One of the most common injuries we see at Kerlan-Jobe is the ankle sprain. So what exactly is an ankle sprain, and how should it be treated?

A sprained ankle occurs following a sudden sideways or twisting movement of the foot. This can happen during athletic events, or simply during everyday activities. The ankle sprain is one of the most common sports injuries, but also an injury for which people typically do not seek medical attention.

Unfortunately, failing to seek treatment from a sports medicine specialist for an ankle sprain can result in laxity of the joints of the ankle complex, which can lead to:

·         impaired balance

·         reduced joint position sense

·         slower firing of muscles that stabilize the ankle

·         slowed nerve conduction velocity

·         impaired sensation on the skin

·         strength deficits

·         decreased ankle range of motion

There are three different grades of ankle sprain, with 1 being the least severe and 3 being the most severe. Patients with a grade 3 sprain are most likely to seek treatment, since damage can be both seen and felt, and ankle surgery is occasionally necessary.

“Sports medicine specialists are most concerned about addressing the grade 1 and grade 2 ankle sprains,” says Ben Butts, a Physical Therapist at Select Physical Therapy in Los Angeles. “With these sprains, patients tend to return to daily activities and sports while being unaware of the deficits in function that have occurred from spraining their ankle.”

A simple acronym to remember when treating an ankle sprain is RICE:

·         Rest

·         Ice

·         Compression

·         Elevation 

When the RICE treatment has reduced the pain and swelling in the ankle, your next course of action is to restore the ankle’s range of motion. “Reduced joint position sense, also known as proprioception, has been found to be the primary impairment after spraining an ankle, and it needs to be addressed once swelling has subsided,” says Butts. Recent research supports proprioceptive and balance training to reduce the associated impairments from ankle sprains:

·         Stretch the calf.

·         Start proprioception exercises, even if it is still painful to fully bear weight on the ankle.  You can begin proprioception training by lying on your back, extending your leg and tracing the alphabet with your toes, flexing the ankle to create the movement.

·         In a seated position using a rocker board, take your ankle through forward and back motions, side to side motions, or circles.

·         Once weightbearing on your ankle becomes tolerable, balance training can begin as part of the proprioception training. You can begin by standing one foot in front of the other, balancing with eyes open or closed on a flat floor, depending on your need of difficulty. Over time, you can progress to balancing on a single leg with your eyes open or closed. Varying the surfaces you stand on or using bands to add resistance will increase the difficulty of the exercise. 

After the sprained ankle is rehabilitated, you should expect that both your ankles have:

·         Equal balance and control

·         Equal strength

·         Equal flexibility and range of motion

If you were lacking any of these abilities prior to the injury, this is a great time to address these deficits.  If you wish to return to a higher activity level, such as soccer or basketball, you should train accordingly.  “Agility training, plyometric training and balance training are vital for a successful return to sport and prevention of future injury. Seeing a physical therapist is the best strategy to help manage this injury,” concludes Butts.

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Ben Butts, PT, DPT, OCS is a staff Physical Therapist at Select Physical Therapy in Los Angeles. He received a Bachelor of Science in Kinesiology from California State University – Long Beach and his Doctorate in Physical Therapy from University of Southern California.

He is passionate about functional exercise and treating sports related injuries and enjoys surfing, basketball and traveling in his spare time.

http://www.linkedin.com/in/benjaminbutts

http://www.selectphysicaltherapy.com/

The transfibular technique is one of the most popular procedures in the ankle fusion surgeries. This technique will offer the advantages of good exposure, ability to reduce the wound issues by improving thickness flaps, and also the availability of distal fibula for the graft of local bone. Either external or internal fixation will be used, and this has been shown to have high fusion rate with low complications. By using the proper fusion alignment, long term outcomes have shown more success rate.

Arthrodesis or ankle fusion fuses the joint bones completely, making one connected bone. Transfibular ankle arthrodesis with the internal fibular onlay grafting and fixation has resulted in the acceptable fusion rates. Transfibular ankle surgery is performed to repair the severely arthritic joint of the ankle. A foot and ankle surgeon removes the damaged bone and arthritic cartilage, and then ankle joint will be re-positioned to its proper position. The ankle will be stabilized and over time, the fibula, talus fuse and fibula fuse together so the joint of the ankle mo longer moves down and up but still it keeps the motion of side to side.

The orthopedic surgeon uses plates, pins and rods or screws to hold up the bones in the correct position while joints are fused. If the joint doesn’t unite or fuse, all these hardware will break.

Sometimes, a bone graft is required if this is loss of bone. The surgeon uses the graft that means a piece of the bone that is taken from the bones of the lower leg or from the pelvic wing to put in the place of the missing bone.

Typically this surgery is quite successful. Few cases have problems with the wound healing. These issues would be addressed by the bracing or an additional surgery.

The biggest and long term problem with the ankle fusion is the development of the arthritis at joints that are adjoining to those fused. This occurs from an increased stress that is applied on the joints.

A transfibular ankle fusion with rigid fibular onlay strut grafting and internal fixation can achieve high union rate in both high risk and low risk patient population. This procedure is an effective approach for most of the revision and primary situations with or without considerable deformity.

If you have developed the arthritis in your ankle, that may cause pain. This means your joint surfaces are no longer smooth. Your bones become rough and also lining of the cartilage will depleted. This may develop stiffness and pain in your ankle. Usually good cartilage forms the joints, which allows for painless motion between the bones. Diseased or damaged cartilage can allow motion but this can be quite disabling and painful.

Ankle fusion surgery would be performed when the motion of ankle joint become degenerative or painful due to the worn out of cartilage. Sometimes, ankle fusion would be called as arthrodesis. The most common cause of arthrodesis is an ankle fracture.

Ankle Fusion surgery Procedure:

Different types of surgeries are now developed to perform the ankle fusion. The basic method in each surgery remains the same. The common way of ankle fusion surgery is performed by making small incision through the skin to open the joint. After opening the joint, surfaces of the articular cartilage of the joint must be taken off. Once the cartilage is removed on both the sides of the joint, your body would try to heal two surfaces of joint together as if it were broken or fractured.

Once the incisions are made, the bones should be held in the right place while they mend. This can be performed by using the metal plates and large metal screws. Usually the screws are under the skin and they are removed unless they start to rub and induce the pain.

In few situations, especially if fusion is being performed because of a failed initial fusion or an infection, an external fixator will be used to hold up the bones together during the healing process. This external fixator has metal pins, which are inserted into the bones through the skin. The metal pins will be connected to the bolts and metal rods outside the skin, which hold the bones in certain position during the period of ankle fuses. Once the bones have healed, the fixator will be removed, usually the time period will be 12 to 15 weeks.

Some orthopedic surgeons will perform the ankle fusion surgery with the help of arthroscope. This is a miniature TV camera, which is inserted into the ankle joint through a small cut. Arthroscope is used to watch other instruments that are inserted into the ankle joint to remove the surface of the cartilage. The surface of the cartilage would be removed by using a small rotary cutting tool. After preparing the surfaces, screws are placed through small cuts in the skin to grasp the bones together while they are fusing. This method is same as the open procedure but only difference is the incisions are very smaller.

A sprain is a torn or stretched ligament. Ligaments play a vital role in connecting one bone with another bone at the joint. Ankle sprains are mostly happen during daily activities and also in sports. If the foot is based awkwardly, then it affects by twisting the movements of ankle joint. It happens if the ground is not balanced or uneven, and when abnormal amount of physical energy is applied on the joint.

In usual movements, the ligaments may slightly stretch and then come back to their usual size and shape. An ankle sprain appears when ankle ligaments have been elongated beyond their level.

Treatment:

Initial treatment for ankle sprains includes RICE method. To treat the ankle sprains in a proper way you must have to consult your doctor before starting any rehab or treatment. Here is the overview of RICE procedure for the treatment of ankle sprains:

Rest: in the starting period of injury that is 24-48 hours followed by the injury is considered a crucial period for treatment and activities need to be abridged. Gradually put weight on the affected ankle as beard and avoid use of crutch when you can walk with a usual gait.

Ice: after 48 hour of the injury, keep ice pack and lift up the ankle sprains 20 minutes for every 3-4 hours. This ice pack can include frozen vegetables such as corn or peas, which are allowing you to re-use them. Another useful treatment procedure is to fill the paper cups with drinking water then freeze that cup. Use these frozen cubes by peeling away the paper. Kept the ice on ankle sprains for less than 20 minutes, if you kept for more than 20 minutes it may cause tissue damage.

Compression: Continue for compression procedure when lifting up the ankle sprain in initial treatment. Wrap the ankle by using an elastic bandage from the toes to the mild calf, by applying even pressure. The wrap should be comfortable. If the foot becomes blue, cold, or falls asleep, it indicates that the wrap is cutting off the circulation to your ankle and foot so re-wrap it.

Elevate: keep the ankle sprain at height. Lift up it at night by placing pillows, books, or using any material under your foot. Stand up carefully in the morning.

You can start exercises under physician guidance. Without applying any force on ankle, basic exercises should be performed. Some standard exercises such as range of motion exercise, isometric exercise, and resistance exercise can be useful for ankle sprains.

More severe injuries for ankle sprains, including total rips of the ligaments and bone fractures may need various rehab and treatments than simple sprain.

If you won’t get any relief from this RICE procedure, you can consult an orthopedic doctor to know about your condition and treatment.

Foot is the one of the most important parts in our body and it has 38 bones which are connected by ligaments, tendos, muscles and joints. They help us to keep active throughout the day. Constantly they are under stress. They have to bear the weight of our whole body, so they are most important parts in our body and they may cause injury due to infections and problems in shoe fitting.

With the ends of two leg bones and ankle bone, ankle joints are made. Ligaments would support and stabilize it by connecting the bones and the tendons and muscles help in moving them. The most common problem with ankle is fractures and sprains. Ankle problems are common for sports persons. Ligament injury can lead to sprains and the break in a bone lead to fracture. They may take several months to recover completely.

Depending up on the issues foot surgery involves a variety of surgeries. They include:

1. Bunion: Bunions are mainly genetic diseases often found in women. Symptoms include the non alignment of foot fingers in which big toe is moving towards the second toe. The bump is deposited on the bone which connects the big toe and metatarsal. If the alignment is not painful, it can be maintained with non surgical treatments. The surgery methods include:

2. Osteotomy- In this method, by using surgical cuttings, ligaments of the toe joint is realigned. As a result tight ligaments became loose and loose one became tight.

3. Arthrodesis-If the toe is damaged badly, it is removed by arthodesis surgery.

4. Exostectomy- If the toe bone is enlarged, then joint bump is removed by using this surgery.

5. Hammertoes: A contracted, deformed toe is called as hammertoes. It may occur more locations on a toe.

Toe Shortening, Bone Spurs, Calluses, Neuroma are some more foot diseases.

Tear in ligament needs to undergo the ankle surgery. Two adjacent bones of the ankle joint are joined by ligament to stabilizes the foot. Ligament can become loose by sprains or injury, which may lead to pain. To solve this problem, many surgical treatments are available. In this process, extended ankle ligament is created by using a piece of tendon, which is taken from near the ankle area. The bone distortion is also a reason for regular sprains. In these cases heel bone is surgically removed thus the ankle becomes stable and straight.

1. Ingrown Toenail: when nails grow in to the toe flesh, it is known as ingrown toenail. It could be lead to distortion of finger or some diseases of toe. It may also occur because of wearing tight shoe.

2. Matrixectomy: It is the surgery used to remove ingrown toe nail. Under normal anesthesia, this procedure is carried out.

Conventional treatments for various foot and ankle problems can often result in temporary relief from pain. If the pain continues, surgery is recommended sometimes as a solution to permanently solve the problem. But, foot surgery is not always the most preferred procedure for all the patients. Your orthopedic surgeon can tell you whether you are an appropriate candidate or not.

Foot surgery can help with three major problems, such as foot deformity, pain in the toe joints and metatarsalgia. Toe deformities and toe problems such as hammer toe and claw toe occur when the tendons that move the toes become tight or out of balance. The injured toe rubs the other toe at the inside of the shoe thus leading to pain and pressure.

Rheumatoid arthritis can also damage the toe joints and thus make it to come out of the position. Foot surgery can make the toe straighter and fit the foot more comfortably in a normal shoe. The duration and recovery from the surgery mainly depend on your toe condition. The surgery may include releasing or lengthening the tendons, positioning the joints back into the place, leveling the toe and altering the shape of a bone. The surgeon may fix the toes in place with wires or tiny screws.

Foot surgery may also be done for the following the conditions:

1. Toe deformities
2. Toe shortening
3. Ingrown toenails
4. Bunions
5. Flat foot
6. Joined toes
7. Morton's Neuroma
8. Short toe
9. Lumps, bumps and skin lesions

Surgery is the last option when you want to treat the acute ankle sprain. Patients who experience recurring and persistent ankle sprain can consider ankle surgery. These patients may have torn ligaments that are not properly healed.

Why it is essential to perform the surgery for ankle sprain?

People with chronic and recurring ankle sprain can generally have loose ligaments that require to be tightened. One of the most common surgeries that are generally performed to repair the loose muscles is Brostrom repair. During the surgery, ligaments on the outside area of the ankle are tightened and also the wide tissue around the ligaments called known as the retinaculum is advanced. This surgery can tighten the loose tissues to prevent the ankle becoming again unstable. Ankle instability is can be determined by a through physical examination along with X-ray tests.

During the physical examination the physician stresses the ligaments that were injured in order to find out how tightly they have healed. The physician compares the other ankle with the injured ankle to know the extent of injury.

The X-ray test can be conducted to determine the stability of the ankle. X-ray is taken by putting stress on the ligaments and the doctor will see whether the bones are held together tight enough.

There are several problems that can lead to ankle pain, such as:

1. Nerve damage

2. Injury to the ligament, such as Subtalar ligament injuries and syndesmosis ligament injuries

3. Peroneal tendon dysfunction

4. Incomplete rehabilitation

5. Reflex sympathetic dystrophy

Contact an experienced orthopedic surgeon to know about the ankle condition and surgery.