An awkward, sudden movement may result in injuries caused by stretching, as well as partial or complete rupture of the tissues connecting bones and joints.
An ankle sprain is not considered a serious problem; in some categories of people, such as professional athletes, it is a common occurrence that can be dealt with on your own after first aid for a sprained ankle.
However, with repeated injuries, the stability of the joint is reduced, which can cause serious consequences. Therefore, it is necessary to properly and promptly treat an ankle sprain.
Causes of ankle sprains
Sprains occur when walking in heels, when slipping, in beginning athletes who have not yet mastered the correct training technique.
The likelihood of sprains is higher if the following factors are present:
- uncomfortable shoes;
- too high or low instep;
- sedentary or hyperactive lifestyle;
- arthritis, arthrosis, history of diabetes mellitus;
- overweight.
Coronavirus code on sick leave
The main thing you should pay attention to is that code 01 is assigned to sick leave for patients with confirmed coronavirus. Code 03 corresponds to a hospital patient who was forced to go into quarantine without the ability to continue working remotely. If, after 14 days of quarantine, the disease makes itself known, the patient will receive a certificate of temporary incapacity for work 01 from the doctor.
Patients with viral pneumonia should be prepared for the fact that it will take at best 1 month to fight the disease. The condition of the respiratory organ can be assessed on a control CT scan. It is important to exclude pneumonia, incomplete inflammatory processes in the lungs and complications of pneumonia, such as fibrosis. If there are signs of fibrotic changes on CT and characteristic symptoms, the patient should contact a pulmonologist and have a control CT scan done in a year.
Degrees of stretch
There are three degrees of injury:
- With a mild sprain, only some fibers are injured, the pain is not severe, and quickly passes after first aid for sprained ankle joints. The joint is functioning normally. Performance is restored within 1–2 weeks.
- When a moderate muscle strain occurs, about half of the muscle fibers are damaged, the pain is sharp, severe, constant, swelling and hematomas are possible. The functionality of the joint is impaired. Treatment until complete recovery takes up to 4–5 weeks.
- In the case of a severe, severe sprain of the ankle, almost all muscle fibers are destroyed, acute pain does not go away for a long time, and the joint is incapacitated. Depending on how an ankle sprain is treated, the recovery period ranges from three months to six months.
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.
| Mechanism of ankle ligament injury. Scheme |
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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%.
- When the sole is tucked towards itself, the talo-tibial soft tissue structures are affected.
- Eversion often results in a sprain or fracture in the medial malleolus or head of the fibula below the knee.
- Rolling up the outside of the foot injures the lateral group, which restrains excessive supination of the ankle.
- 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:
- Thickening of the ligament, loss of echogenicity in the fatty tissue - the ability to reflect acoustic sound over a certain period of time.
- With partial injury, a hematoma and swollen tissue are clearly visible.
- 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.
- 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.
First aid for ankle sprains
Since no one is immune from injury, you need to know what to do if you sprain your ankle.
As first aid for a sprained ankle, you should:
- remove your feet from shoes;
- ask the victim to take a comfortable position;
- elevate your leg to reduce swelling;
- apply a cold compress to the sore area for two to three hours to relieve swelling, taking half-hour breaks to avoid the risk of hypothermia;
- provide fixation of the damaged area by applying a bandage;
- To relieve pain, you can give the victim an over-the-counter pain reliever. Anti-inflammatory drugs and ointments can only be taken as prescribed by a doctor.
How is sick leave paid for coronavirus?
The procedure for payments for sick leave during coronavirus is no different from other situations, for example, from sick leave for ARVI or for caring for a sick child. The amount of payments is not affected by whether the patient suffers from viral pneumonia caused by COVID-19, or whether he is forced to quarantine due to contact with the patient, chronic diseases or old age.
The amount of payments is affected by:
- Seniority;
- The employee's actual earnings for the last two years;
- Established minimum wage level.
Treatment
In case of a mild sprain, it is enough to provide the victim with qualified, quick assistance. For more severe injuries, you need to call a doctor - only he will determine how to treat an ankle sprain effectively and safely.
Therapy consists of taking medications with analgesic and anti-inflammatory effects. After eliminating the swelling, the doctor will recommend taking medications that improve blood microcirculation, applying absorbable ointments and warming medications.
Diagnostics
The basis for diagnosing traumatic damage to the structures of the knee joint is their visualization. The following diagnostic procedures are used for this:
- X-ray of the knee in frontal and lateral projection.
- Computer or magnetic resonance imaging.
- Ultrasound examination of the joint.
- Arthroscopy is a diagnostic and treatment technique that involves inserting a flexible tube with a camera and lighting (arthroscope) into the knee joint.
Using an arthroscope equipped with microinstruments, the doctor can perform therapeutic manipulations directly during diagnosis.
Recovery after a sprain
The rehabilitation period for a sprained ankle depends on the severity of the injury, the age and physical condition of the patient. On average, the healing period can last for 1–5 months.
This period can be divided into three stages:
- Reduced symptoms of the acute period. Physiotherapy and massage of the ankle and calf muscles are indicated to speed up healing.
- Preventing muscle atrophy and joint contracture. Exercise therapy in water can help increase the range of motion of a joint.
- Preparing the patient for normal exercise. For this purpose, the exercise therapy complex includes strength exercises and active exercises in the gym.
How to pay for sick leave periods
Temporary disability benefits are paid to the employee as a guarantee of earnings lost during the period of illness (clause 2, clause 1, clause 1.1, article 7, clause 5, clause 2, article 8 of the Federal Law of July 16, 1999 No. 165-FZ “On the basics of compulsory social insurance”).
Therefore, benefits cannot be paid twice for the same period. This means that for two sick leaves with overlapping deadlines, benefits need to be paid for only one of them. Let's look at two of the most illustrative situations.
Prevention of sprains
Preventive measures are very simple and can be implemented regardless of the level of physical activity:
- choose comfortable shoes for everyday wear and sports;
- regularly engage in moderate physical activity to maintain muscle tone and strengthen the ligamentous apparatus;
- avoid injuries and falls.
Shoe selection
Sprains are common among those who wear high-heeled shoes that do not provide enough support to the foot. To avoid this, it is recommended to wear comfortable shoes with low heels (up to 6–7 cm), and be sure to have a set of sports shoes and accessories for sports.
General recommendations
When actively involved in sports, it is advisable to always have painkillers and an elastic bandage on hand to fix the joint in case of sprain. Self-fixing bandages of varying degrees of extensibility are best suited.
Situation 1. Both sick leaves were issued due to illnesses of the employee himself.
If both sick leaves are issued to one person for two different diseases, you must first pay for all calendar days of incapacity for work for the first sick leave. The second sick leave is paid from the day following the day the first sick leave ends.
It is important to remember that in case of incapacity for work due to a general illness, that is, if the employee himself is ill, the first three calendar days are paid at the expense of the employer, and starting from the fourth, at the expense of social insurance funds.
This is what you should do when paying for your first sick leave. As for the second sick leave, the employer must pay for the first three days of the paid period of incapacity for work, which begins to run from the day following the day the first sick leave ends.
If the periods of incapacity for work on two different sick leaves coincide, the first three days are understood to be the first three days of the paid period of release from work on the second sick leave, and not the first three days of incapacity for work on it - they fall during the period when the first sick leave is still in effect.
Example. Payment for two sick leaves for different diseases when their terms overlap An employee of Volna LLC Trunov brought two sick leaves for different diseases, issued by different medical institutions: one from March 10 to March 19, the other from March 18 to March 25. Both certificates of incapacity for work were issued without violations and are subject to payment. Benefits for the first sick leave are paid:
- for March 10, 11, 12 – at the expense of the employer
- from March 13 to 19 – at the expense of the Social Insurance Fund.
For the second sick leave you need to pay:
- March 20, 21, 22 – at the expense of the employer
- from March 23 to 25 – at the expense of the Social Insurance Fund.
The period from March 18 to March 19 (overlapping periods of incapacity for work) is paid only once (for the first sick leave).
If the sick leave for one disease is not closed and you need to go to another clinic for another illness, there is no need to open a new sick leave there. Just show the doctor at the second clinic your unclosed sick leave, and he will extend it by changing the reason for the disability. Then this will be one insured event, and the employer will not have to pay for 3 days on the second sheet from his own pocket.
Complications and prognosis
No injury goes away without a trace, especially when it comes to damage to ligaments, because the latter recover very slowly. Even a minor injury is fraught with serious complications, but after more severe injuries they occur even more often. These include:
- sprained ankle;
- flat feet;
- arthritis and arthrosis;
- tendonitis - inflammation of the tendons.
After mild to moderate sprains, the prognosis is generally favorable. In particularly severe cases, there is a high probability of an unfavorable prognosis, such as the development of lameness.
How many days does sick leave last for coronavirus?
Sick leave for coronavirus lasts as long as necessary for the patient’s body to completely defeat the virus and restore it.
For a patient with coronavirus confirmed by laboratory diagnostics, but without pneumonia, the first sick leave is issued, as a rule, for 14 days. All this time, the patient is treated according to the doctor’s recommendations and monitors the dynamics of therapy. After two weeks, the patient does a PCR test, and the doctor decides on the length of the sick leave.
It is important that the virus does not provoke the development of complications - pneumonia, vascular thrombosis, kidney failure. If there are severe signs of a respiratory disease: cough, shortness of breath, chest discomfort, lack of air, a CT scan of the lungs should be done.
The patient should remain on sick leave until a negative test result - PCR or immunoglobulin - comes back. However, it is important to understand that antibodies (responses to the virus) can remain in the blood for another 2-3 months, even when the patient is already healthy. Taking into account the rather high percentage of error, sometimes it is preferable to do not one, but two tests. After the first negative result, the attending physician can discharge the recovered patient or extend the sick leave, but under quarantine.
If coronavirus provokes pneumonia, then the disease is more severe and the sick leave will last longer. Before discharging the patient, the doctor must make sure not only that there is no viral or viral-bacterial infection, but also that there are no unresolved inflammatory foci in the lungs (infiltrates, “ground glass”, “cobblestone” symptoms).
It can take a month or more to treat viral pneumonia. At the same time, residual effects of coronavirus, such as cough, sore throat, difficulty breathing, may persist for another 1-2 months after pneumonia has already been defeated.
Elderly people over 65 years of age and patients at risk with chronic diseases or “in conditions requiring self-isolation” work remotely or are on sick leave until special orders from the government and the Chief Sanitary Doctor of the Russian Federation, that is, as long as there is a threat for their life and health.