Ankle joints, undependable as they are, can easily slip. As joints they are fragile, and, unlike the hip, are not surrounded by protective strong muscles. Instead the bones are held in place by ligaments — the rope-like ends of muscles — that are not as strong. They are also more prone to displacement, stretching and tears. This means around 25,000 people sprain their ankles every day just in the US.
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The ankle is a hinge joint, meant to move upwards and downwards. If torsion or twisting movement occurs accidentally, the ligaments fail to hold. The ankle can then be forced out of its normal position. As the body is unprepared, the joint can “give way” resulting in a sprain.
The entire weight of the body rests on this weak pair of ankle joints. Acute injury usually means that the person either falls or hobbles away painfully.
Age is no bar, and both the young and old can “sprain” their ankles. An ankle sprain is more likely to occur if:
• The footwear is unsuitable, with hard unyielding soles, or spiky or rocker-bottom heels.
• The foot is placed awkwardly while landing after a jump.
• A fall causes the ankle to twist.
• One walks or exercises on an uneven surface resulting in loss of balance.
• A person is overweight.
• The ankle has been injured before and is unstable, causing a repetition of the injury.
If the sprain is mild, after a few painful minutes it is possible to put the foot back on the ground and walk. With a more severe injury, the foot may be swollen. There may be a bluish red discolouration over the joint. Weight bearing may cause such excruciating agony that it is impossible to walk. If there is a popping sound or weight bearing is impossible, the ligament may have been torn. In the process, a small piece of bone may have been dislocated or chipped off.
In many mild sprains “home remedies” work wonders. This consists of PRICE — Protection, Rest, Ice Compression and Elevation:
• Protect the joint from further dislocation with elastocrepe bandages and an ankle support. These are available in medical stores.
• Avoid bearing weight by using a crutch or leaning on a cane.
• Rest as much as possible.
• Elevate the leg so that the ankle is above the level of the heart. Keep it like that as long as possible. This will reduce the swelling.
If the sprain is mild, with these measures the pain will disappear in three days. If discomfort persists, it is better to consult a physician, as the ligaments may be torn or the bone chipped. An X-ray or a scan may be needed to evaluate the joint.
The first stage of recovery takes around a week. The ankle should be rested as much as possible. For the next two weeks, passive exercises should be done to increase the strength and restore flexibility. This is very important because if the ligaments are not moved they can become stiff and fixed.
Plaster of Paris (POP) can be applied as a cast if the sprain is severe. It keeps the joint fixed and helps rapid recovery. Casts can also be made with new lightweight materials and fitted to facilitate walking.
Surgery is rarely required, but can be performed if pain and instability persist after months of using elastocrepe bandages and exercises. Arthroscopy can be done with a scope to visualise the joint and remove any loose fragments of bone or cartilage. If the ligaments are badly damaged, reconstruction of the joint can be undertaken.
Athletes sometimes tape their ankles or wear an elastic guard prior to exercise to prevent a sprain from occurring. This is not effective unless the joint is already known to be unstable.
If the sprain is unrecognised or neglected, the joint can become chronically unstable and troublesome. A sprain is diagnosed as chronic if it lasts for more than four weeks. This is because by then the muscles have become weak and the ligaments lax. This predisposes the joint to instability and repeated injury.
The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility.
• Don’t start exercising with “cold” stiff muscles. Warm ups are essential to prevent dislocations.
• Run in well-lit areas. That way, uneven surfaces, stones and obstructions can be seen well.
• Pay attention to footwear. Wear sports shoes for games. Formal stilettos, spiky heels and elevated shoes can cause loss of balance and are better avoided.
• If the ankle suddenly pains, stop the activity and check to see what is wrong.
Sources: The Telegraph (Kolkata, India)