Management of Ankle Sprains: Difference between revisions
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== Risk Factors and Outcome == | == Risk Factors and Outcome == | ||
Predisposing factors are the risk factors for ankle sprains. <ref name=":2" /> Identifying risk factors helps the clinician to choose the most appropriate treatment regimen given the fact that | Predisposing factors are the risk factors for ankle sprains. <ref name=":2" /> Identifying risk factors helps the clinician to choose the most appropriate treatment regimen given the fact that these risk factors have a significant impact on the patient's recovery.<ref name=":2" />They are divided into two categories:intrinsic and extrinsic. | ||
Intrinsic risk factors for outcome prediction include:<ref name=":1" /> | Intrinsic risk factors for outcome prediction include:<ref name=":1" /> | ||
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* landing technique after jump<ref name=":3" /> | * landing technique after jump<ref name=":3" /> | ||
In summary, | In summary, the following prognostic factors suggest good clinical outcomes after foot and ankle injury: younger age, low-grade sprain, low activity level, good functional status, good neuromuscular function, no associated injury.<ref name=":2" />Long lasting symptoms with functional limitations can be predicted based on the presence of systemic laxity, joint geometry, limb and foot malalignment, re-sprain, and multi-ligament injury.<ref name=":2" /> | ||
== Classification Grading Systems == | == Classification Grading Systems == | ||
The severity of the ligament injury defines the grade I, II, or III of the ankle sprain. Functional grading divides ankle sprains into mild, moderate and severe sprains. Mild and moderate are usually grades I. A mild sprain is characterised by the patient's inability to run and jump, difficulty with stair climbing, and presence of discomfort. Ligaments are intact. Moderate sprains require support to walk, there is the presence of significant pain, swelling and bruising. Severe sprains are grades III sprains where weight bearing is impossible, pain is high and the patient | The severity of the ligament injury defines the grade I, II, or III of the ankle sprain. Functional grading divides ankle sprains into mild, moderate and severe sprains. Mild and moderate are usually grades I. A mild sprain is characterised by the patient's inability to run and jump, difficulty with stair climbing, and presence of discomfort. Ligaments are intact. Moderate sprains require support to walk, there is the presence of significant pain, swelling and bruising. Severe sprains are grades III sprains where weight bearing is impossible, pain is high and the patient needs further testing towards ankle fracture. Immobilisation is usually required for 10 days or more and surgery is often the treatment of choice. | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Clinical assessment including Ottawa Ankle and Foot Rules can be supported by: | |||
'''X-ray:''' allows to rule out ankle or mid-foot fracture within 7 days after the injury. Testing in weight bearing position is recommended | |||
'''Ultrasound''': it is considered a good diagnostic tool for ligamentous injury, functional impairments, and joint instability. | |||
<br> | |||
== Management == | == Management == | ||
Revision as of 01:08, 26 January 2022
Introduction[edit | edit source]
Ankle sprains are considered one of the most frequent traumatic types of injuries. Yeung et al, 1994, in an epidemiological study of unilateral ankle sprains, reported that the dominant leg is 2.4 times more vulnerable to sprain than the non-dominant one.[1]There were reports proposing that the greater the level of plantar flexion the higher the likelihood of sprain. [2]A conservative treatment is the common approach to an ankle injury. The prognosis is generally good, but there is a number of factors influencing the full recovery.[3]These factors, when early identified, can change the treatment protocol to a more aggressive approach.[3]
Clinically Relevant Anatomy[edit | edit source]
Lateral Ankle Sprain[edit | edit source]
The literature suggests that 85% of ankle sprains involve lateral ligaments. [4]The anterior talofibular ligament (ATFL) of the lateral ankle ligament complex is the most frequently damaged when lateral ankle sprain occurs. Their anatomical location and the mechanism of sprain injury mean that the calcaneofibular (CFL) and posterior talofibular ligaments (PTFL) are less likely to sustain damaging loads.
Medial Ankle Sprain[edit | edit source]
On the medial side the strong, deltoid ligament complex [posterior tibiotalar (PTTL), tibiocalcaneal (TCL), tibionavicular (TNL) and anterior tibiotalar ligaments (ATTL)] is injured with forceful "pronation and rotation movements of the hindfoot". [5]
Syndesmotic Ankle Sprain[edit | edit source]
The stabilising ligaments of the distal tibiofibular syndesmosis are the anterior-inferior, posterior-inferior, and transverse tibiofibular ligaments, the interosseous membrane and ligament, and the inferior transverse ligament. A syndesmotic ankle sprain occurs with combined external rotation of the leg and dorsiflexion of the ankle.
Risk Factors and Outcome[edit | edit source]
Predisposing factors are the risk factors for ankle sprains. [3] Identifying risk factors helps the clinician to choose the most appropriate treatment regimen given the fact that these risk factors have a significant impact on the patient's recovery.[3]They are divided into two categories:intrinsic and extrinsic.
Intrinsic risk factors for outcome prediction include:[5]
- Age and gender: female athletes have a 25% greater risk of suffering from a grade 1 ankle sprain[6]
- Height and weight: increase in height or weight proportionally increases the risk of sprain due to an increased magnitude of inversion torque
- Activity level
- The grade of injury
- functional status
- Associated injury, especially previous sprain
- Limb characteristics including limb dominance, anatomic foot type and foot size, joint laxity, anatomic alignment, range of motion of the ankle-foot complex: abnormalities in foot biomechanics such as pes planus, pes cavus, and increased hindfoot inversion were risk factors for lower extremity overuse injury[7]
- Muscle strength
- Posture, particularly postural sway: increased sway leads to a 7-fold increase in ankle sprains [8]
Extrinsic risk factors for outcome prediction include:
- level of competition: the higher the level, the number of ankle sprains increases
- ankle bracing or taping: introducing this intervention early on can lower the incidence of ankle sprains
- shoe type
- lack of warm-up stretching
- landing technique after jump[4]
In summary, the following prognostic factors suggest good clinical outcomes after foot and ankle injury: younger age, low-grade sprain, low activity level, good functional status, good neuromuscular function, no associated injury.[3]Long lasting symptoms with functional limitations can be predicted based on the presence of systemic laxity, joint geometry, limb and foot malalignment, re-sprain, and multi-ligament injury.[3]
Classification Grading Systems[edit | edit source]
The severity of the ligament injury defines the grade I, II, or III of the ankle sprain. Functional grading divides ankle sprains into mild, moderate and severe sprains. Mild and moderate are usually grades I. A mild sprain is characterised by the patient's inability to run and jump, difficulty with stair climbing, and presence of discomfort. Ligaments are intact. Moderate sprains require support to walk, there is the presence of significant pain, swelling and bruising. Severe sprains are grades III sprains where weight bearing is impossible, pain is high and the patient needs further testing towards ankle fracture. Immobilisation is usually required for 10 days or more and surgery is often the treatment of choice.
Diagnostic Procedures[edit | edit source]
Clinical assessment including Ottawa Ankle and Foot Rules can be supported by:
X-ray: allows to rule out ankle or mid-foot fracture within 7 days after the injury. Testing in weight bearing position is recommended
Ultrasound: it is considered a good diagnostic tool for ligamentous injury, functional impairments, and joint instability.
Management[edit | edit source]
Acute Phase[edit | edit source]
Subacute Phase[edit | edit source]
Chronic Phase[edit | edit source]
add text here relating to management approaches to the condition
Resources
[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ Yeung MS, Chan KM, So CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Sports Med. 1994 Jun;28(2):112-6.
- ↑ Wright IC, Neptune RR, van den Bogert AJ, Nigg BM. The influence of foot positioning on ankle sprains. J Biomech. 2000 May;33(5):513-9.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Ferreira JN, Vide J, Mendes D, Protásio J, Viegas R, Sousa MR. Prognostic factors in ankle sprains: a review. EFORT Open Rev. 2020 Jun 1;5(6):334-338.
- ↑ 4.0 4.1 Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop. 2020 Dec 18;11(12):534-558.
- ↑ 5.0 5.1 Beynnon BD, Murphy DF, Alosa DM. Predictive Factors for Lateral Ankle Sprains: A Literature Review. J Athl Train. 2002 Dec;37(4):376-380.
- ↑ Hosea TM, Carey CC, Harrer MF. The gender issue: epidemiology of ankle injuries in athletes who participate in basketball. Clin Orthop Relat Res. 2000 Mar;(372):45-9.
- ↑ Kaufman KR, Brodine SK, Shaffer RA, Johnson CW, Cullison TR. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999 Sep-Oct;27(5):585-93.
- ↑ McGuine TA, Greene JJ, Best T, Leverson G. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sport Med. 2000 Oct;10(4):239-44.
