An ankle sprain is the most frequent orthopedic injury, being one of the most common diagnoses performed at our Emergency Department. Ankle sprains can happen to everyone at any age. Participating in sports, running, jumping or even walking can all cause this type of injury. Around 95% of an ankle sprain occurs when the foot suddenly twists or rolls, forcing the ankle joint out of its normal position.
The ankle joint is bound by the strong deltoid ligament and three lateral ligaments: the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular ligament. Though it does not span the ankle joint itself, the syndesmotic ligament makes an important contribution to the stability of the ankle.
When an inward mechanism of twisting occurs (or outward, more rarely), these ligaments are forced beyond their normal resistance and may, in the later degrees of this injury, lead to their rupture.
This type of injury can be divided into three stages depending on the degree of ligament injury:
I – Ligament stretch.
II – Partial rupture of the ligaments.
III – Total rupture of the ligaments.
Clinically, it is characterized by the presence of edema of the ankle joint and pain, which is exacerbated by palpation of the injured ligament. In more severe cases, patients are unable to support and load the affected limb.
Diagnosis and staging of the lesion may be confirmed by additional diagnostic tests, such as joint ultrasound or nuclear magnetic resonance imaging.
The treatment depends on the type of sprain. The general principles of the treatment go through rest, anti-inflammatory measures like the application of ice, the elevation and compression of the limb and associated to the discharge of the foot, using the use of gaiters, like crutches, during a period between 2 and 4 weeks.
It may be associated with taking medications to decrease inflammation, both topically (ointments and creams) and systemic (tablets or injections).
Surgical procedure may be indicated, in the case of ruptured anterior ligaments (chronic instability) of the ankle, with episodes of repetitive sprain. It consists of reconstruction of the injured ligament, and is reserved for cases of non-surgical treatment failure. It can be done in conventional or arthroscopic way.
The prognosis of this type of injury is most of the times positive, with total recovery and return to sport activity in the vast majority of cases. However, it can progress to chronicity when the basic principles of treatment are not respected, and there is no ligamentous healing, evolving to repeated episodes of sprain.
Dr. Miguel Duarte Silva
Internal 5th Year of the Orthopedic Specialty of the Hospital of Cascais