Ankle Sprains

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How do ankle sprains usually happen?
It occurs with a twisting motion, most commonly with your toes pointed down and in. Some ways this can happen are as follows:
Stepping on an uneven surface
Landing on the outside of the heel
Running with too much cross-over

What are signs of a sprain?
Swelling, commonly on the outside of the ankle.
Pain and difficulty putting weight on that foot.
If the pain is too great to bear weight at all, this is a sign of a fracture.

Which structures are most commonly affected?
In order of occurrence:
Anterior talofibular ligament (aka ATFL)
Calcaneofibular ligament
Posterior talofibular ligament

How serious is it?
It depends on the grade of the sprain; which can be determined by the stability of the joint and how much pain is felt with walking. The grading system is as follows:
Grade 1: Slight tearing of the ligament with mild swelling and stiffness. There is mild pain with walking.
Grade 2: The tearing of the ligament is more severe but incomplete. There is less stability and moderate swelling and discoloration. Walking is painful.
Grade 3: A complete tear of the ligament with severe swelling and bruising. The ankle is unstable and cannot support walking. The pain is intense, especially when the ankle gives way under the persons full weight bearing on the ankle. This injury requires medical attention and surgery.

What are the possible complications?
Fracture of the talus
Fracture of the base of the fifth metatarsal
Dislocation of the peroneal tendons
Bifurcate ligament sprains
Achilles tendon injury
Ankle injuries are extremely common but fractures are found in only 15% of cases.

What is the quickest road to recovery?
Until the swelling has gone down:
Avoid full weight bearing. If it is a Grade 2 sprain, use crutches only for the first 1-3 days. Toe touching with crutch use will improve recovery time.
Ice three to five times a day for 20 minutes with an hour in between.
Rest, elevate, and compress the ankle.
See a chiropractor as soon as possible so that they may ensure that the bones in the foot are appropriately positioned to decrease undue stress on the ligaments and to speed the recovery.
Have the ankle braced with either a splint, a boot, or tape.

Once the swelling has decreased:
Wean off the crutches with gradual weight bearing.
Ice after activity

To avoid chronicity:
Before returning to activity, be sure that you are able to balance on one leg and hop on one leg without pain
Continue to ice after activity
Stretch prior to activities such as running and jogging

If chronicity does occur, do the above but also:
Tape for support before sport activities
Consider getting an orthotic fitting
Seek physical therapy

References:
Souza, Thomas. Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms. Jones & Bartlett Learning; 4th edition (October 3, 2008).

By: Dr. Eugenie Giasson-Gomez

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