ANKLE STRAIN |
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General Information
DEFINITION--Strain to any muscles or tendons that surround the ankle. Muscles, tendons and bones comprise units. These units stabilize the ankle and allow its motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Tendons and muscles surrounding the ankle.
Lower-leg bones (tibia and fibula) and foot bones.
Soft tissue surrounding the strained muscle and attached tendon, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS
Pain when moving or stretching the ankle.
Muscle spasm in the calf.
Tenderness to the touch.
Swelling in the ankle.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the ankle is pressed with fingers.
Calcification of the muscle or its tendon (visible with X-ray).
Inflammation of the sheath covering the tendon.
CAUSES
Prolonged overuse of muscle-tendon units in the ankle.
Single violent injury or force applied to the muscle-tendon unit in the ankle.
RISK INCREASES WITH
Sports that require quick starts, such as starting a race.
Contact sports.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous ankle injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape the ankle area before practice or competition.
Wear proper shoes and protective equipment.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Application of tape, splints or walking casts (sometimes).
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the leg, foot and ankle to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic ankle following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
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
Use ice massage 3 or 4 times a day for 15 minutes at a time. 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 softball.
After the first 24 hours, 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.
If a cast was used, wrap the injured ankle with an elasticized bandage between treatments after the cast is removed.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain (rare).
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation (rare).
ACTIVITY
For a moderate or severe strain, walk with crutches for at least 72 hours--longer with a cast or splints. See Appendix 3 (Safe Use of Crutches).
Resume your normal activities gradually.
DIETEat 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.
REHABILITATIONBegin 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 a moderate or severe ankle strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.
The following occurs with a cast or splints:
Pain, numbness or coldness below the injury.
Dusky, blue or gray toenails.
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