

Grade III (severe):

Total ligament rupture with pronounced swelling, haematoma, pain and tenderness. Loss of ankle function as well as pronounced abnormal ankle movements and instability, bruising, no weight bearing capability.

Diagnosis

First the doctor examines the foot for movement limitations, the development of heat, swelling, reddening, protruding bones etc. The circumstances that led to the injury are clarified in a consultation along with where the pain is located, and whether there were any previous injuries or illnesses in this area. Further test procedures such as X-rays or MRI are performed depending on the findings.

Therapy

Early functional mobilisation treatment of ankle ligament injuries has established itself as the modern standard. It includes following the PRICE rule (protection, rest, ice, compression, elevation) immediately following an injury. Light exercise with no weight bearing can begin after just 48 to 72 hours to restore the range of motion and muscular strength. After the swelling recedes, the ankle joint is stabilised with an orthosis and weight bearing is re-established step-by-step over the course of 2 to 4 weeks.

Accompanying sensomotoric training is desirable as well and should start as early as possible – usually after 3 to 4 weeks.

Operation yes or no?

A comprehensive review to compare immobilisation and early functional treatment has shown that early functional treatment is significantly superior to longer-term immobilisation:

  • Over the long term, more patients resume participation in the sport in which they were involved before sustaining the injury
  • Participation in sports resumes more quickly
  • More patients more quickly return to work more quickly
  • Over the short term, fewer patients suffer from ongoing complaints such as swelling
  • Fewer patients exhibit mechanical ankle instability in X-ray images
  • More patients are satisfied with the treatment


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