When think about it, it’s not very surprising that ankles are frequently injured.
Each year, around 230,000 Australians see a GP for an ankle sprain or strain, according to NPS MedicineWise.*
And if you play sport, chances are, an ankle injury will put the brakes on your mobility at some point.
A review of studies conducted around the world revealed that ankle sprains are more common in particular sports – for court games it’s tennis and squash; while in team sports (rugby, soccer, volleyball, handball and basketball) are the standouts.
About the ankle
Orthopaedic surgeon Dr Jonathan Young said if you consider the ankle as part of the foot, it is the most proximal linkage of a very complicated system that allows us to adapt to the terrain we are moving over.
“Yet, it efficiently transmits the forces of our muscles’ contraction to propel us,” he said.
“When standing behind a child running barefoot it is possible to see the heel change angle to the axis of the leg, as the foot strikes the ground and when the toes lift off.
“When the foot contacts the ground the heel slopes outward (into valgus), yet when the toes lift off the heel slopes inward (into varus).
With the heel in valgus the linkages of the foot (the midfoot) are loose and the foot more compliant. With the foot in varus the midfoot is more rigid and so a better transmitter of force.”
The risk factors
There’s a number of proven risk factors in obtaining an injury to the ankle, according to Sports Medicine Australia. They include:
- Previous or existing ankle injury, especially if poorly rehabilitated
- Lack of strength and stability related to the ankle,
- Lack of, or extreme flexibility in the ankle joint
- Poor balance
- Sudden change in direction (acceleration or deceleration)
- Increasing age
How do ankle sprains occur?
Dr Young says most ankle sprains are inversion injuries.
They occur with the heel in varus (tilted inward) the foot is rigid and so the forces are transmitted to the ankle, most often damaging the ligaments, though sometimes the joint surface and bone.
There are two main ligaments that resist these forces – the Anterior Talofibular ligament and the Calcanoefibular ligament.
Grades of injury
Grades of injury range from stretching of these ligaments to rupture. The vast majority of injuries are treated non-operatively – in a brace with early movement (ice and analgesics are used to help with the pain). Chronic ankle instability is not very common.
The first 48 hours
The Emergency Care Institute of NSW** recommends the five actions within the first 48 hours following ankle sprain.
- Rest – from weight bearing but start trying to move your ankle straight away. Use crutches to take weight off your ankle if you are having trouble walking.
- Ice – apply to the injured area for 15minutes every 2 hours. Use a damp cloth layer, such as a towel, between the ice and your skin. Commercially available ice packs work well as they mould to your skin.
- Compression – using a compression bandage/stocking during the day may help with discomfort.
- Elevation – raise your ankle above the level of your heart to minimise swelling. The best position is lying down with your foot on some pillows. Hanging the ankle will do the most harm.
- Avoid ‘HARM’ – Heat, Alcohol, Running / sport and Massage.
Dr Young said there was little evidence that supported the debate that even complete ruptures should be operated on immediately, as the results of early brace treatment were usually very good.
“At times there are problems with the foot that lead to recurrent sprains – and these can be difficult to overcome,” Dr Young said.
As always, seek medical advice if you have worsening pain that is not resolving.
Seeking a treatment that’s right for you? Arrange a consultation with Doctor Jonathan Young today. Call 02 4958 7777.
*NPS MedicineWise is an Independent, not for profit body committed to supporting quality use of medicines to improve health decisions and health and economic outcomes in Australia.
**The Emergency Care Institute’s primary role is to improve outcomes for patients presenting at hospital emergency departments (ED) across NSW through coordination, networking and research.