Synonyms
supination trauma, pronation trauma, ligament stretching, ligament rupture, ligament lesion, sprain trauma
Definition
Injuries to the upper ankle joint (OSG) often occur during sports activities, but also in everyday life. Most events do not lead to serious structural damage, i.e. an injury with permanent consequences. Nevertheless, a torn ligament can occur, especially in the area of the outer ankle. When the ankle joint is examined by the doctor, it is hardly possible to distinguish them from ligament stretching or partial or complete torn ligaments. The transition is fluid.
Introduction
An ankle joint injury occurs frequently and is usually harmless. In some cases, however, a supposedly harmless ligament stretching can have permanent consequences with pain and restriction of movement of the injured ankle joint. Only very few ankle joint injuries require magnetic resonance imaging (MRI) to determine the extent of the ligament damage.
A magnetic resonance tomography is a magnetic examination – i.e. free of X-rays – that shows layered images of the ankle joint. The treatment concept usually provides for conservative therapy. Even if most ligament injuries heal without consequences, patients still complain of persistent pain and restricted mobility or of a permanent instability of the ankle joint.
In order to avoid such injury consequences, physiotherapeutic treatment is of great importance. One of the most common injury mechanisms in the area of the upper ankle joint is twisting while running or landing after a jump. In most cases, the foot bends over to the outside of the ankle, resulting in a so-called “supination trauma”.
The much rarer bending over to the inside is called “pronation trauma”. This description of the type of injury does not, however, say anything about which structures of the ankle joint were injured. The most common injury is damage to the capsule and ligaments (capsule-ligament apparatus) of the ankle joint.
A thorough examination directly after the injury has occurred often gives first indications of the severity of the injury. However, a final diagnosis is often only possible by using imaging techniques (X-ray, magnetic resonance imaging). As a matter of principle, every twist injury with the development of significant swelling should be X-rayed to exclude a fracture. Depending on the exact mechanism of the accident, the following bone fractures may occur:
- External ankle fracture
- Inner ankle fracture
- Lower leg fracture
- High fibula fracture (Maissoneuve fracture)
- Fracture of the 5th metatarsal
Therapy
The therapy of ligament stretching is often very simple. Here the patient should proceed according to the so-called PECH – scheme: Another possibility of therapy for a ligament extension with severe pain is a drug treatment. For example, pain and swelling reducing gels can be applied to the affected area.
Furthermore, the patient can take painkillers to reduce the pain. However, it is important to mention that painkillers are not an actual therapy for ligament stretching, but can only relieve the associated pain and swelling. Nevertheless, a break during sports and a relief of the affected joint has absolute priority, as this is the best therapy for ligament stretching.
Only by taking a break from sport can the affected ligament regenerate without being pulled again directly when it is strained again. If a torn ligament is not treated with a sufficient break, a torn ligament can occur more quickly when the patient is under renewed strain. Therefore a sports break for a few days is absolutely essential.
If the ligament is severely strained, an orthopaedic surgeon or an accident surgeon can prescribe additional stabilising splints (for example for the knee or ankle joint). These help the patient not to expose the strained ligament to the full body load but distribute the load adequately. This therapy of ligament stretching is mainly used in cases of severe strains or if the patient is very susceptible to a strained ligament.
The splints are usually worn for over a week. – In this case the P stands for a break, which the patient should definitely take. It is important to note that therapy for ligament stretching can only lead to an improvement in symptoms if the patient does not repeatedly overload the ligament (ligamentum).
A break during sports should be observed without fail, and the ligament should be protected as much as possible for the first 2 days. – The E stands for ice, whereby the main purpose here is to cool the torn ligament. If a patient notices that he or she has pulled the ligament, he or she should apply an ice pack to the affected area as soon as possible to relieve swelling and pain.
Cooling is not a real therapy for the stretching of the ligament, but cooling does lead to an alleviation of the symptoms. – The C in the PECH scheme stands for compression. Although it is not always possible to wrap the affected joint with a compression bandage, it is possible, however, the patient should try to relieve the torn ligament by using the compression bandage. – The H indicates that the affected joint is positioned high. A high position is not always possible, especially in the shoulder area, but if the knee or ankle joint is affected, the affected leg should be positioned higher.
