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Ankle

Friday, 26 February 2016 02:08

Recognising and Managing Ankle Fractures

in Ankle

Ankle fractures are surprisingly common injuries, both in athletes and the general population. Being able to quickly identify the signs and symptoms of a fracture is extremely important in ensuring quick and effective medical management.

Ankle fractures come in different shapes and forms. For example, a netballer with shin splints may experience a stress fracture, while a soccer player colliding with another player may experience a large break of the bone at the base of the ankle. In either case, bony tissue has been disrupted and must be treated accordingly.

Knowing the signs and symptoms of fracture

Understandably, swelling and bruising will occur when a bony injury to the ankle takes place. Inability to bear weight on the affected leg, along with extreme pain when the affected area is touched are also very common signs of fracture. However, as an ankle sprain will often present with these same symptoms, it can be easy to misdiagnose an ankle fracture as a severe sprain.

Luckily, there are some established rules to follow if you a suspect an ankle fracture. If one or more of the following signs are present, along with a history of trauma, it is recommended that you seek medical advice as soon as possible.

1) Inability to fully bear weight on the affected limb for 4 or more steps.

2) Tenderness to touch along the inner and outer bony aspects at the base of the ankle.

3) Pain to touch at the outer part of the foot.

Following diagnosis of a fracture, the doctor may decide to use a plaster (cast) to protect the bones while they heal. Severe fractures will need to be surgically stabilized. After surgery or time in a cast, ankles can be surprisingly weak and stiff due to disuse, leaving them vulnerable to becoming reinjured.

After removal of a cast, wearing a fabric brace is usually recommended for a few weeks. The brace provides an element of stability while the joint is regaining strength and balance. During this time, it is important to start strengthening and mobilizing the ankle. A physiotherapist can develop a rehabilitation program that involves a gradual return to normal daily activities and eventually sport.

This rehab program will allow your bones to continue healing while adjusting to the increasing stresses being placed on them. You may begin rehab in a non-weight-bearing setting such as the pool, and progress to increased weight-bearing activities such as cycling. Eventually you will be able to start a weight-bearing program on the grass or even on a hard surface to assist with your return to sport.

Friday, 26 February 2016 02:08

High Ankle Sprains

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WHAT IS A HIGH ANKLE SPRAIN?

The ankle consists of three bones, the tibia, fibula and talus, all held together by thick fibrous ligaments. At the bottom of the leg they form a mortise or hinge joint with the foot. The bottom parts of the tibia and fibula join together and surround the talus in such a way that it is able to hinge forwards and back while providing stability and restricting the side-to-side movements.

Syndesmosis describes the ligaments holding the tibia and fibula together and a high ankle sprain is a tear of these ligaments. A normal ankle sprain is a tear of the ligaments lower in the ankle, and this is why we refer to a syndesmosis tear as a “high” ankle sprain.

HOW DO THEY OCCUR?

These injuries usually occur through twisting of the ankle during sport, however they can also happen with day-to-day activities. The foot is typically pushed back and rotated outwards, putting excess pressure on the ligaments keeping the lower leg bones together. This force can cause the syndesmosis to tear resulting in a gapping of the two bones, which can lead to significant instability of the ankle.

HOW CAN YOU TELL THE DIFFERENCE BETWEEN A NORMAL ANKLE SPRAIN AND A HIGH ONE?

High ankle sprains are much rarer than lower ankle sprains, accounting for only 1-11% of all ankle injuries. It can be very difficult to tell the two injuries apart. To complicate things, a fracture of the ankle will also have similar symptoms. Your physiotherapist will have a set of physical tests they can perform if they suspect a high ankle sprain. Ultimately imaging may be required to confirm the diagnosis.

WHY IS THIS IMPORTANT?

High ankle sprains can take up to two times longer to heal than normal ankle sprains and require more immediate attention. Syndesmosis tears that are left untreated can result in chronic instability and pain, making them vulnerable to further injury in the future.

WHAT IS THE TREATMENT?

Severe and unstable tears may require surgery and most syndesmosis tears will need to be put into a supportive boot for 4-6 weeks. Following this period a rehabilitation program of strengthening, mobilization, balance, control and agility will need to be commenced before your ankle will be at its pre-injury function. Cortisone injections may be recommended in some cases and have been shown to have good results, when accompanied with proper rehabilitation program. Speak to your physiotherapist for more information.

Friday, 26 February 2016 02:05

Ankle Sprains

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Ankle sprains are extremely common, however, this doesn’t make them easy to cope with when they happen to you. If you’ve ever spent two weeks hobbling around on crutches after an unfortunate twist, you’ll understand just how painful and difficult they can be.

What are they?

Ankle sprains refer to a tear to the ligament fibres of the ankle. Commonly, a person will roll their ankle inwards and tear the ligament on the outside. Occasionally, the ankle will twist outwards and the ligaments on the inside of the ankle are torn and even less commonly, the fibres of the ligament that hold the two bones of the lower leg together tear (high ankle sprain). A sprained ankle will usually be painful, swollen, bruised, difficult to walk on and in some cases unstable.

How does it happen?

Ankle sprains can occur from something as simple as putting weight onto your leg when you think your foot is flat even though it’s not. The most typical pattern is of a person jumping and landing on the outside of their foot or simply slipping and twisting their ankle. A sprained or twisted ankle is one of the most common injuries presented to emergency departments around the world. This is important as a severely sprained ankle can actually have very similar symptoms to a broken ankle and will need an X-ray.

A medical professional should assess any severe sprain. However, there are some guidelines to help decide if a sprained ankle needs X-ray.

  1. You are unable to put weight on the ankle immediately after the injury.
  2. You are unable to take more than 4 steps immediately after the injury.
  3. Pain on the bony edges of the outer foot and ankle.

How long do sprains take to heal?

Depending on the severity of the tear, from one to six weeks. Your physiotherapist is able to help with recovery and ensure nothing slows down the healing. Following any injury of the body, joints may remain a little stiff and lose strength and control. Even though the injured tissues have healed, the ankle doesn’t move quite the way it used to. This means that your risk of twisting it again is higher than before the injury.

How can physiotherapy help?

Correct rehabilitation can help to prevent recurring injuries. As well as providing support to the unstable ankle, your physiotherapist will help you to strengthen any weak muscles and restore balance and control through exercise. They are also able to correct any abnormal movement of the joint following swelling.

Friday, 16 July 2010 09:35

Ankle Sprains

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Ankle sprains are normally caused by rolling of the ankle, commonly in such sports such as netball, basketball and football. However, ankle sprains can also occur during the course of everyday life and cause significant pain and disability.