Today at FisioPoint we will address ankle sprains in inversion, a common injury that, apart from being painful, can affect mobility and disability.
Causes of ankle sprain:
Ankle sprains can occur when the foot turns inward, causing excessive stress on the ligaments surrounding the joint. These ligaments includeAnterior Talar Fibular Ligament (LPAA) Fibular Calcaneal Ligament (LPC) Posterior Talar Fibular Ligament (LPAP)and the syndesmal or deltoid ligament. Each of these plays an important role in ankle stability and can be affected during a sprain.
In some cases of ankle sprains, especially the most severe ones, the peroneal muscle and the fifth metatarsal head may also be affected. The peroneus muscle is located on the outside of the leg and is responsible for stabilizing the ankle when the foot rolls in (inversion). When the stress of the weight of the fall exceeds the contractile or response force of this muscle, it can become so stretched that it can avulse the 5th metatarsal head. Likewise, in the most severe sprains, the malleolus of the fibula may be involved and it may break.
Ankle sprains are classified into three grades based on the severity of the injury:
1. Grade I Sprain: At this grade, the ligaments can be slightly stretched without significant tearing.
2. Grade II sprain: At this stage, the ligaments are partially torn. This is where the peroneus brevis muscle and fifth metatarsal head can be further injured, such as a strain or even a tear.
3. Grade III sprain: This grade is the most severe, with a complete tear of the ligaments. In addition to the ligaments, both the peroneus brevis muscle and the fifth metatarsal head may be affected. In more severe cases, the malleolus of the tibia and fibula can crack. It is in grade III where surgery is usually chosen since the ligaments need to be reinserted in bone-ligament-bone.
Sprain Phases:
- Stage 1: Acute phase (0-72 hours after injury):
During this initial stage, the main goal is to reduce inflammation, relieve pain, and promote early healing. Common treatments include:
1. Rest, Ice, Compression, and Elevation (RICE): Rest the affected joint, apply ice wrapped in a towel for 15-20 minutes every 2-3 hours, wear a compression bandage, and elevate the foot above the level of the heart to reduce swelling.
2. INDIBA: To reduce pain and inflammation.
3. Gentle mobilizations and movement exercises (ROM): To maintain mobility and prevent stiffness.
- Stage 2: Subacute phase (3 days to 3-4 weeks):
Once the initial swelling has subsided, he focuses on restoring ankle strength, stability, and functionality.
1. Strengthening exercises: Specific exercises to strengthen the muscles around the ankle, including the peroneus brevis and tibialis anterior muscles.
2. Proprioceptive training: Proprioception is the body's ability to perceive its position and movement in space. Balance and stability exercises can be performed on unstable surfaces.
3. Relaxing massage and drainage: The physiotherapist can perform gentle massages and release techniques to relieve muscle tension and improve circulation in the affected area. Thus also draining the edema created by the injury.
- Stage 3: Rehabilitation phase (3-4 weeks onwards):
At this stage, the goal is to regain full ankle strength, stability, and functionality.
1. Advanced Strengthening Exercises: Strengthening exercises will be progressed, adding additional resistance and functional challenges to simulate daily activities and sports.
2. Manual therapy and joint manipulations: To improve mobility and proper alignment of the ankle.
Conclusion:
Physiotherapy plays an essential role in the treatment of these injuries, and techniques such as Indiba therapy and specific exercises can be beneficial in speeding recovery and relieving symptoms.
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