A sprained ankle is usually said to occur when the foot or ankle joint bends over. Small tissue fibres tear due to the sudden overstretching, joint-supporting ligaments are affected and the classic signs of inflammation appear: redness, swelling, overheating, pain and functional impairment. Especially the appearance becomes a torture, the affected person takes a relieving posture, the gait pattern changes and the affected area becomes painful to touch. In most cases, the foot bends outwards, where it has greater freedom of movement and is therefore more unstable. Depending on the severity of the injury, in addition to small traumas in the tissue, the stabilizing ligaments may be overstretched or torn, and in severe cases the bone may even break.
How long is the healing phase?
The time it takes to heal a sprained ankle varies greatly depending on the severity of the injury. Each injury heals according to the same wound healing pattern, but the duration of each phase varies depending on the structure affected. If only connective tissue fibers are torn and responsible for the swelling, it takes a few days for the inflammation to subside and new fibers to form, which eventually heal within a few weeks.
The healing of torn ligaments takes much longer, since tendon tissue has a very poor blood supply and therefore heals only slowly. In addition, a torn ligament means a considerable restriction of stability in the joint and therefore requires longer reconstruction training even after healing. Finally, a broken bone takes about six weeks to grow together and a few more months until it is stable and fully loadable again.
Frequent concomitant injuries
Extreme bending of the foot, with possible external force, can lead to ankle fracture (fracture of the bones that form the ankle joint). Depending on the direction in which the ankle is bent, the narrower calf bone on the outside or the tibia on the inside is affected. In extreme cases, both bones are affected.
If the fractured bone ends are not too far from their natural location or are twisted, a fracture can heal in a plaster cast while immobilised. It becomes problematic if the joint itself is also affected by the fracture. Even after the fracture has healed, there is still a risk that arthrosis (premature cartilage wear) will develop, which is very painful and once it has occurred, it is irreversible.
For this reason, fractures with joint involvement are usually treated surgically to restore optimal joint function and avoid consequences. Bones grow together within about six weeks, are stable and resilient again after about three months and heal completely after up to a year. Not only ligaments but also the tendons of muscles, which enable movement, pass through joints.
On the outer side of the lower leg are the muscles peronei, from where the tendons of the peronei pull under the foot behind the outer ankle. If the foot now bends outwards, these tendons are suddenly overstretched. Small injuries to the tendon tissue can lead to peroneal tendon inflammation, especially if the regeneration period is disregarded.
It is important to relieve and cool the foot to prevent the development of chronic inflammation. A chronic tendon inflammation has consequences on the elasticity and thus on the mobility of the joint, the muscle and continuously the entire muscle chain. In physiotherapy, the peroneal muscles are massaged out and, once the inflammatory phase has subsided, gently stretched to relieve the tension from the tendon.
A rupture of the outer ligament (tear) is the most common concomitant injury of a sprained ankle. In most cases of ruptured ligaments in the foot, the ligamentum talofibulare anterius is affected, which connects the talus (heel bone) of the foot with the fibula of the lower leg. It is a relatively narrow ligament, which is easy to feel due to its superficial course.
After a rupture, the severing of the ligament is palpable with the fingers. Symptomatic symptoms are swelling, possibly with bleeding and hematoma formation, as well as pain under pressure and strain. Surgery is usually not necessary, but in the course of healing and therapy, active work must be done to restore stability to the ankle joint. In the acute phase and also later when returning to sports, in case of a still existing feeling of instability, an adapted bandage or splint can be worn. Surgery is only performed if the entire external ligament apparatus is torn – which occurs relatively rarely and only with additional external force.The healing of the ligament usually takes from a few weeks to three months.
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