Ankle dislocation: treatment, symptoms, causes of injury, first aid

The most common causes of ankle sprains are twisted ankles, traffic accidents, and falls from a height. Damage to the joint is clinically manifested by acute pain, the formation of inflammatory edema and extensive hematoma. Treatment is carried out by closed reduction of the dislocation followed by immobilization of the injured leg. If conservative therapy is unsuccessful, the patient is prepared for surgery.

What is an ankle sprain and its severity?

An ankle sprain is a displacement of the articular surfaces of the bones that form the ankle joint relative to each other. The anatomical relationship of the tibia, talus and fibula is disrupted. Complete ankle dislocation is diagnosed extremely rarely and is usually combined with an ankle fracture. In everyday life, this term often refers to a sprain, tear or rupture of the ankle joint ligament with partial displacement of the bony articular surfaces.

Sprain with rupture of individual fibers

A ligament is a strong, but not elastic, connective tissue cord. It cannot stretch, but immediately breaks under the influence of a force exceeding the limits of its strength. In everyday life, a sprain is a tear of a small number of ligament fibers. An injury of the first degree of severity is characterized by rapid easing of pain, slight swelling of the joint, preservation of support and moderate limitation of mobility.

Ankle ligament tear

A tear is a violation of the integrity of about 50% of the fibers of the ligament. The ankle joint loses stability and partial displacement of the bone surfaces occurs. There is a sharp pain that intensifies when you try to take a step. Within a few hours, inflammatory edema forms. It compresses the nerve endings, which causes increased pain. Movements are difficult, but support is preserved.

Complete ligament rupture

This is the name for injuries of high severity with complete rupture of the ankle ligaments or their separation from the bone base. The resulting pain is so severe that the victim may lose consciousness. Swelling and hematoma are initially localized in the joint area, but gradually spread to the dorsum and plantar part of the foot. Due to the lack of support, a person can only move with outside help.

Subluxation

Subluxation of the ankle joint is an incomplete dislocation that occurs against the background of ligament injury of any severity. Injuries can be isolated or combined with simultaneous ankle fractures. The severity of symptoms depends on the number of fibers torn at the time of injury.

Complete dislocation of the joint

Complete ankle dislocation is a pathological condition characterized by displacement of the tibia, talus and fibula. It may be accompanied not only by complete rupture of the ligaments, but also by damage to the tibiofibular syndesmosis, periarticular muscles, tendons, and joint capsules. The injury is quite rare, severe, and requires immediate medical attention.

Ligament damage

The most common injury to the ankle ligaments occurs as a result of bruising of the joint or ligaments; sharp pain and swelling in the ankle area are observed, while movement becomes limited. There are cases when the victim can step on his foot almost immediately, but as a result, this can lead to more serious consequences.

First of all, you need to apply ice and raise your leg, secure it with a tight bandage. For fixation, use an elastic bandage or a special joint fixator.

Sports medicine uses the term taping, which involves the use of wide adhesive tape, which provides more serious fastening.

Also, pneumatic splints, which are placed on the joint after a strong blow or when there is swelling around the joint, deserve great popularity. These tires are inflated and completely neutralize the possibility of movement. Very often these tires have coolant packs in them. After a ligament rupture, not only pain and swelling are monitored, but also bruising. If it is small, this means that the ligaments are selectively damaged: in this case, applying a tight bandage will suffice. If the hemorrhage is more severe, it is necessary to use a splint and seek qualified assistance.

For dislocation and fracture in the ankle area

When performing movements that significantly exceed the working amplitude of the joint, and at the same time insufficient strength of the ligaments is monitored, dislocation of the joint occurs. The joint emerges from a “fork” that is formed by the ends of the lower leg bones.

In this case, soft tissues, nerves, and blood vessels are damaged, and open wounds may form.

An open dislocation entails quite severe injuries with soft tissue ruptures. During treatment, first of all, you need to apply a sterile bandage. If soft tissue damage is not monitored, the limb should simply be fixed in one position.

Without anesthesia of the ankle, it is forbidden to reset the dislocation on your own, and you also cannot put any weight on the injured leg. In this case, the victim must be sent to the emergency room as quickly as possible.

An open fracture is accompanied by tissue damage and bleeding. First, you need to stop the blood loss with a tourniquet, then you need to apply a sterile bandage and ensure complete rest for the joint.

Applying a bandage.

Types of dressings: bandage, scarf, adhesive plaster.

When providing first aid with a bandage, the easiest way is to make a reversible bandage: in this case, the toes need to be separated using cotton wool, then several circles are made around the ankle, then the roll of the bandage is held vertically and the foot is wrapped along the inner surface around the toes, making a couple of circles such revolutions that it allows you to completely neutralize the foot. The bandage is secured to the ankle on all sides, but the ankle should not be overtightened. If you need to bandage your thumb, you need to use a bandage up to 5 cm wide: wrap it around your finger several times. The bandage is wrapped around the ankle, then passed back to the big toe and secured to the ankle.

If you don’t have a bandage on your hands, you can simply make a scarf bandage; for this, use a triangular fabric similar to a scarf made from natural material.

Classification of subluxations and dislocations

In traumatology, subluxations and dislocations are classified depending on the direction of displacement of the bone surfaces and the accompanying injuries. What groups are dislocations and subluxations of the ankle joint divided into:

• external The most commonly diagnosed injuries, usually associated with fractures of the outer malleolus;
• internal. Such dislocations and subluxations are accompanied by fractures of the inner ankles;
• rear Such injuries are characterized by combined fractures of the posterior edge of the tibia;
• front These are the most rarely detected dislocations and subluxations with concomitant fractures of the lower third of the tibia or other damage to the articular structures.

The type of injury quite often becomes the main criterion when determining treatment tactics. For example, the integrity of the internal collateral ligament is restored during conservative therapy, and the external ligament is restored only during surgical intervention.

What is a shoulder dislocation

Many different movements are performed by the shoulder joints. He is vulnerable to injury. If there is a dislocation of the shoulder joint, a person will experience severe and sharp pain, and joint functioning will be impaired. In addition, the shoulder hardens or becomes deformed and moves to the side. As a result, asymmetry of the shoulder joints appears. During palpation, the localization of the head of the shoulder joint in an unusual area is determined. Also, the joint will be immobile.

Another symptom is a weak pulse in the radial artery. This occurs due to compression of the vascular trunk by the head of the humerus bone. It is often found that due to the presence of such a dislocation, the sensitivity and motor function of the hand are impaired. In addition, there are other characteristic symptoms:

1. Swelling, painful attack in the corresponding place.

2. there is a noticeable decrease in mobility.

3. The shape of the shoulder joint becomes less smooth.

4. numbness of the upper limb.

5. the presence of bruises, by which the affected area is determined.

6. disappearance of sensitivity in the forearm and other components of the hand.

If we talk about the causes of shoulder dislocations, we can highlight the following:

• with an excess of movements that are aimed at this part of the body. This is called joint hypermobility.
• The presence of an overly inclined glenoid cavity. This is the main cause of posterior or anterior shoulder dislocations.
• Hypoplasia of the joint cavity.
• Accelerated movements of the same type, resulting in repeated stretching of the ligaments and joint capsule. This includes athletes (swimmers, handball players, etc.).

What causes injury?

Common causes of subluxations include running or walking on uneven terrain, bruising or a strong blow to the foot, wearing high-heeled shoes, and playing sports, especially athletics and football. The ankle is injured as a result of the foot turning inward or outward. Predispose to subluxations and dislocations:

• history of ligamentous-tendon injuries;
• excess weight;
• deforming osteoarthritis;
• inflammatory pathologies of the joint (gout, arthritis of various etiologies);
• flat feet, clubfoot, hallux valgus.

People with congenital ligament weakness often suffer from dislocations and subluxations. Their body produces special, “super-stretchable” collagen - a fibrillar protein, which is the main component of all connective tissues. In such people, due to the increased elasticity of the ligaments, the foot may turn inward even when walking on a flat surface as a result of an awkward, excessively intense movement.

Causes of ankle injury

There is a misconception that ankle injury is a professional problem for athletes. In fact, injuries to the ligamentous apparatus are also observed in the everyday life of an ordinary person. Sudden movements, incorrect position of the foot when walking, excess weight, sedentary lifestyle - all this creates conditions for foot injury. Thus, the most common causes of dislocations include:

• sports involving jumping or running;
• wearing uncomfortable shoes;
• walking on wet or uneven surfaces;
• damage to the nervous system, as a result of which a person’s coordination is impaired;
• strong pressure or impact, leading to joint sprain.

An ankle sprain occurs when the foot suddenly turns inward or outward. This leads to overload of the internal or lateral ligaments and displacement of the bones. In addition, twisting the foot can lead to a sprain or fracture.

Symptoms and signs of damage

When a sprain occurs, the victim feels only mild pain at the time of injury to the ankle, which quickly disappears. But it may intensify the next day, accompanied by slight swelling of the skin. Severe injuries tend to have more severe symptoms. With dislocation or subluxation, acute pain and a crunching sound occurs, reminiscent of the sound of a dry branch being broken. The intensity of the pain syndrome decreases slightly in the supine position.

Inflammatory edema quickly forms, spreading to the lateral and (or) medial ankle. As soon as it begins to dissolve a little, a blue-violet extensive hematoma immediately forms, gradually descending to the sole. As blood cells break down, the color changes to pale yellow.

Why does dislocation occur?

The cause of dislocation is indirect trauma, when the injured area is distant from the affected joint. In addition, the appearance of traumatic dislocation is associated with sudden movements that exceed the norm of joint mobility. More rarely, you can find a dislocation that is the result of direct injury to the joint.

It often happens that a person is diagnosed with a dislocation due to a previous illness. This includes the appearance of tuberculosis, osteomyelitis, arthrosis, arthritis, etc. Such joint damage can be either acquired or congenital. The appearance of congenital dislocation is due to the fact that the child’s musculoskeletal system, which develops in the womb, is not formed correctly.

Diagnostic methods

A traumatologist can suspect a dislocation or subluxation at the stage of external examination based on characteristic signs - ankle instability, swelling, subcutaneous hemorrhage and pain on palpation. X-rays can exclude or confirm concomitant fractures and avulsions of bone fragments. To assess the condition of ligaments, muscles, cartilage tissue, and blood vessels, ultrasound or MRI is prescribed. The last study is the most informative for determining the surgical field.

Diagnostics

X-ray of a dislocation
As a rule, a person who is injured is usually taken to the emergency room, where he is examined by a surgeon and a traumatologist. The doctor conducts a survey; it is very important to answer how long ago the injury occurred, whether it happened for the first time or repeatedly, and what first aid measures were taken. If a person has taken pain medication, it is very important to tell the doctor.

After examination, the patient is sent for studies to confirm the diagnosis:

• X-rays are always prescribed;
• CT and MRI may be prescribed for clarification, on the recommendation of a doctor;

• Blood tests may be needed if there are signs of infection.

As a rule, when visiting the emergency room, the patient is given an x-ray, after which the doctor immediately straightens the joint, applies a bandage and sends the patient home if there are no complications.

First aid

The victim must be helped to get to bed, lay him down, raise the injured leg by placing a bolster or high pillow under it.

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Cold should be applied to the ankle, such as an ice pack wrapped in a thick cloth, for 10 minutes every hour. You can fix the joint with a bandage, but it is better to use a transport or homemade splint. To eliminate pain, you need to give the victim a tablet of any analgesic. These are Ketorol, Nise, Nurofen, Diclofenac, Ketonal.

Diagnostic methods

In order to correctly diagnose and begin adequate treatment, consultation with an experienced doctor and the use of modern instrumental examination methods are necessary. If you suspect a disease, you can contact Dr. Petrosyan. The doctor has extensive experience in diagnosing and treating ankle injuries, and the equipment of the clinic allows him to make the correct diagnosis using modern techniques.

A diagnostic search begins with a survey. The doctor clarifies when the injury occurred, under what circumstances and how it happened. Afterwards, the injured foot is examined. The doctor pays attention to swelling, redness of the skin, the presence of hemorrhages, and joint deformation.

After the examination, the doctor may ask the patient to perform several tests that will help to understand exactly what type and form of instability the patient is suffering from. Typically, you are asked to perform certain movements in the ankle, assessing the behavior of the joint at rest and when under load.

Additionally, a plantoscope study is performed to determine how the load is distributed across the feet. An MRI examination is often required to determine how severely damaged the ligaments and cartilage of the ankle joint are.

Treatment options

If, during the diagnosis, blood was found inside the ankle joint, it is removed using a puncture, and then the cavity is washed with antiseptic solutions. Patients with subluxations of grade 1 and 2 are treated on an outpatient basis. If a complete dislocation occurs, the victim is usually hospitalized for elective surgery.

Drug therapy

Complete dislocations, subluxations in combination with fractures are always manifested by acute pain, which is eliminated by intramuscular administration of non-steroidal anti-inflammatory drugs (Xefocam, Ortofen, Movalis). For moderate pain, NSAIDs are prescribed in tablet form - Nise, Ketorolac, Nurofen, Diclofenac. Subsequently, external agents are used more often in therapy. They have a gentle effect on internal organs, and their use rarely leads to side effects.

External remedies for the treatment of dislocations and subluxations	Names of medicines
For pain and inflammation	Indomethacin, Voltaren, Fastum, Artrosilene, Dolgit, Ibuprofen, Ketoprofen, Finalgel, Diclofenac
For edema and hematomas	Heparin ointment, Indovazin, Troxevasin, Troxerutin, Lyoton, Trombless, badyaga, Bruise-off
To accelerate the recovery of damaged tissues, improve blood circulation	Dolobene, Dexpanthenol, Apizartron, Viprosal, Finalgon, Bepanten, Panthenol, Capsicam, Finalgon, Efkamon, Nayatox, sea buckthorn oil

Cold treatment

During the first two days, the application of cold compresses continues. Instead of an ice pack, you can use a heating pad with cold water or simply apply a towel soaked in it and slightly wrung out to the injury site. Under the influence of cold, a reflex narrowing of blood and lymphatic vessels occurs, so inflammatory edema does not spread to healthy tissue.

Applying a tight bandage

In case of subluxation of high severity against the background of severe ligament damage, a plaster splint is applied. It can only be removed during the next medical examination or for hygiene procedures. Patients with grade 1 and 2 subluxations are advised to wear an orthosis or elastic bandage with an open heel and toes for a week. Before going to bed, it must be removed to prevent deterioration of blood circulation.

Compresses and warm baths

Such procedures are carried out only a week after the main treatment. To prepare an infusion for foot baths, pour 2 liters of boiling water into 3 tablespoons of dry plant materials - chamomile, elecampane, peppermint and lemon mint, string, plantain. After an hour, filter, pour into a basin and take a foot bath for 30-40 minutes before bed.

In the treatment of dislocations at the rehabilitation stage, compresses with honey are most useful. A fresh leaf of cabbage, horseradish or burdock is scalded with boiling water and dried. Lubricate it generously with honey and apply it to the ankle for an hour.

Physiotherapy

After the torn ligaments and damaged bones heal, the patient is sent to a physical therapy doctor to create an individual set of exercises. Daily physical therapy exercises contribute to the rapid restoration of ankle function by strengthening the muscles. Circular rotations of the foot, picking up small objects from the floor with the toes, and rolling a bottle filled with water with the sole are recommended.

Massage

Classical massage is especially in demand in the treatment of dislocations and subluxations. Due to kneading and superficial palpation, the blood supply to all ankle structures with nutrients necessary for their regeneration improves. Subsequently, therapy can be supplemented with vacuum or acupuncture massage.

Physiotherapy

To relieve severe pain, electrophoresis with NSAIDs and anesthetics is used. The physiotherapy procedure promotes the continuous flow of drugs into the ankle and provides a long-term analgesic effect. During the recovery period, sessions of magnetic therapy, ultrasound, UHF therapy, and ozokerite treatment are prescribed.

Surgical intervention

Unsuccessful closed reduction, inability to compare fragments in anatomical position are indications for surgical treatment. Open reduction is carried out together with osteosynthesis of the tibia, inner or outer ankle using screws and plates. The operation can also be performed using transarticular fixation of the ankle joint with knitting needles.

Symptoms

Dislocation
As a rule, an injury never goes away without symptoms; a person always feels a sharp pain, so he can name the exact time when it happened. It is important to note that when diagnosing a dislocation, it is very important to know how long ago it happened, since different treatments will be needed at different times.

Symptoms of dislocation and subluxation:

• The pain appears suddenly, it is acute. If you step on the affected limb, the pain intensifies, and the same thing happens when you palpate the diseased joint.
• During the injury, a crunching sound could be heard, this indicates a ligament rupture.
• With subluxation, the joint protrudes slightly; with dislocation, it becomes severely deformed.
• It is difficult to move the leg, since the joint is deformed and cannot perform its functions normally.
• The patient keeps his foot elevated and refuses to step on it, as sharp pain appears.
• After some time, the leg swells, redness and hematoma may appear.

It is important to note that severe pain, swelling and hematomas of the subluxation are accompanied only if a ligament rupture or fracture occurs. If the movement was not very sharp, the joint could fly out without injuring the surrounding tissues, but such a dislocation must be corrected, since the mobility of the joint is still impaired. Therefore, if after an injury the pain is mild and the swelling is very small, you still need to go to the doctor for prevention.

Clinical picture

Patients with CNHS have a history of recurrent ankle sprains or more severe inversion injuries. Therefore, they take special precautions when carrying heavy objects, strenuous activities, and walking on uneven surfaces.

CNHS is characterized by a number of disorders that can be assessed by a variety of sensorimotor indicators. It is obvious that in CNGS there is conscious perception of afferent somatosensory information, reflex reactions and deficits in efferent motor control. The specific origin of these disorders, localized to the ankle ligaments or to the spinal or supraspinal levels of motor control, remains to be fully elucidated. It is clear that both inverse and direct mechanisms of motor control are altered in ankle instability.

Read about ankle syndesmosis sprain here.

The main identified causes of CNGS are: a decrease in proprioceptive abilities due to the loss of mechanoreceptors and a decrease in the strength of the muscles that perform inversion and eversion of the foot. When a lateral ankle ligament sprain occurs, the injury affects not only the structural integrity of the ligaments, but also the various mechanoreceptors in the joint capsules, ligaments, and tendons located around the ankle complex. Collectively, these receptors provide feedback regarding joint pressure and tension, ultimately providing a sense of joint movement and position. Through afferent nerve fibers, this information is integrated, along with data from the visual and vestibular systems, into a complex control system that regulates posture and coordination. When afferent input is altered following injury, the corresponding corrective muscle contractions may be altered. Thus, injury to the mechanoreceptors surrounding the ankle joint during lateral extension may contribute to the development of functional impairment and chronic instability.

Proprioception

Proprioception is described as part of the sensory information collected in the central nervous system from mechanoreceptors found in the joint capsule, ligaments, muscles, tendons and skin. Injury to ligamentous tissues containing mechanoreceptors can lead to proprioceptive deficits and, consequently, the development of CNGS.

Muscle weakness

In addition to sensorimotor impairment, researchers suggest that peroneal muscle weakness is also associated with ankle instability. Lack of eversion strength reduces the ability of the associated muscles to resist inversion and return the foot to a neutral position and thus prevent an inversion sprain. In patients suffering from chronic hepatitis C, non-concentric, but eccentric weakness of the muscles responsible for eversion of the foot was revealed. Other investigators have identified deficits in concentric inversion force in patients with chronic hepatitis C. They gave two explanations for the causes of invertor muscle weakness. First, it may result from selective reflex inhibition of the ability of the ankle inverters to initiate movement in the direction of the initial injury. The second reason may be deep dysfunction of the peroneal nerve, which is a consequence of its overstretching. Another theory the researchers have considered is that the pool of motor neurons associated with the invertor muscles became less excitable to lateral ankle extension, while the pool of motor neurons associated with the evertor muscles did not. greatly affected.