Ankle Sprains, Strains & Fractures

Common causes of ankle strains, sprains and fractures involve sports, biomechanical instability, trauma or footwear. Here are some points to help you distinguish whether you have a strain, sprain or fracture, however it is best to seek medical advice if your pain is more than minor.

STRAINS are an injury to the muscle or tendon and are usually attributable to overuse and repetitive damage over time. They are common in athletes who undergo long training sessions without adequate breaks to allow muscles and tendons enough time to rest. They also occur in the elderly people, particularly if they have chronic health issues. A mild strain will leave the ankle feeling sore and weak and the joint may be swollen. Severe strains can result in a partial or full tear of the muscle or tendon which has slowly developed over a period of time rather than a sudden injury. The patient is often unaware of what they had done to injure the ankle and it can be very painful requiring a long recovery. If pain has been creeping up on you for a while then the problem is likely to be a strain or stress fracture. 

SPRAINS occur when ligaments are suddenly stretched or torn by awkwardly twisting the ankle during sport or by simply stepping off kerb, walking on uneven surfaces or missing your footing. The pain is immediate. They usually affect the outside of the ankle and tend to be caused by a sudden movement that causes the ankle to roll outwards while the foot rolls inwards. Sprains can also occur in the opposite direction by a sudden eversion force causing the ankle to roll in whilst the foot rolls out thereby damaging the ligament on the inside of the ankle. These are less common and are usually minor. Severity of the injury is graded based on the degree of damage. 

Grade 1 sprains – the patient is still able to walk with minor discomfort and there will be no tearing of ligaments, but there may be some swelling.

Grad 2 sprains – there will be partial tearing of the ligaments and the patient finds it difficult to weight bear on the affected foot. The ankle will be inflamed and bruised.

Grade 3 sprains – the patient may have heard an audible pop at the time of injury, indicating that the ligaments will be completely torn. Severe sprains will present with extensive bruising and inflammation. Complete tears can be less painful than partial tears, meaning that patients may delay seeking treatment

Most sprains will bet better within a few days by using simple remedies like rest, compression and elevation. You can usually walk, although it may be with a limp.  If there is significant deformity or swelling and you are unable to put weight on the affected foot, it is best to seek medical advice as an x-ray may be required. Healing time for a sprain can take from a few weeks for a minor sprain to several months for a major injury and they may require periods of immobilisation in a Moon Boot.  With severe sprains a good rehabilitation program is essential for optimal outcomes, reduced risk of re-occurance and reduced incidence of ankle arthritis in later years.

FRACTURES affect the bone and can result from either trauma such as an awkward fall or by landing with a lot of force. They can also be due to overuse in the form of a stress fracture and may be accompanied by strains or sprains.  Symptoms include pain at the site of injury, inflammation of the joint, bruising, blisters and sometimes inability to walk. Often patients with a fracture present with symptoms consistent of a sprain and it is difficult to know if you have a fracture without an x-ray. Minor fractures involve small fragments of bone that have come loose and these will usually heal well. A severe fracture involves the shattering of bone and may require surgery to realign the bone for it to heal properly.

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