ANKLE SPRAIN, GRADE 2 (Moderate or 2nd Degree Ankle Sprain) |
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General Information
DEFINITION--Stretching and partial tearing of one or more ligaments of the ankle, resulting in weakening and some loss of ankle function. 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
Severe ankle pain at the time of injury.
A feeling of popping or tearing in the outer part of the ankle.
Extreme tenderness at the injury site.
Loss of function. The injured person usually falls, but can walk a little since direct weight-bearing does not place stress on the injured ankle. Then, depending on the extent of injury, the joint may seem to lose some stability.
Looseness in the joint if the foot is forced in the direction of pain.
Generalized swelling immediately throughout the ankle and foot.
Bruising that appears soon after injury.
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 torn.
RISK INCREASES WITH
Previous ankle injury.
Any sport in which sideways displacement of the ankle is likely. Runners, walkers, and participants in sports such as basketball, soccer, volleyball, skiing, distance jumping and high jumping are prone to ankle sprains. They often accidentally land on the side of the foot.
Use of shoes with inadequate 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 to apply a walking cast, and to apply tape after cast removal.
Whirlpool, ultrasound and massage (to displace accumulated fluid in injured joint spaces).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the injured areas 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 injury cannot be determined for 12 to 24 hours. A second-degree ankle sprain requires an average of 6 to 10 weeks to heal completely. If this is a first-time injury, proper treatment and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures.
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
Keep ice packs on the injured area almost continuously for 24 hours.
Wrap an elastic bandage over a sponge-rubber donut over the sprained area to compress the area for about 72 hours.
After the first 24 hours, your doctor may apply a stirrup boot splint from below the knee to the toes. This will support the ankle enough to walk on crutches, but you should not bear weight on the injured ankle yet.
When the swelling subsides in several days, the splint is replaced by a walking-boot cast for 10 to 21 days. You may walk on the walking cast immediately.
After the cast has been removed, strapping will be necessary for a minimum of 6 weeks.
After cast removal (or if a cast was not used), 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.
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.
Gentle massage will frequently provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Non-prescription medicines such as aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Injection of procaine and hyaluronidase to decrease pain soon after injury.
Stronger medicine for pain, if needed.
ACTIVITYUse a splint and crutches or a walking-boot cast as prescribed by your doctor. After the cast is removed, resume your normal activities gradually. Don't drive until the ankle is completely healed.
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.
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 in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a second-degree ankle sprain.
Ankle pain, swelling or bruising increases despite treatment.
You experience numbness or discoloration of toes when the walking cast is in place.
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