Ankle sprain: symptoms, causes, first aid and treatment

• June 26, 2019
• Orthopedics and traumatology
• Author Etxt

A sprained ankle, the symptoms of which everyone should know, is a fairly common injury. Moreover, people of any age receive it. For those who play sports, this is a very common occurrence. But people with an inactive lifestyle can also injure their ankles, since their muscles and ligaments are weaker. In women, such an injury is most often associated with wearing shoes with high and uncomfortable heels.

If you receive such an injury, you should immediately consult a doctor. He will set the limb. After this, treatment is carried out at home using various ointments, gels and other means.

Causes of injury

Everyone knows where the ankle is. Its medical name is ankle joint. It is fixed on both sides by ligaments. Located at the transition point to the foot. If you twist your leg unsuccessfully, you will get a dislocation, and with it a sprain or rupture of the ligaments.

The most common causes of ankle sprains are:

• wearing uncomfortable shoes, high heels;
• sports training;
• walking, running;
• sudden movements of the legs;
• jumping from great heights;
• vehicle accidents.

Depending on the cause of the injury, the foot turns inward or outward.

What to do if you have a sprained ankle?

Ankle sprain is a fairly common injury at any time of the year. But with the arrival of spring and an increase in people's activity, as a rule, there is a surge in such injuries.

The ankle joint, along with the knees, supports the entire weight of the body during movement. Therefore, weakening of the ligamentous apparatus and decreased muscle tone, especially with inactivity and excess weight, creates conditions for various injuries, including injuries. Sloppy, sudden movements, incorrect positioning of the foot with overload of one part of the joint, threatens with ankle dislocations.

Damage to the ankle joint, especially with ligament rupture or bone fracture, can lead to quite severe pain, limited mobility and temporary disability.

The most common causes of ankle sprains:

• walking on wet floors, ice or slippery surfaces, leading to falls and joint damage;
• wearing uncomfortable shoes, including high-heeled shoes, platforms, mules;
• movement on uneven surfaces, stones, when there is a high risk of twisting your leg;
• sports, outdoor games with running, jumping;
• professional competitions;
• skeletal pathologies with damage to joints, ligaments and bones, muscles, leading to “loose” joints and gait instability;
• lesions of the nervous system, in which coordination and stability when walking suffer, a person places his foot incorrectly on the floor.

Damage to the joint occurs if the foot turns sharply inward or outward during movement. Then the external or lateral ligaments are overloaded, the bones of the joint are displaced relative to each other. In parallel with a dislocation, ligament sprains or ruptures, as well as bone fractures, are possible.

Symptoms of a sprained ankle:

• severe, acute pain that occurs immediately after the injury - it intensifies when trying to move the foot;
• increasing swelling of the tissues at the site of injury, especially pronounced in the lower part of the leg, the junction of the foot - due to swelling and pain, it is almost impossible to step on the leg and walk;
• When blood vessels rupture, a hematoma can form and the skin becomes bluish.

With ankle subluxation, the symptoms are not as pronounced as with dislocation and rupture of the ligament. Pain and discomfort are especially pronounced when walking; they may subside with rest. The joint is swollen, deformed, foot movements are limited, the skin has a normal color.

Treatment of a sprained ankle

If, after an injury (fall, twisted leg), pain and swelling occur, or a cracking or crunching sound is heard, you should immediately go to the emergency room. It is necessary to determine the severity of the damage to the joint and exclude bone fractures, which will be important for the treatment of a sprained ankle. Self-medication for this type of injury threatens subsequent instability of the ligaments and repeated injuries at the slightest damage and the development of osteoarthritis of the joint (a chronic inflammatory lesion with the destruction of cartilage and bones).

1. Diagnostics

If you suspect a sprained ankle, you need to go to the emergency room and/or make an appointment with a traumatologist-orthopedist at the Canon clinic.

The first stage is to clarify the circumstances of the injury and examine the doctor, during which he will find out where the most severe pain is localized, how limited the movement of the foot is, and what additional complaints the patient has. The traumatologist will assess the amount of swelling, the presence of bruises or hematomas, and the position of the foot.

An X-ray of the affected joint is required to rule out bone fractures. In order not to miss possible damage, x-rays are taken in two projections, this makes it possible to assess the condition of the tibia and fibula, the outer and inner ankle.

2. Modern methods of treatment

After making a diagnosis, the doctor administers anesthesia to reduce the dislocation and apply a fixing bandage. If a bone fracture, joint deformity or bone displacement is confirmed, after restoring the correct structure of the joint, the doctor fixes the foot in the correct position with a plaster cast.

If this is a dislocation of the ankle without a fracture, the doctor will apply a U-shaped plaster splint (from the toes, along the bottom of the foot, covering the heel and upper third of the leg) for a period of 12 - 14 days. If the injury is more serious, the entire foot and lower leg are cast for up to 3 to 5 weeks.

To reduce pain and inflammation for the first 3 to 4 days, it is recommended to take non-steroidal anti-inflammatory drugs (in tablets or capsules). They reduce pain, swelling, and discomfort in the affected area.

After removing the bandage, physical therapy and massage of the limb are prescribed, gradually increasing the load on the foot to help restore the functions of damaged joint tissues, ligaments, and improve blood circulation. When walking for the first time, you should not overload the joint; it is possible to walk with a badik. Additionally, a course of physical therapy may be recommended, especially in old age when the healing process is slower.

It is important to choose comfortable and non-slip shoes to prevent re-injury during the first weeks after removing the bandage or plaster, which can seriously damage the tissues of the joint.

Prevention of ankle sprains

There are a number of tips that can help prevent serious leg injuries, including the ankle joint. To prevent ankle sprains, before any sports activities, a warm-up is necessary, a series of warm-up exercises that increase blood flow to the joints and improve the elasticity of the ligaments.

It is important to move carefully on wet floors or slippery surfaces, holding onto objects and handrails. It is necessary to select the most comfortable shoes without heels or with a stable thick heel no higher than 3 - 4 cm and a hard heel.

You should avoid walking on rough terrain where there is gravel or stones, and do not exercise on treadmills covered with pebbles or steep mountain paths.

When it comes to preventing re-injury, at first it is important to use special fixing orthoses with elastic bandages. The doctor will show you how to properly bandage damaged joints.

Rehabilitation for a sprained ankle

In the first 24 - 48 hours after injury, any warming procedures are contraindicated; rubbing, compresses, ointments. Do not take a hot bath or drink alcohol. Since all this dilates the blood vessels and will inevitably lead to an increase in edema. If you did everything correctly and it became easier, it is still better to see a doctor and undergo additional tests - x-rays, ultrasound to rule out more serious damage.

With this type of damage, it is enough to wear a fixing 8-shaped bandage made of an elastic bandage for 10 - 14 days or, for convenience, an elastic bandage; it is recommended to remove the bandage at night. Non-steroidal anti-inflammatory ointments and gels (Dolobene, Artrosilene, Indovazin) are used locally.

Also, in a complex of rehabilitation measures, you can use a modern and well-proven method - kinesio taping. Depending on the application method, it can be used both in the acute period to reduce swelling, and in a later period to accelerate the recovery of ligaments and stabilize the ankle joint.

Pain and swelling usually go away within the first 10 to 14 days. But complete restoration of the ligaments occurs no earlier than 4 - 6 weeks. Therefore, during this time it is recommended to avoid excessive physical activity (running, jumping, dancing, etc.), and ideally undergo a course of physical rehabilitation in order to restore the biomechanics of movement not only of the foot, but of the entire body.

First aid for a sprained ankle:

1. It is necessary to exclude any load and movement in the ankle joint in the first hours, or preferably a day after the injury.

2. Give the limb an elevated position, at an angle of 15 - 30 ° - any pillows that you have at home are suitable for this.

3. Apply cold to the area of ​​maximum pain and swelling. This could be a piece of meat from the freezer, a bag of frozen berries, etc. It must first be wrapped in cloth. To prevent tissue frostbite, the exposure time is no more than 10 minutes, then a 10-15 minute break and repeat this 3 times.

4. Apply an 8-shaped fixing bandage, you can use a regular bandage, but preferably an elastic bandage. The main thing is not to overdo it: the bandage should not increase pain, cause numbness or coldness of the fingers.

Questions and answers

Questions about the treatment of injuries and diseases of the musculoskeletal system that interest you, you can ask the head doctor of the Canon clinic, orthopedist-traumatologist, candidate of medical sciences Leonid Kurzov weekly on Fridays from 10.00 a.m. until 12.00

Symptoms

It is important to know what an ankle looks like when it is sprained. A bruise and redness appear.

Swelling occurs at the site of injury when the ankle sprains. The shape of the joint changes. It can be directed inward or outward. The heel bone moves forward, during the injury the pain is strong and sharp, but then it decreases, although it does not go away completely.

Foot mobility is limited. If you try to stand on this limb, the pain will intensify again. When an injury occurs, a clicking sound will be heard. It indicates a dislocation and at the same time a ligament rupture. In the damaged area, tissue temperature may increase.

Symptoms of a leg injury in the ankle area

The first and main signal when an ankle is sprained is pain, which often spreads to the entire foot. Without proper treatment, the pain will inevitably intensify in the first hours and become sharp when attempting to move the joint. Often the pain is accompanied by numbness in the ankle area.

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Symptoms of severe damage to the ankle joint are a loud, characteristic click and a visible distortion of the shape of the joint.

For example, the foot may roll outward or curve inward, and in some cases the heel may protrude forward. Other signs of a sprained foot include swelling in the ankle area, redness and hyperthermia, and sometimes bleeding under the skin. The totality of manifestations of an ankle injury affects the degree of limitation of foot mobility: starting with pain when moving and ending with complete blocking.

How to distinguish an ankle fracture from a sprain

Many people are interested in how to understand whether a victim has a dislocated or broken ankle. To distinguish them, look at the symptoms.

Taking into account all these differences, it is possible to determine the fracture and dislocation of the ankle.

Drug treatment for ankle arthritis

Treatment of ankle arthritis with medications is carried out in several directions:

• relieving inflammation;
• elimination of pain;
• restoration of the cartilage lining of the joint;
• removal of decay products from the joint and periarticular tissues;
• improvement of tissue nutrition (stimulation of blood circulation).

In case of secondary ankle disease, treatment of the underlying pathology is also necessary - for example, taking antibiotics, cytostatics, antihistamines and basic drugs for the treatment of rheumatoid arthritis. The drugs are taken orally, externally, or as intra-articular injections for ankle arthritis.

Drug treatment for arthritis can quickly relieve pain and partially restore the cartilage tissue of the joint.

Attention: conventional analgesics for the treatment of ankle arthritis are used no longer than 3 days before visiting a doctor, as they mask complications!

Severe degree

In a severe ankle sprain, the symptoms are pronounced. This condition is characterized by complete rupture of the ligaments. In this case, severe pain is felt, the foot does not move.

A bruise appears on the ankle and below. In this place, the temperature of the tissues rises. The joint is displaced. With this form of dislocation, the pain does not go away on its own, and special injections with painkillers are required. Treatment requires plaster casts and sometimes surgery.

Symptoms of ankle arthrosis

Before understanding how and how to treat osteoarthritis of the ankle joint, it is important to identify its symptoms.

Considering the clinical picture of the disease, one can notice that the key symptoms of arthrosis localized in the ankle joint are increased fatigue and severe pain. As the disease develops, the situation worsens, which leads to increased pain that does not go away even during periods of rest and long sleep.

Over time, the motor activity of the affected joint is significantly limited, and a fairly severe deformation of the ankle is visually visible. However, in addition to this, symptoms of ankle arthrosis include:

• an increase in pain even with minor exertion;
• discoloration of the skin and swelling of the tissues of the affected joint;
• swelling of the foot;
• characteristic crunch when moving the joint;
• loss of the ability to freely move the ankle;
• local increase in temperature indicators.

The presence of just a few or even one symptom of ankle arthrosis should be the reason for urgently seeking qualified medical help.

First aid

First aid for a sprained ankle is aimed at controlling symptoms. It is as follows:

1. Place the affected limb so that the damaged joint is completely at rest. Sometimes experts advise placing a bolster under your foot. It should be soft. It can be made from clothes. This option is used in cases where the injury occurred on the street, where there are no necessary conditions.
2. Apply a cold compress to the damaged area. This helps reduce swelling and pain.
3. The ankle must be secured with a tight bandage. It is best to use an elastic bandage. But if you don’t have it at hand, then other options are also suitable - a belt, a scarf, a scarf.
4. If the victim is in severe pain, he is allowed to be given a painkiller to ease the suffering. But local anesthesia is prohibited. Only a doctor can do this. This is explained by the fact that otherwise, during palpation during diagnosis, the symptoms will be blurred and it will be difficult to determine the exact condition of the affected limb.

After all these steps, be sure to call an ambulance. This applies to cases where the patient has a severe form of dislocation. In other situations, he is supposed to be taken to the emergency room (hospital) himself. There, the doctor will examine the victim, determine the shape and degree of the dislocation, and select appropriate therapy.

Treatment

Further treatment for a sprained ankle involves realigning it. To do this, the doctor first administers local anesthesia. If surgery is required in the future, the doctor will not realign the limb. Your leg will need to be placed in a plaster cast. Other fixing agents, including orthopedic ones, can be used.

Drug therapy involves the use of drugs with anti-inflammatory and analgesic effects. If necessary, additional hemostatic medications are prescribed. To strengthen, products with vitamins and calcium are used.

Diagnostic measures for a sprained ankle

An important aspect is the difference between a dislocation and a foot fracture, bruise or sprain. Confirmation of the fact of the injury and a conclusion regarding the diagnosis is given by a traumatologist or surgeon. An experienced specialist will be able to identify the damage after an initial examination, palpation of the affected area of ​​the body and conversation with the patient. X-rays can be used to determine for certain whether a leg dislocation is in the ankle or ankle area. It is carried out from two sides: from above and from the side. Magnetic resonance imaging and ultrasound are also prescribed as clarifying diagnostics.

A specific type of examination is arthrography of the ankle area. It is carried out by quickly introducing a contrast agent or gas into the joint cavity to obtain more informative results on an x-ray. The accumulated joint fluid is also removed. If necessary, it can be examined in the laboratory.

Self-reduction

In emergency cases, when it is not possible to go to the hospital immediately, you need to know what to do if you sprain your ankle. In such situations, you will have to adjust the limb yourself. But this procedure is considered dangerous.

You need to bend your knee at a right angle. One hand holds the shin, and the other should be placed on the outer edge of the ankle. In one sharp movement you need to press from the outside and in.

This procedure causes very strong and sharp pain. Before carrying out it, you need to check that there is no fracture in this place. Otherwise, if you adjust the limb yourself in such a situation, the victim’s condition will worsen.

After the limb is set, you need to place a cold compress on the place where the ankle is located. This will remove swelling and reduce pain. Then you need to secure the place with an elastic bandage or improvised means. Do not tighten the bandage to prevent disruption of blood flow in the injured leg.

Treatment at home

If the dislocation is mild, you can treat it at home. In this case, the following rules must be observed:

1. Position your leg so that it is constantly at rest. Under no circumstances should you strain her.
2. Place a cold compress on the affected area.
3. Secure the ankle with a tight bandage.

3-5 days after injury, warm, rather than cold, compresses are used. To do this, you can use vodka or hot water, which will help remove swelling.

Many people are interested in how to lubricate a sprained ankle. The best medications to help with such an injury are Indovazin, Bystrumgel, and Voltaren.

They eliminate inflammatory processes at the site of the resulting stretch and accelerate the process of tissue regeneration. Before going to bed, it is recommended to keep the sore limb in warm water in which salt is dissolved. To reduce pain, analgesics can be taken.

Ankle fractures

Patient N., 52 years old, twisted her right foot while going down the stairs in the entrance of her house. I felt a sharp pain that intensified when I tried to step on my foot. I contacted our clinic on the advice of friends, four hours after receiving the injury. She was examined by a traumatologist, an X-ray examination was performed, and the resulting images were described by a radiologist. The diagnosis was made: “Closed comminuted transsyndesmotic fracture of the fibula with displacement of fragments, fracture of the medial malleolus and posterior edge of the tibia with displacement of fragments. Subluxation of the foot outwards."

It should be noted that ankle fractures are a very common injury, they rank second among fractures of the lower extremities. Mostly young men and women over 45 years of age are injured. Obese people are also more likely to suffer this injury.

Considering the nature of the damage, it was decided to abandon attempts at treatment in a cast, since, according to the literature and our own experience, the results of such treatment in the vast majority of cases are unsatisfactory. The benefits and risks of the operation were explained to the patient. Blood and urine tests were taken. The woman was examined by an anesthesiologist and epidural anesthesia was approved. Within two hours the patient was prepared for surgery. Through the smallest possible incisions, the bone fragments were installed in their correct position, taking into account individual anatomical features. Fixation was performed with specialized titanium plates and screws, as well as knitting needles.

The next day after the operation, physical therapy began with our instructor; the patient walked independently on crutches without stepping on the operated leg. She was discharged two days after the operation. The sutures were removed as an outpatient on the 12th day. At a follow-up examination after 10 weeks, it was determined that the fracture had healed.

Patient A., 27 years old, while playing football, was hit by a boot on the inner surface of the lower third of his left shin as a result of an unsuccessful tackle by a player from the other team. I felt a very strong piercing pain; any attempts to move my foot were accompanied by increased pain. It was not possible to move independently. Friends took him to the nearest emergency room, where he was examined by a traumatologist. An X-ray of the left ankle and foot was taken, a diagnosis was made, an attempt was made at closed reduction of the fracture, a plaster cast was applied, and he was sent home. However, the pain did not decrease; burning and tingling appeared. While independently studying the problem on the Internet, I came across the website of our clinic, and then contacted us on the second day after the injury. He was examined by a traumatologist and photographs were taken in a cast. The diagnosis was made: “Closed fracture of the fibula and posterior edge of the tibia. Deltoid ligament rupture."

The position of the fragments on the X-ray was unsatisfactory, and the outward subluxation of the foot persisted. After removing the bandage, pronounced swelling of the soft tissues of the foot and ankle joint, an abrasion on the inner surface of the lower third of the leg, and multiple conflicts (blisters with transparent or bloody contents) were detected.

Remember that if while wearing plaster casts you experience pain, a feeling of pressure, tingling, burning, numbness - and these symptoms increase, you should immediately consult a doctor.

Due to the age of the injury, severe swelling and the presence of blisters, a decision was made to postpone the operation. The phlyctens were opened, treated with antiseptic solutions, and the limb was placed on a Beler splint in an elevated position. Daily dressings were carried out, on the seventh day the swelling decreased, the conflicts healed, and the operation was performed. The fibula is secured with a specially designed pre-modeled titanium plate that conforms to the contours of the bone.

Under the control of an electronic optical converter during the operation, stress radiographs of the ankle joint were taken, the nature of the damage to the deltoid ligament was clarified, and it was decided to abandon the suture of the ligament. In the postoperative period, it is recommended to wear a rigid orthosis for two weeks. Rehabilitation was carried out according to European protocols. On control radiographs after 10 weeks: the fracture has healed, the relationships of the articular surfaces are correct.

Patient S. injured her leg while walking over rough terrain. She noted severe pain in the ankle and rapidly increasing swelling. My husband took me to the clinic. After further examination, a fracture of the inner ankle and posterior edge of the tibia with displacement of fragments, as well as a fracture of the fibula in the lower third, was diagnosed. Doctors sometimes call this type of fracture a trimalleolar fracture.

The patient did not suffer from chronic diseases, tests did not indicate any pathology, therefore she was operated on a few hours after her presentation. Open reduction of ankle fractures and osteosynthesis of bones with plates and screws were performed. Control radiographs confirmed that the anatomy of the joint was completely restored.

In traumatology and orthopedics, in addition to surgery, rehabilitation and care are very important. Proper postoperative treatment can reduce the incidence of complications. After reducing pain in the ankle joint, treatment includes physiotherapy and a complex of physical therapy.

Usually the patient walks with the help of crutches without putting any weight on the operated leg until the sutures are removed. Then, in a special bandage, small dosed loads are allowed, which are gradually increased every week. X-rays are taken every four weeks to monitor the position of the ankles after surgery.

In the postoperative period, medications for the treatment of osteoporosis, chondroprotectors that improve the nutrition of articular cartilage, and blood thinning medications may be prescribed.

Folk remedies

In addition to traditional therapy, it is additionally recommended to use traditional medicine. This comprehensive approach will speed up healing and recovery. But you need to use traditional medicine recipes only after receiving permission from the treating doctor.

Warm compresses are used to treat a sprain. This procedure is allowed only at least 3 days after the dislocation occurs. Warm compresses improve blood circulation, reduce pain, and remove swelling.

The following compresses are recommended:

1. Lactic. Heat the liquid to 30 °C. Soak gauze, folded several times, in milk. You can also use other cotton fabric. Apply it to the sore spot, cover it with plastic wrap (or a bag), and then insulate it with a blanket.
2. Onion. You need to grind the root vegetable in a blender or meat grinder. The gruel must be mixed with salt. Suitable for both table and sea food. Both components are taken in equal parts. The pulp should be placed on gauze and applied to the sore spot. Then cover with film and a blanket.
3. Vodka. Both vodka and rubbing alcohol are suitable for this recipe. But in the latter case you will have to dilute it with water. The liquid needs to be warmed up a little. Then soak a gauze bandage in it and wrap it around the affected ankle. Cover the top with film and add additional insulation.
4. Tea. For this option, it is recommended to use green tea. The compress is made in the same way as in the case of milk.

Such compresses help relieve the unpleasant symptoms of a dislocation. They should be kept for at least 30 minutes. It is best to do the procedure before going to bed. Sessions should be repeated until the ankle is completely restored.

Surgery

If the dislocation is caused by other serious injuries, then immediate hospitalization of the patient is required. Surgical intervention is prescribed in the following cases:

• a fracture was sustained along with a dislocation;
• the tibiofibular joint was injured along with a dislocation;
• There is a rupture of the delta-shaped ligament along with a dislocation.

The doctor assesses the general condition of the patient. If a person has a torn ligament, the doctor makes an incision and examines the cartilage. After this, he sews the ligaments together or fixes them to the bone (if they are completely torn off). Then the wound is stitched and a bandage with plaster is applied.

Healing and rehabilitation times

The duration of recovery of ankle function depends on the severity of the injury, the timeliness of assistance and the correctness of the selected therapy. In addition, the general condition of the victim, as well as the chosen rehabilitation program, influences.

If the patient has a slight dislocation, then everything will go away in a couple of weeks. If a ligament rupture occurs along with such an injury, the recovery period will take approximately a couple of months.

The rehabilitation program includes the following:

• physiotherapy;
• therapeutic exercises;
• massage.

As for permissible exercises, it is allowed to bend and straighten the leg, and make slow circular movements with the foot. If pain occurs, then do not continue. Gradually the load is increased. All this is done under the supervision of a doctor.

As for massage, it is allowed only from the third day after injury. It must be done by an appropriate specialist.

Rehabilitation after treatment

Additional measures to help you forget about a sprained leg in the ankle area are foot massage, exercise therapy and physiotherapy. They are used after the patient’s condition improves, during the recovery stage. The transition to this stage takes from several days to several months, depending on the severity of the damage. Read more about how to snack on whiskey.

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Massage

It is used no earlier than 24 hours after the procedure for realigning the joint. The massage session is carried out in two stages. First, preparation is carried out by stroking and kneading the foot, and then the main part - pinching, concentric rubbing, squeezing. All movements are repeated for 4-5 circles.

It is better to trust a post-traumatic massage to a specialist who will monitor the load level and monitor the risks.

Therapeutic gymnastics (therapeutic exercises)

The exercises are aimed at developing mobility of the ankle joint and foot as a whole. The simplest options are flexion and extension, as well as rotational movements performed while lying down. In the future, doctors recommend moving on to more complex exercises - springing movements on the toes, rolling from the toes to the heels. It is also common to use a gymnastic stick. Gradually, the victim begins to perform various exercises from a standing position (lunges, squats, walking up stairs).

In all cases, it is necessary to coordinate the exercise therapy complex with a doctor.

Prevention

Preventive measures will help prevent dislocation or other joint injuries. The following rules must be followed:

1. Choose comfortable shoes. It should be suitable for the size and fullness of the foot. The heel height should be up to 5 cm.
2. Do exercises at home to strengthen the joint ligaments and leg muscles. Additionally, it is recommended to play sports.
3. Before training, always warm up your muscles before starting the main exercises. Thanks to this, the ligaments will be more elastic.
4. Wear special bandages during training.
5. Get rid of excess weight.
6. Change your diet. It should be balanced, high in vitamins, minerals and other beneficial compounds.
7. Always follow safety rules on sports grounds and the workplace.

All of these steps will help minimize the risk of a sprained ankle.