Classification of Ankle Sprains And Healing Process

An ankle Sprain is the commonest injury in the leg we have, Regardless of whether the lateral or medial ligaments are injured, the severity of an ankle sprain is typically placed into one of three grades based on the amount of ligamentous damaged or bruised. The degree of tissue damage, the amount of joint laxity, and the extent of dysfunction increase with each increase in grade.

we can classify the ankle sprain into three grades :

Grade I ankle sprains result in a stretching of the ligamentous fibers and are considered minor sprains. there is Stretching of ligaments, anterior talofibular ligament usually the one who gets stretched in an ankle sprain. there will be Point tenderness and Limited dysfunction. No laxity will be present at the joint. the patient will be able to bear full weight and Little to no edema will be there.

Grade II ankle sprains result in partial tearing of the ligamentous fibers and are considered to be moderate sprains. there will be Partial tearing of ligaments, usually the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Point and diffuse tenderness may be present at the site. Slight to moderate laxity and Moderate dysfunction are seen in a patient who is moderately injured and Mild to moderate edema will be there. Antalgic gait and pain with full weight-bearing persist and the patient may need Support or a supportive device to ambulate.

Grade III ankle sprains result in substantial tearing of the ligamentous fibers and are considered severe sprains. Substantial tearing of ligaments may involve the posterior talofibular ligament (PTFL) in addition to the ATFL and CFL. Point and diffuse tenderness with Severe edema and Moderate to severe dysfunction will be there. Moderate to severe laxity is a key feature of severity. the patient won't walk and Limited to no ability for full weight-bearing without the supportive device.

Mechanisms of injury

A high ankle sprain is a sprain in the upper ligaments of your ankle, above the ankle itself. These ligaments are attached to the fibula and the tibia, stabilizing the entire area for activities like running and walking.

When you damage or tear those ligaments — often due to rotating or twisting your ankle — you’re experiencing a high ankle sprain. This type of sprain doesn’t occur as often as a sprain in the lower part of the ankle.

Low ankle sprains are the most common type of ankle sprain. They happen when you rotate or twist your ankle toward the inside of your leg, which causes the ligaments on the outside of your ankle to tear or stretch.

High ankle sprains can happen when you have a fractured ankle bone. Sometimes, these can happen when the deltoid ligaments, the ligaments on the inside of your ankle, have been torn. You might feel pain in the deltoid area, in the ligaments of the high ankle, or even in the fibula.

High ankle sprains are also called syndesmotic ankle sprains after the bone and ligaments involved. there are commonly two kinds of mechanism is observed,

A. Inversion with plantarflexion is the most common mechanism of injury for ankle sprains and will typically result in injury to the anterior talofibular ligament (ATFL) and possibly the calcaneofibular ligament (CFL).
B. Although not as common as an inversion sprain, eversion is the mechanism of injury for sprains of the deltoid ligament complex(DLC).
C. The peroneal tendons are lateral dynamic stabilizers of the ankle.

The Injury and Healing Process

The body’s healing process occurs in a natural sequence of events and can be divided into three stages:
the inflammatory or acute stage; the subacute, repair, or proliferation stage; and the remodeling or maturation stage. It is important to have an understanding of what takes place during each of these stages to support the body’s natural healing process and limit the potential for additional injury. Your doctor will ask you to show them where you’re experiencing the pain in your ankle. Then, your doctor will examine you to determine whether your pain is referred to another area of your foot, ankle, or leg.

• In the acute stage, the cardinal signs and symptoms of inflammation (pain, edema, erythema, warmth, decreased function) are evident. This stage begins immediately after the onset of injury and typically lasts 3 to 5 days.

• The subacute stage, which begins at about 3 days after injury and can last up to 6 weeks, is marked by a decrease in the signs and symptoms of inflammation and the beginning of tissue repair. while during this stage that weak collagen fibers begin to develop a scar at the injured site. Approximately 7 days after injury, there is a significant amount of collagen accumulation in the area. As the subacute stage progresses, it is important to provide some stress to the newly forming scar tissue to minimize adherence to surrounding tissues and to encourage proper scar tissue alignment and development; however, in the early stages the collagen fibers are weak and unorganized so it is more important to avoid too much stress, which can be detrimental to the healing tissues.

• maturation stage Activities begin approximately 1 week after injury in grade I sprain and approximately 3 weeks after injury in grade III sprains. During the maturation stage, the collagen tissues become stronger and more organized. Although nowhere near normal, the scar’s tensile strength usually has increased considerably by the fifth or sixth week. It is important to stress the scar tissue adequately to decrease the potential of developing a dysfunctional scar. limited tissue stress will also continue to encourage proper alignment and development as the scar tissue matures. The maturation phase can last longer than a year, although patients typically return to their activity level much sooner than that.

Treatment and Rehabilitation Protocol for Acute Ankle Sprain

Even something as common as a slightly sprained ankle requires therapy. Nearly every athlete or active person will at some point need physical therapy (PT), which is the rehabilitation of an injury. Don’t shake your head. It doesn’t have to be a major injury, such as a broken bone. Even something as common as a slightly sprained ankle requires therapy. Ankle Sprains are among the most common in the lower limbs. It is usually caused by low-velocity trauma such as twisting injuries, falls, car accidents, and injuries related to sports activities.

the ankle is one of the most complex joints in the human body in the lower limb as per anatomy. It has numerous bones, ligaments, and tendons. It’s definitely worth some research. Type “anatomy of the human ankle” into a search engine and you may be surprised at what you learn.

For our purposes, let’s follow the timeline of a sprained ankle without PT. You first realize something is wrong with your ankle after an activity. You felt a sharp pain when it happened, but the pain didn’t go away. Instead, your ankle became swollen and painful when touched. You iced it and spent a day or so inactive rest. Then you returned to your active life.

The ankle grew more painful as you kept walking and playing your sport, and it hurt every time you put weight on it. You naturally began to favor the injured ankle to prevent pain, transferring more work to the healthy ankle. This caused an imbalance in the way you shifted your weight. The imbalance quickly because chronic, affecting your entire active and athletic performance.

A physical therapist would have identified the imbalance in the way you walked and given you exercises and a program to follow that would help prevent favoring the sore ankle. The therapist would schedule more visits to keep track of how you were recovering, analyzing not only the ankle but the distribution of your weight. Some therapists have a pressure plate that measures the weight of each foot placement, showing whether you are doing less work on one side of the body.

Without this professional analysis and correction, you may continue letting one side of your body do more work than the other side. The results of such a change will eventually affect not only your walk but all activities. Your athletic performance will subtly decline over time, and you will always wonder why.

This timeline is common with any injury, whether it’s a broken bone or a pulled muscle, tendon, or ligament. Having Physical Therapy, where you are observed and analyzed in your movement, is usually the solution to lingering effects of even a mild injury; not to mention a serious one.

If you have been smart enough to get Physical Therapy after a problem, never second-guess the therapist. If he or she tells you to ice it twice a day, do it. If there is a rehab program assigned by the therapist for homework, follow it as scheduled Regularly.

What Should Someone Do After an Ankle Injury?

You can apply Basic first aid for an ankle injury by remembering R.I.C.E: rest, ice, compression, elevation. these are basic Treatment concept which can vary accordingly.

1. Rest. It's important to rest the ankle to prevent further damage and keep weight off of it.
2. Ice. Using ice will help slow or reduce the swelling and provide a numbing sensation that will ease the pain. Proper icing includes icing within 48 hours of an injury, never leave ice on for longer than 15 minutes to 20 minutes at a time to prevent frostbite. Wait 40 minutes to 45 minutes before applying ice again to allow tissues to return to normal temperature and sensation, and repeat as needed. You can apply an ice compress using a plastic freezer bag filled with ice cubes and water to mold to your ankle or use a frozen bag of veggies like corn or peas, (don't eat them after you use them and refreeze them), use a layer of towel between your skin and the plastic bag.
3. Compression. Wrapping the injured ankle with an elastic bandage or off-the-shelf compression wrap will help keep it immobile and supported. Be sure not to wrap the ankle too tightly. If your toes turn blue, get cold or lose sensation the wrap is too tight.
4. Elevate. Elevating the injured ankle to at least the level of your heart will reduce swelling and pain.

It is important not to put any weight on the ankle until after it's been evaluated by a doctor, which should be done as soon as possible. Fractures and sprains that are ignored or aren't treated properly can lead to long-term chronic problems with the ankle, such as repeated injury, ankle weakness, and arthritis.

How Does the Doctor Diagnose an Ankle Injury?

The first thing a doctor will do is ask questions about how the injury occurred. Then the doctor will examine the ankle, noting the amount of swelling and bruising. The physical examination of the ankle may be painful because the doctor needs to move the ankle to evaluate the pain and swelling in order to make a proper diagnosis.

The doctor may order an ankle X-ray to determine whether there are any broken bones. In addition to an ankle X-ray, your doctor may ask for X-rays of the leg and foot to determine whether there may be other related injuries. If the doctor suspects a stress fracture, the doctor will ask for other imaging scans such as an MRI, which will show more detail about the injury. If there is a fracture, the doctor may also ask for a stress test, which is a special X-ray taken with pressure applied to the joint. This will help the doctor determine whether surgery is needed.

For most ankle injuries, pain is controlled by using an over-the-counter medication such as acetaminophen or another nonsteroidal anti-inflammatory drug such as ibuprofen. The specific treatment of the injury depends on the type of injury.

Now comes the big problem: if you don’t have insurance that covers this kind of treatment, how are you going to pay for it? Be upfront with the issue. If necessary, tell the therapist that you will be paying out of pocket and will need to arrange an installment plan, if that’s the case. Most PT companies will do more than let you pay over time; they will often give you a break on the price of each visit.