Diagnosis

In most cases, the doctor can determine whether the twisting of the foot has led to a ligament injury by talking to the patient and physically examining the ankle joint. Supination trauma is characterized by swelling and painful pressure on the joint. In addition, as already mentioned, a hematoma on the outside of the ankle joint can be seen.

If the outer ligaments have been injured in the sense of a torn ligament, a so-called “lateral opening” in the joint is evident. This means that the ankle joint can be moved outwards in comparison to the lower leg. However, this examination may also be impossible due to pain.If the anterior portion of the outer ligament (ligamentum talofibulare anterius) is torn, the ankle joint can be advanced significantly forward (talus advancement).

This is not the case with a pulled or overstretched ligament. The examinations are always performed in a side comparison. This is important, because the ankle joints have different mobility in each person and thus anomalies can only be reliably determined by comparing the sides.

Imaging techniques are also used in the diagnosis. X-rays in two planes are taken as standard to rule out injuries to the bony structures. Weber fractures are among these concomitant injuries.

Retained radiographs are used when there is uncertainty about the stability of the ankle joint. The MRI is usually only used if further injuries need to be diagnosed more precisely. However, this is usually not the case if the foot is simply bent over.

Therapy

There are some measures you can take immediately after bending the foot yourself before consulting a doctor. You follow the so-called PECH rules:

P: The joint should be spared immediately after the event, i.e. a break should be inserted (P).
E: Afterwards the ankle joint should be cooled (E=ice). This relieves both the swelling and the pain.
However, the cold pack should not be placed directly on the affected ankle joint, as this can lead to cold damage.
C: To reduce the swelling even more effectively, it is recommended to apply a compression bandage (C=Compression).
H: The last thing to do is to elevate the affected foot (H). This reduces the static blood pressure at the injured ankle and relieves the pain and swelling.

For simple strains and distortions, these decongestant measures are usually sufficient. Ligament ruptures are usually also treated conservatively with the above mentioned measures.

In addition, the joint is supported with special splints or bandages (orthoses) so that the ligaments can grow together again under less stress. The joint is thus not completely immobilized, but still has room to move. Simple movement exercises and physiotherapy are also recommended to promote the mobility of the joint.

These orthoses are worn for about 6 weeks. Painkillers and anti-inflammatory drugs can also be taken. This depends on the intensity of the pain.

In order to remove bruising more quickly, ointments with low-molecular heparin are also used. This also serves as thrombosis prophylaxis. For more serious injuries, e.g. complicated capsule and ligament ruptures, bony fractures, surgical interventions may also be necessary.

These are performed in different ways depending on the structure affected. Among other things, plastic reconstructions of the ligamentous apparatus, ligament sutures, but also other procedures are used to restore the bony structures. The duration of treatment can vary from a few weeks to months.

Surgical measures are usually only considered in cases of severe injuries or existing joint instability despite long conservative therapy. If the affected person still bends over after 6 weeks of physiotherapy and splinting of the joint, surgery may be necessary. In the case of professional and competitive athletes, surgery may sometimes become necessary earlier in order to restore full performance.

However, these are individual decisions. Serious injuries cannot be ruled out if the foot is twisted. In case of pain and swelling, a doctor should be consulted.

We strongly advise against primary homeopathic treatment. However, those who wish to do without pain medication can treat the symptoms with the measures explained above, such as immobilization, cooling, compression and elevation. Homeopathy also offers numerous preparations that are used to treat pain. These include chamomile, buttercup and arnica.