Introduction
Especially people who are active in sports and wear high heels run the risk of injuring their ankle joint. It can happen very quickly – a bump on the soccer pitch or the running track, overlooking a kerb, and then you twist your foot. Due to the anatomy of the musculoskeletal system, in the majority of cases this is a so-called supination trauma.
This means that the foot bends over the outside. Pain, swelling and even the blue coloration of the foot can be the result. Often the affected extremity is not able to bear weight for a long time or only under pain. In order not to prolong the duration of the movement restrictions, adequate treatment should be sought. In the event of severe pain, malpositioning, severe swelling and if the symptoms persist, a physician should be consulted to rule out the consequences of injury requiring treatment.
Symptoms
Supination trauma, i.e. bending the foot outwards, can lead to injuries to the ligamentous apparatus and the bones. Although most incidents remain without consequences, albeit painful, damage should be detected and treated early on. Immediately after the injury, the pain that occurs primarily during movement or under stress dominates.
If deformities or instability are already apparent at this time, a doctor should be consulted immediately or the emergency services alerted to ensure gentle transport to the nearest hospital. Minutes to hours after bending over, the foot can become swollen, which is usually very worrying for those affected. Just like the blue coloration of the foot as a result of bleeding into surrounding tissue, this does not necessarily indicate serious consequences of injury, but should be clarified by a physician in case of severe symptoms.
Swelling, which is the result of an influx of fluid into the tissue, can in principle assume a large extent, so that in some cases it is no longer possible for the injured person to wear his usual shoes. The severity of the injury can be divided into three degrees, the first of which is characterized by slight swelling and slight pain or by minor restrictions of movement. The second degree is characterized by significant pain and slight instability, whereas the third degree is characterized by severe pain, severe movement restrictions and great instability.
In grade one, self-treatment can be attempted, in grades two and three, medical advice should be sought. If the foot is bent outwards, one or all of the three outer ligaments may tear. In addition to the ligamentous apparatus, the surrounding tissue and blood vessels are also stretched.
The injured foot may swell due to fluid inflow into the tissue and bleeding. An injury to the lower leg with subsidence of the bruise in the direction of the foot can simulate an ankle joint involvement. If a doctor is consulted, he or she will test the integrity of the ligamentous apparatus by means of so-called stress tests.
In doing so, he moves the injured joint in certain degrees of freedom and pays attention to the pain information given by his patient. In addition, pressure pain over certain points can provide information about the nature of the injury. In order to diagnose a torn external ligament, the doctor will also check talus tilt and talus advance.
In the case of talus tilt, the foot is tilted laterally inwards in the ankle fork, while in the case of talus advancement the ankle joint is moved forward in a right-angled position. A talus tilt of more than eight degrees and a talus advance of more than eight millimeters indicate a torn outer ligament. Imaging techniques are used to confirm the previously made suspected diagnosis.
As a rule, conventional x-rays are sufficient for this. The respective injury can be made more clearly visible in so-called held images. For this purpose, the affected limb is clamped in an apparatus that fixes the joint in a certain position with a previously defined application of force. If the ligament structures are injured, gaps between bony structures can be unnaturally widened, which would be prevented by intact ligaments. In exceptional cases, CT or MRT images of the foot are taken to confirm the diagnosis.Because of the higher radiation exposure in computed tomography and the high costs involved in MRI examinations, conventional X-rays are still the method of choice.
