ANKLE SPRAIN, GRADE 1 (Mild or 1st Degree Ankle Sprain) |
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General Information
DEFINITION--Stretching and slight or partial tearing of one or more ligaments in the ankle. A two-ligament sprain causes more disability than a single-ligament sprain.
BODY PARTS INVOLVED
Ligaments that support the ankle joint.
Three main bones of the ankle joint--the talus (heel bone), and the tibia and fibula (lower leg bones).
Blood vessels, nerves, periosteum (covering of bone), and other soft tissue close to the injury.
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SIGNS & SYMPTOMS
Ankle pain at the time of injury.
A feeling of popping or tearing in the outer part of the ankle.
Mild tenderness at the injury site.
Little loss of function. The injured person can bear weight and walk without help for 30 minutes or so following injury. Then, depending on the extent of injury, the joint may seem to lose some of its stability.
Swelling in the ankle.
Little or no visible bruising for several hours after injury. Then some bruising may appear.
CAUSESStress imposed from either side of the ankle joint, temporarily forcing or prying the ankle or heel bone out of its normal socket. The ligaments that normally hold the joint in place are stretched and sometimes torn.
RISK INCREASES WITH
Previous ankle injury.
Any sport in which sideways displacement of the ankle is likely. Runners, walkers, and participants in such sports as basketball, soccer, volleyball, skiing, distance jumping and high jumping are prone to ankle sprains. When jumping, they often accidentally land on the side of the foot.
Use of shoes with insufficient support to prevent sideways displacement when stress occurs.
Poor muscle strength or conditioning.
Inadequate strapping prior to participation in contact sports.
Walking or running on rough surfaces, such as roads with potholes.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape the ankle from midfoot to midcalf before practice or competition. If you cannot use tape, wrap the ankle with elastic bandages or use an elastic brace.
Wear proper protective shoes.
Provide the ankle with substantial support during sports activities for 12 months following any significant ankle injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care only if discomfort is great or doesn't improve in 24 hours.
Self-care after diagnosis.
Whirlpool, ultrasound or massage (to displace fluid from the injured joint space).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the ankle, foot and knee to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic ankle joint following repeated injury.
PROBABLE OUTCOMEThe full extent of the injury cannot be determined for 12 to 24 hours. A first-degree ankle sprain usually heals enough in 5 to 7 days to allow modified activity. Complete healing requires an average of 6 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDThe goal is to prevent further injury to the torn ligaments. Follow instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Continue using an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
After 72 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.
Keep the foot elevated whenever possible to decrease swelling.
Massage the ankle gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Non-prescription medicines such as aspirin, acetaminophen or ibuprofen.
Topical liniments or ointments.
Your doctor may prescribe:
Injection of procaine and hyaluronidase to decrease pain soon after injury.
Stronger medicine for pain, if needed.
ACTIVITYExcept for very minor injuries, walk with crutches for about 72 hours. See Appendix 3 (Safe Use of Crutches). Resume your normal activities gradually.
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 before and 10 minutes after exercise. 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.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of an ankle sprain that does not improve within 1 week.
Ankle pain, swelling or bruising increase despite treatment.
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