.png)
What is a sprain?
A traumatic distortion of a joint (without any lasting displacement of the joint surfaces) and which is accompanied by a stretching or tearing of the ligament.
External sprain of the lateral collateral ligaments (especially the anterior talofibular ligament) of the ankle without fracture represents 90% of ankle sprains.
In some cases, especially when the rotational forces are very strong, the trauma results in a fracture. Damage to the cartilage of the ankle joint can also occur. Tendons can also be affected (tendonitis or rupture).
Grades of sprain
Grade 1: This is a minimal elongation or tear of the affected ligament with low ligament laxity. No instability is noted. This is the most frequent and least serious type of sprain. Healing occurs in a few hours or days.
Grade 2: This is a partial tear of the affected ligament with the presence of ligament laxity. A hematoma appears at this stage. Healing takes a few days to a few weeks.
Grade 3: This is a complete tear of the affected ligament, with significant residual ligament laxity. Healing takes 6 to 8 weeks.
Causes
Intrinsic factors
Weak ligament tone, muscle weakness (fibular atrophy), a history of repeated sprains, abnormal foot biomechanics, a hollow foot, physical deconditioning and excess weight.
Extrinsic factors
The use of worn or inadequate footwear for the activity performed, impact, an irregular training surface or high training intensity.
Diagnosis
The diagnosis is mainly made following a clinical examination. Various medical imaging techniques will allow to verify the level of damage of the injured structures.
Ultrasound of the foot and ankle will allow for a quick assessment of the extent of the damage without radiation. If there is any doubt about bone damage, an X-ray will be ordered to rule out the presence of a fracture.
Finally, in certain more complex cases, a magnetic resonance imaging (MRI) scan may be of interest in order to better visualize all the potentially injured structures.
Traitment
Initial management is done with ice, rest, elevation and compression.
Simple strain: following these basic guidelines for a few days may be sufficient. When the injury is more severe, the use of crutches is sometimes necessary.
Absence of a tear or fracture, ground support should be started when the reduction of swelling and pain is sufficient in order to promote optimal rehabilitation and avoid asignificant loss of mobility.
Presence of a significant ligament tear, more complete immobilization with a cast, in addition to surgical management, may be required.
Prompt rehabilitation with osteopathy and physiotherapy will help ensure better healing. Therapeutic taping may be recommended as well as the prescription of an orthopedic splint, in order to provide additional support when resuming walking or physical activity.
Chronic ankle instability is frequently found following a severe sprain that is not adequately managed. Proprioception exercises are essential and should be performed as early as possible.