Ankle joint distortion

Ankle joint distortion: what’s that?

In the jargon, this is the description of an injury to the ligaments and/or the ankle joint articular capsule, also referred to in the vernacular as a “sprain”. Pain in the ankle joint region after vigorous twisting, for example during sports or in everyday situations, is typical. Frequently, the twisting takes place via the outer edge of the foot, accompanied by overstretching of the capsular and ligamentous apparatus. It may also result in a partial tear or a full tear (rupture) of the inner and outer collateral ligaments. Such injuries are often incurred in connection with sports types such as squash, tennis and further ball sports.

Symptoms of ankle joint distortion

Typical ankle joint distortion symptoms include severe pain, fast emerging swelling and restricted movement, bruising (haematoma) in case of torn blood vessels and further tissue injuries as well as pressure pain in the region of the injury.

Classification of ankle joint distortion

Grade 1: The ligaments are over-extended but not torn. The ankle joint is stable, whereby the ankle is painful and swollen (pulled ligament).

Grade 2: The ligaments are massively over-extended or one or several ligaments are partially torn but not fully severed. The joint shows low instability, whereby pain and swelling hamper walking. A haematoma can also exist (partial tear of the ligaments).

Grade 3: One or several ligaments are fully severed. The joint shows severe instability and the ankle is extremely swollen, mostly accompanied by an extensive haematoma (full tear of the ligaments).

Without adequate therapy, distortion can result in complications and long-term effects such as long-term instability of the joint, malposition and osteoarthritis (arthrosis).

Diagnosis of ankle joint distortion

Tentative diagnosis is made based on case history, i.e. description of the course of the accident as well as clinical examination by an orthopaedic specialist or a casualty surgeon. Various tests are available for this, based upon which the extent of the injury can be assessed. For more precise diagnosis, imaging procedures such as an X-ray in two planes or magnetic resonance imaging (MRI) can be applied.

How can ankle joint distortion be prevented?

As several stumbling blocks or opportunities exist to distort the ankle joint, the best means of avoidance is to train the joints. Thus, for example, coordination exercises can improve kinaesthesia (the sensation of movement) as they enable the body to recognise external stimuli and react accordingly fast. A sufficient warm-up phase for sports and appropriate footwear can also contribute to the avoidance of injuries.

What therapy options are available for ankle joint distortion?

Normally therapy is conservative, i.e. without surgery – possibly with stabilising bandages (“supports”) or braces.
As an immediate measure, the “RICE rule” should be applied (Rest, Ice, Compression and Elevation):
Rest: The person concerned should take an immediate rest.
Ice: Cooling can reduce haematoma and swelling. However, ice should not come into direct contact with the skin as the risk of frostbite exists.
Compression: The use of a compression bandage can also avoid massive swelling. In case of severe pain, a pain gel can be applied and, as organic alternatives, arnica or comfrey come into question.
Elevation: Elevation of the foot helps to decrease the blood supply in the affected region, thus reducing the swelling.
During the first days after an injury to the ankle joint, the use of crutches may make sense. After abatement of the acute phase, an ankle brace is often prescribed for 4 to 6 weeks. Moreover, strengthening and coordination exercises and sensomotoric training can ensure an ideal course of healing.

If several ligaments are injured or even torn off the bone, an operation may make sense, above-all if in addition to the lateral collateral ligament also the medial collateral ligament or the connecting ligament between the tibia and fibula is injured (syndesmosis).