By Misael Jonathan A. Ticman, MD, FPOA
First things first: “Sprain” is different from “strain” in that the former involves injury to the ligaments and the latter to muscles. Ankle sprain involving the lateral ligaments is the most common musculoskeletal injury in sports. The anatomy and biomechanics of the foot and ankle are so complicated that from time to time we, orthopaedic surgeons, need to read on these topics.
According to some studies, sometimes ankle pain may be present in almost half of patients more than one year after sustaining the injury. It is for this reason that early diagnosis and usually non-surgical treatment for most acute ankle sprains are necessary. Long standing and recurrent ankle instability are the conditions that would require surgical treatment.
In orthopaedics, classification systems for specific injuries are developed as guides for the prognostication and treatment of a particular injury or problem. A simple system, based on clinical evaluation, helps the clinician in the initial treatment (Jackson, et al.). In this system, ankle sprain is classified as mild, moderate or severe depending on the presentation of the signs and symptoms.
The usual cause of these afflictions is by a twisting occurrence to the ankle joint. The point or site of the pain can help in determining the possible ligaments involved. Diagnosis of such injuries can usually be made by getting a good history and making a thorough physical examination. Oftentimes, patients seek medical attention several hours after the acute ankle sprain and by this time swelling and ecchymosis (the escape of blood into the tissues) have set in making the physical examination more difficult.
The purpose of X-rays in the evaluation of acute ankle injury depends on the presentation of the patient. In spite of the fact that a certain group of patients do not initially need radiographic studies, all other patients probably should have a simple X-ray examination to rule out concealed foot and ankle injuries (Rockwood). Because Magnetic Resonance Imaging (MRI) is expensive and has not been shown to affect the management of these injuries, it is not routinely requested or done.
Nonsurgical or conservative management is the recommended approach in the initial treatment of acute ankle sprains. The mnemonics R-I-C-E is important in the first management of ankle injuries. This stands for Rest, Ice packs, Compression (elastic wraps), and Elevation. In addition to this, protected weight bearing is also encouraged. For mild sprains, exercises, early range of motion and mobilization are initiated. For moderate to severe sprains, the ankle is immobilized for two weeks and then physical therapy and exercises is started. Preventive techniques taught in the physical therapy and rehabilitation is necessary to avoid repeat ankle sprains (Baumhauer et al.). And of course, the role of analgesics (pain medicines) is indisputable.