Treatment of ankle sprains in Moscow

Symptoms of a sprained ankle

Injuries of 1st and 2nd degrees are partial micro and macro ruptures of soft tissue structures.
When severely affected, they tear off the bone, causing the leg to completely lose functionality. When an ankle sprain occurs, pain of varying intensity occurs, regardless of the degree. Due to the high permeability of blood vessels and pressure on the capillaries, swelling forms and pain increases. If the ankle is sprained, damage to the walls of large vessels occurs, a hematoma appears with blood filling, and the skin becomes blue-purple. If measures are not taken, an inflammatory process develops - ligamentitis, which affects the tendons. The patient may hear sounds similar to clicks when moving or moving his fingers, caused by loss of integrity of the annular ligament.

Orthopedic doctor Alexey Yurievich Moiseenko comments

Sprained ligaments extremely limit the range of rotation and mobility. At grades 2 and 3, it is almost impossible to step on your foot. With complete separation of solid tissue structures, abnormal joint activity is observed.

Stages of rehabilitation

In case of a serious sprain, the doctor prescribes comprehensive treatment to alleviate the victim’s condition and speed up the recovery process. Medicines, physical therapy, and physiotherapeutic procedures are prescribed. The duration of treatment depends on the degree of injury, the age and health of the patient, as well as whether first aid was provided after the injury.

Medicines are prescribed to reduce pain and get rid of swelling. As a rule, doctors prescribe pain-relieving ointments and anti-inflammatory drugs. After the swelling subsides, local warming drugs are prescribed. Therapy is supplemented with angioprotectors and absorbable ointments.

To improve the circulation of blood and lymphatic fluid, as well as speed up recovery and prevent complications in the form of accelerated tissue fusion, lameness and other negative consequences, the following physiotherapy procedures are prescribed:

• cryotherapy;
• electrophoresis;
• ultrasound;
• UHF;
• magnetic currents;
• amplipulse therapy.

A traumatologist or physiotherapist will determine the duration and number of procedures.

Causes

The main etiological factors are sprain or strain due to excessive load on the ligamentous apparatus of the joint, which causes stretching or rupture of the ligaments. Overstrain occurs due to repeated microtrauma of soft tissue structures, disrupting local capillary microcirculation with changes in the structure of the fibers. The problem is accompanied by infiltration (penetration) of fluids and cellular elements into the tissue.

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Partial ruptures of connective fibers occur due to improper foot position, household and sports injuries. About 20% of people whose activities require standing for a long time complain of relapses. Among athletes, the number of joint injuries reaches 50%.

1. When the sole is tucked towards itself, the talo-tibial soft tissue structures are affected.
2. Eversion often results in a sprain or fracture in the medial malleolus or head of the fibula below the knee.
3. Rolling up the outside of the foot injures the lateral group, which restrains excessive supination of the ankle.
4. When the leg is fixed and the center of gravity is shifted forward at the moment of flexion of the lower leg, the Achilles tendon suffers.

Occasionally repeated injuries disrupt the stability of the joints, ultimately leading to wear and tear of the bone tissue.

In addition to traumatic causes, there are also degenerative ones that arise due to physiological changes. With age, due to low collagen production, the structural density and elasticity of the fibers decrease. Microtraumas and infections, deforming loads lead to inflammation and the appearance of growths on the bones - osteophytes.

Based only on the symptoms of an ankle sprain, it is impossible to make a conclusion about the patient’s condition. A differential diagnosis is needed to exclude dislocation and intra-articular fracture. In the absence of certain informative measures that determine the degree of rupture and the lesion, it is easy to make a mistake in choosing a treatment method.

Diagnostics

Before treatment for a sprained ankle begins, the patient is sent for an x-ray. Pictures in two projections with an extended and bent lower limb help to form a clinical picture. To assess the stability of the talofibial fibers, the traumatologist performs a test in parallel. One hand creates resistance when moving the ankle, the other holds the heel and moves it forward. To determine problems of the fibula, avulsion fractures of the metatarsal and talus bones, more informative diagnostics are used.

Ultrasound examination

Using high-frequency waves, specialists detect areas involved in the pathological process. On the monitor you can see signs of an ankle sprain:

1. Thickening of the ligament, loss of echogenicity in the fatty tissue - the ability to reflect acoustic sound over a certain period of time.
2. With partial injury, a hematoma and swollen tissue are clearly visible.
3. When a complete rupture occurs, fluid is present in the tendon sheath. In this case, there are disturbances in the movement of the fibers, their intermittency is visible. There is a lot of effusion in the synovial capsule.
4. With an old injury, damaged connective tissue and fibrous areas are visible.

If an ankle sprain does not go away for a long time, soft tissues are additionally scanned. This allows you to determine the condition of the fibrous capsule, blood vessels, bone surfaces, and the volume of effusion.

Magnetic resonance scanning

It is prescribed when it is not possible to differentiate the pathology by other methods. It shows:

• condition of the tendons after a sprain in the ankle joint:
• fractures;
• bleeding in the joint (hemarthrosis);
• inflammation;
• arthrosis destructive-dystrophic changes;
• purulent infections and other pathologies.

Diagnostics

In case of partial muscle rupture, doctors at the CELT clinic apply a plaster cast, thus fixing the damaged limb in a certain position, which ensures maximum approximation of the edges of the injured muscle.

Complete muscle rupture requires surgery, in which a surgical suture is placed on the muscle itself. Sutures are also applied if a tendon tear occurs.

Professional medical care is decisive in terms of a favorable prognosis. During the recovery process, complete restoration of muscle tissue functions is observed. If you do not consult a doctor, there is a danger of the formation of rough scars that will limit the mobility of the muscle.

First aid

At the first symptoms of an ankle sprain, the leg should be immobilized and elevated. Apply crushed ice in a towel or a cold heating pad to the swelling for no more than 15 minutes several times a day, otherwise the effect will be the opposite. To avoid further trauma, the joint is stabilized with an elastic bandage or neoprene bandage, orthosis, or taping.

Orthopedic doctor Andrey Sergeevich Litvinenko comments

In the first week, with grade 1 and 2 sprains, active loads are excluded; thermal procedures and massage are avoided for 3 days. They will provoke hemorrhage and increase the size of the swelling.

Ointments with anti-inflammatory formulas

Along with cold, when a sprained ankle occurs, the acute condition is relieved with local remedies with different active ingredients:

• with propionic acid - Ibuporfen, Nurofen, Deep Relief;
• phenylacetic - Diclak, Ortofen, Voltaren, Diclovit;
• indolylacetic – Indovazin, Indomethacin-Acri;
• with ketaprofen - Fastum, Ketonal, Artrosilene;
• drugs from the oxicam group - Piroxicam - Final gel;
• analgesics - Nimesulide, Nise.

Due to the risk of side effects, ointments are not recommended for long-term use. To relieve pain and treat ankle sprains, painkillers in tablets, non-steroidal drugs are prescribed: Troxevasin, Nimesil, Ketanov, Diclofenac-akos, Movalis, Flexen. Medicines are effective for overexertion and acute conditions.

For chronic processes, corticosteroid injections are prescribed. They block the pain, but do not provide a complete cure. Long-term use reduces collagen production and tendon strength during stretching. Administration is justified only when used once every 2 weeks.

Decongestants

To improve tissue nutrition in the affected area, anticoagulants are prescribed.

1. Troxevasin, with its angioprotective effect, reduces the area of ​​edema and the risk of secondary lesions of soft tissue structures.

1. Heparin ointment, after entering the systemic circulation, resolves hematomas, effectively relieves swelling when the ankle joint is sprained, and prevents the formation of blood clots at the site of vascular damage.
2. Lyoton gel with a high concentration of heparin, in addition to all the listed actions, inhibits the catarrhal process.

Warming ointments for the treatment of ankle sprains

In the acute period, the use of locally irritating drugs is prohibited. They are recommended to be used after 3-4 days to accelerate local blood flow and metabolic processes.

1. Capsicum with camphor and gum turpentine warms up and relieves pain for 12 hours.
2. Apisatron with bee venom increases the elasticity of the ligamentous muscles.
3. Comfrey with tannins, allantoin, vitamin E activates nerve endings and reduces pain.

Chondroprotectors for joints

To prevent the development of degenerative processes in the capsule, chondroprotectors are prescribed for inflammation. Due to the inclusion of mucopolysaccharide and chondroitin, the drugs give a good effect:

• relieve swelling;
• stimulate metabolic processes in bone tissue;
• restore elasticity to soft tissue structures;
• accelerate the production of protein structures, hyaluronic acid, proteoglycan, intra-articular fluid;
• relieve inflammation.

This group includes: Artra, Teraflex, Alflutol, Chondroguard, natural remedies - Mucosat and Toad Stone.

1.Types of muscles

All muscles of the human body are divided into three groups: skeletal, smooth and cardiac. Only skeletal muscles are at risk of being stretched, since only they contract consciously. The other two groups are responsible for the work of internal organs and contract unconsciously, so the load on them is always proportionate to what is natural and physiological.

The muscles that support the skeleton and are responsible for our movements work at the will of our thoughts, and it is not always possible to calculate a safe load. In everyday life we ​​sometimes set ourselves impossible tasks, in sports we strive for high results, in critical situations we make sudden movements that go beyond the resources and training provided by nature.

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What measures are taken in case of severe damage?

In case of a complete rupture, patients are hospitalized, the leg is immobilized, and complex therapy is prescribed, including physiotherapy and exercise therapy. To treat a severe ankle sprain with accumulation of blood in the joint, a therapeutic puncture is performed and the fluid is removed. This measure speeds up rehabilitation and reduces the risk of inflammation.

The leg is immobilized for a month, after removing the plaster, an 8-shaped bandage is applied at a 90º angle of the foot for another 4 weeks. It stabilizes the joint and protects against similar injuries. At the same time, rehabilitation measures are carried out. It takes about 3 months to restore the functionality of the leg.

When is surgery needed?

If, when the capsular-ligamentous apparatus of the ankle joint is damaged, the tibiofibular syndesmosis, a fibrous joint of 3 ligaments connected by connective tissue, diverges, then surgery is indicated. This happens when the distance between the tibia and fibula shortens. This is rare, since a syndesmosis injury is usually associated with a tibial fracture. In this case, the bones are connected with a screw for 2 months, and the ends of the fibers are sutured.

For diagnosis and treatment, minimally invasive arthroscopy is performed under local anesthesia. The technology consists of performing 2 skin punctures. Through small holes, tissue growths, osteophytes, and excess fluid are removed with a special tool. After surgical measures, light loads are allowed after 10 days. To avoid muscle atrophy, they begin to develop the joint according to the program proposed by the traumatologist. Doctors do not recommend choosing exercise therapy exercises on your own. The complex includes: walking on the toes and plantar arches, cross-stepping, climbing stairs, rotations with different amplitudes.

Our doctors

Poltavsky Dmitry Ilyich

Traumatologist-orthopedist

Experience 28 years

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Zubikov Vladimir Sergeevich

Traumatologist-orthopedist, Doctor of Medical Sciences, doctor of the highest category, professor

44 years of experience

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Marina Vitaly Semenovich

Traumatologist-orthopedist, head of the minimally invasive traumatology and orthopedics service

Experience 36 years

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Samilenko Igor Grigorievich

Traumatologist - orthopedist, doctor of the highest category

24 years of experience

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Physiotherapy

If the ankle is sprained, UHF therapy is prescribed. Alternating currents dilate blood vessels and accelerate regenerative processes.

1. The effect of ultrasound is comparable to micromassage. The technology relieves inflammatory reactions and reduces the sensitivity of nerve receptors in the affected area.
2. Paraffin applications have an analgesic and stimulating effect.
3. Alternating different-frequency currents in diadynamic therapy is used for pain blockade.
4. Hardware massage enhances the effect of procedures, relieves muscle spasms, and improves nutrition of soft tissue structures.

Treatment

In case of local separation, treatment begins with immobilization and fixation of the affected area. The traumatologist applies a plaster cast to bring the torn edges closer together (this will speed up recovery). If the rupture is complete, then surgery is required, after which fixation and immobilization are performed.

Surgical sutures are required. Recovery takes one and a half or two months, depending on the severity of the pathology. During rehabilitation, you need to visit a specialist to perform physical procedures, as well as independently perform therapeutic massage.

Ultrasound

Ultrasound
In order to reliably determine the location, nature and severity of the injury, the orthopedic traumatologist prescribes an additional examination. It includes techniques that allow you to visualize internal structures. These include radiography, tomography with layer-by-layer scanning of tissue (tissue visualization can be carried out using X-rays or the effect of resonance of atomic nuclei in a magnetic field), ultrasound of components of the musculoskeletal system, as well as arthroscopy (a minimally invasive diagnostic and treatment technique). The choice of examination method is determined by the results of the examination by the doctor, as well as the technical capabilities of the medical institution.

Prevention

The main way to avoid injury is to use warming ointments and warm up thoroughly before physical activity. It is necessary to correctly time under load to avoid significant damage. Additionally, you need to carry out therapeutic massage and get plenty of rest to ensure 100% recovery of the body. It is also imperative to consume a sufficient amount of carbohydrates, proteins and fats, and during intense physical activity, take a vitamin-mineral complex.

Our clinic employs experienced traumatologists who are able to make a diagnosis based on palpation, determining the presence of a gap between the ends of the affected muscle.
If the gap is partial or closed, instrumental diagnostic studies are performed, including ultrasound. Do not self-medicate - contact traumatologists at the CELT clinic, and your full recovery is guaranteed!