Sprains and ligament injuries of the ankle joint are among the most common injuries of all. Studies show that early functional treatment with orthoses is superior to longer-term immobilisation.
Causes, symptoms and treatment
Sprains and ligament injuries of the ankle joint are among the most common injuries of all. Based on data from comparable countries, more than one million people are estimated to experience an ankle joint injury every year in Germany alone. The lateral ligament complex of the ankle joint is affected in 85 per cent of these cases.
Ottobock supports and orthoses
Whether external force is involved or not, twisting the ankle can cause the ligaments in the ankle joint to stretch excessively or even to rupture. Such injuries often occur during sports activities. Acute ankle injuries are the most common type of injury here. They account for about 15 to 20 per cent of sports injuries across all sports. Sports with frequent, fast changes in direction and jumps as well as contact with opposing players are particularly dangerous for the ligament structures of the ankle joint. Examples of sports in which acute ankle injuries occur particularly frequently include football, basketball and volleyball.
There is an increased risk of a recurring ankle injury, especially among athletes. Around a third of all patients have another ankle injury within three years. This figure is even higher among athletes with up to 73 per cent of all cases. Even over the long term, many patients still complain about a slight yielding of the ankle joint, pain while walking and running, minor swelling and a slight instability of the ankle joint.
Type of ligament injury
Injuries to the ligament apparatus of the upper ankle joint affect the lateral ligaments in 85 per cent of all cases, with the anterior lateral ligament in turn being affected most often. The lower ankle joint may be injured as well. While isolated injuries of the lower ankle joint are rare, an instability of the lower ankle joint also exists in an estimated 10 per cent of patients with chronic lateral instability of the upper ankle joint.
Degree of severity of the injury and its symptoms
Ligament injuries in the ankle joint are broken down into three degrees of severity:
Degree I (minor)
A pulled ligament without macroscopic rupture (tearing), slight swelling and/or sensitivity of the affected structures. No or only a minimal loss of function, generally no bleeding, no mechanical instability of the ankle joint, no problem bearing weight.
Degree II (moderate)
Macroscopic partial rupture with moderate pain, swelling and sensitivity of the affected structures. Slight to moderate functional limitations and slight to moderate instability of the ankle joint, bleeding and problems bearing weight in many cases.
Degree III (severe)
Complete ligament rupture with pronounced swelling, haematoma and algesia (sensitivity to pain). Loss of ankle joint function and pronounced abnormal joint movement and instability, bleeding; bearing weight is not possible.
The doctor first examines the foot to determine whether there are movement limitations, heat, swelling, reddening, protruding bones, etc. The circumstances that led to the injury, where the pain is located and any prior injuries or pre-existing conditions in this area are clarified in a consultation. Further examinations such as X-rays or MRIs are carried out depending on the results.
Early functional mobilisation treatment for ligament injuries in the ankle joint has become the standard today. As a rule, this consists of protection, rest, ice, compression and elevation directly after the injury. Light movement exercises without placing weight on the joint commence as soon as 48 to 72 hours after the injury in order to restore the range of motion and muscle strength. After the swelling goes down, the ankle joint is stabilised with an orthosis and weight bearing is gradually built up again over two to four weeks.
Accompanying sensorimotor training is also desirable and should commence as soon as possible, generally after three to four weeks.
Operation – yes or no?
A comprehensive review comparing immobilisation and early functional treatment has shown that early functional treatment is significantly superior to longer-term immobilisation:
Over the long term, more patients resume the sport they participated in before the injury
The time until they resume sports activities is shorter
More patients resume the job they did before the injury more quickly
Over the short term, fewer patients have ongoing issues such as swelling
Fewer patients exhibit mechanical instability of the ankle joint in X-rays that were taken
More patients are satisfied with the treatment