Ankle sprain is the most common joint injury. “Pain and swelling are just the tip of the iceberg,” warns Brice Picot, sports physiotherapist.
Ankle sprain is the most common joint trauma : nearly 6,500 people visit the emergency room every day for this reason. “The pain and swelling are just the tip of the iceberg” warns Brice Picot, sports physiotherapist.
What is an ankle sprain?
The sprain mainly concerns the lateral (or external) compartment of the ankle with more than 80% of damage to the anterior talofibular ligament. She is most often the consequence of a forced inversion movement under load, for example following a misstep (on the stairs, hollow ground, with heels that are too high, etc.). “The latest works highlighting above all the adduction and supination components of the foot” says Brice Picot. The patient thus describes a mechanism of torsion of the ankle inside. This is called an external ankle sprain.
What are the symptoms of a sprained ankle?
The most common symptoms are:
- the pain under the malleolus,
- the appearance of a edema (i.e. swelling) or even a hematoma in the following hours,
- the cracking sensation at ankle level.
It is generally difficult to continue the activity in progress (for example, running) sometimes even to put the foot on the ground, we then speak of functional impotence.
How long does an ankle sprain last?
The Sprain symptoms usually disappear within ten days. However,”the pain and swelling are just the tip of the iceberg” warns the physiotherapist. Indeed, the risk factors for recurrences are more difficult for the patient to assess and it is therefore necessary to properly manage them to avoid recurrence. On average, it takes 4-6 weeks to fully recover of a sprained ankle. The feeling of stability perceived by the patient at the level of his ankle during activity such as running is a good indicator of the progress of rehabilitation.
What to do in case of a sprained ankle?
“Ankle protection is the priority”
“In the case of a sprained ankle and in the absence of a doctorankle protection is the priority” explains Brice Picot. L’use of a splint for example avoids a new twisting mechanism of the ankle. In addition, the use of crutches prevents the placing of the foot on the ground if this is painful. “The elevation of the foot associated with the application of ice and compression of the joint reduces pain and D’avoid the appearance of edema who will be deleterious for rehabilitation. However, it is recommended to do not take anti-inflammatories so as not to slow down the healing process” he advises.. Regarding theapplication of ice, its use is debated at present. It is a benefit/risk balance. “To date, the antalgic capabilities of ice (i.e. its ability to relieve pain) outweigh their possible detrimental effect on ligament healing. It is therefore recommended to put ice if it decreases the pain in the patient in the first days following the sprain” believes Brice Picot. A new acronym has recently appeared in the literature: PEACE and LOVE for trauma care
- Pprotection
- Eelevation
- HASinflammatory drugs to avoid
- VScompression
- Eelevation
- And
- Load (weight-bearing in the absence of pain)
- Ooptimism
- Vascularization
- Eexercise (start rehabilitation as soon as possible)
What are the treatments for average sprains?
“Regardless of the severity of the injury, rehabilitation is needed to reduce the risk of recurrence and chronic ankle instability” warns Brice Picot. The initial treatment by immobilization (splint) lasts approximately 10 days. Rehabilitation begins as soon as possible in order to combat pain and the appearance of edema. Similarly, the onset of proprioceptive work and muscular awakening are considered according to the pain. In the case of a loss of amplitude, early work is recommended by controlling risky movements and gradually returning to normal use of the ankle.
What are the treatments for severe sprains?
The principle of rehabilitation is the same, however the treatment times are longer. Lcomplete immobilization lasts 4 to 6 weeks with a reloading at 2 weeks depending on the pain. Here again, rehabilitation must be started as soon as possible in order to combat the deficits linked to immobilization.
When walking is impossible, it is necessary to consult urgently.
What to do in the event of a repeated sprain?
The chronicity of ankle sprains is their most common complication. This is why it is important to take care of them correctly.. “The role of the physiotherapist is to establish a complete and precise assessment of the deficits linked to this chronic instability. Rehabilitation can then be carried out on a case-by-case basis with proprioception exercises, of muscular reinforcement adapted to each patient” explains Brice Picot.
When to consult urgently?
When more serious injuries such as a fracture are suspected (walking is impossible and the pressure on certain bone areas is very painful), it is necessary to consult quickly. However, in the current context of overcrowding in emergency departments, it appears necessary to reduce consultations in emergency departments for this type of trauma. Thereby, the current policy seeks to refer patients to other health professionals such as physiotherapists in the case of an ankle sprain. In all cases, whatever the supposed seriousness of the sprain, it will be advisable to consult in order to be able to follow an optimal care.
Can you ride a bike with a sprained ankle?
“As soon as the pain in the support is gone, it is quite possible to ride a bike”, reassures the physiotherapist. And to continue: “Cycling is even a regularly used rehabilitation exercise.” Moreover, the V of PEACE and LOVE refers to cardiovascular activities such as cycling, rowing…
Complications: beware of the fracture!
“The first complication in the event of an ankle trauma is the fracture of the bones of the foot or ankle” explains Brice Picot. “Exceptionally, nerve or vascular damage may occur,” he adds. In the case of a sprain without associated lesions, the main complication is recurrence which can lead in the long term to chronic ankle instability or even ankle osteoarthritis.
What are the risk factors for ankle sprain?
The sprain is usually accidental but predisposing factors may exist. “The first risk factor for ankle sprain is the fact of have ever sprained an ankle” notify the physiotherapist. Indeed, poor or even absence of care leads in 50% of cases with recurrences or even the development of chronic ankle instability. Other risk factors appear to be emerging, including a ankle dorsiflexion amplitude deficit, weakness of ankle and hip muscles, decreased proprioception (which is an important component of balance).
Thanks to Brice Picot, sports physiotherapist, for his details. Comments collected in 2019.