ANKLE DISLOCATION |
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General Information
DEFINITION--An injury to the ankle so that the adjoining bones are displaced and no longer touch each other. Ankle dislocations are almost always associated with sprains (damage to ligaments) and fractures.
BODY PARTS INVOLVED
Bones of the ankle, including the tibia, fibula and talus.
Ligaments that hold the bones of the ankle together.
Soft tissue surrounding the dislocated bones, including nerves, tendons, muscles and blood vessels.
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SIGNS & SYMPTOMS
Excruciating pain at the time of injury.
Loss of ankle function and severe pain when attempting to move the ankle.
Locking of the dislocated bones in the abnormal position or spontaneous reposition, leaving no apparent deformity.
Tenderness over the site of the dislocation, fracture and sprain.
Ankle swelling and bruising.
Numbness or paralysis in the foot from pressure, pinching or cutting of blood vessels or nerves.
CAUSES
Serious injury with stress on the side of the ankle, forcing the ankle through a motion for which it is not designed.
End result of a severe ankle sprain (injury to ligaments, fibers or attachment due to overstress).
Recurrent sprains and strains that leave weakened ligaments.
Powerful muscle contractions.
RISK INCREASES WITH
Running or fast walking, especially on uneven terrain.
Participation in contact sports.
Repeated ankle injury of any sort, especially dislocations or sprains.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT
Protect ankle joints with protective
devices, such as wrapped elastic bandages or
tape wraps.
Develop a high level of lower leg and ankle strength and conditioning.
Warm up adequately before physical activity.
Avoid irregular surfaces for running or track events.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care.
Surgery (sometimes) to insert metal pins or screws to hold broken bits of bone together and to repair ruptured tendons.
Physical therapy after the cast is removed.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas to assess total
injury. Dislocations of the ankle bones are
frequently associated with fractures and
sprains (torn ligaments) of the ankle.
POSSIBLE COMPLICATIONS
Excessive bleeding or postoperative infection.
Prolonged healing time if usual activities are resumed too soon.
Proneness to repeated ankle injury.
Unstable or permanently arthritic ankle joint, if many repeat injuries occur.
PROBABLE OUTCOME
A dislocated ankle with a fracture-sprain requires an average of 18 to 20 weeks to heal completely. Surgical pins or screws are usually removed in 8 to 12 weeks. If this is a first-time injury, proper care, surgery and sufficient healing time before resuming activity should prevent permanent disability.
If non-surgical treatment is chosen, healing time with total lack of weight-bearing may require 12 months.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
The doctor will reduce (realign) the dislocated bones with surgery or, if possible, without. The setting lines up the dislocated bones as close to their normal position as possible. Manipulation should be done as soon as possible after injury. Six or more hours after the dislocation, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
Following surgery, the physician may apply a stirrup boot splint from below the knee to the toes. Stirrup boots are less likely to cause problems with swelling at this time than a cast may cause. This will support the ankle enough to allow you to walk with crutches, but you should not put weight on the injured ankle.
When the swelling subsides several days later, sutures may be removed and the splint replaced by a walking-boot cast. This cast may need to stay in place for 10 to 21 days. Start walking on the walking cast immediately.
After the cast has been removed, strapping will be necessary for a minimum of 6 weeks.
Bathe and shower as usual after the cast is removed, even if sutures are still in place.
Use ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Gentle massage will frequently provide
comfort and decrease swelling.
MEDICATIONS
For minor discomfort, you may use:
Non-prescription medicines such as aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain, if needed.
ACTIVITY
Walk with crutches until your doctor applies the walking cast. See Appendix 3 (Safe Use of Crutches).
Resume your normal activities gradually.
Don't drive until healing is complete. Use a vehicle with an automatic transmission, if possible.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity. Your doctor may suggest vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of any severe ankle injury.
Pain, swelling or bruising increases despite treatment.
You notice numbness or discoloration of the toes when the walking cast is in place.
Signs of postoperative infection occur, such as fever, drainage from the surgical wound or increasing pain at the operative site.
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