Unit of Foot and Ankle
Specialists in the study, diagnosis, and application of surgical techniques for foot surgery.
Ankle and foot sprains
Ankle sprains account for approximately 60% of the injuries that arrive at our emergency services and outpatient consultations, with more than half of them occurring during sports practice.
A sprain is an injury to one or more ligaments caused by a forced movement of the ankle (inversion or eversion) that exceeds the mechanical resistance of these ligaments.
It is very important to perform a proper assessment and subsequent treatment to avoid future complications.
Types of Ankle and Foot Sprain
A sprain can affect:
- Lateral External Ligament Complex: This is the most common sprain and involves the ligaments on the outer part of the ankle (anterior peroneal-astragalus or talofibular anterior bundle, peroneal-calcaneal or calcaneofibular bundle, and posterior peroneal-astragalus or talofibular posterior). It is caused by a forced inversion mechanism, typically injuring the anterior peroneal-astragalus bundle and occasionally the peroneal-calcaneal ligament.
- Internal Lateral Ligament Complex: This is a less common sprain. It occurs with a forced eversion mechanism, injuring the internal lateral ligament or deltoid ligament.
Depending on the severity of the injury, sprains can be classified into three grades:
Grade I (mild): This involves ligament stretching with rupture of some of its fibers. On clinical examination, there is mild pain, minimal or no hematoma, and no instability.
Grade II (moderate) or partial rupture: A swelling, hematoma, or bruising can be seen on the outer edge of the ankle or foot. In addition, the patient experiences pain and may present instability.
Grade III (severe) or complete ligament rupture: Physical examination reveals significant pain, hematoma, swelling, and an inability to walk.
What factors can lead a patient to suffer an ankle and foot sprain?
There are several factors that can lead a person to suffer an ankle sprain:
- The older the age, the higher the likelihood of suffering a sprain, especially in athletes.
- Previous conditions in the foot and ankle, such as misalignments in the hindfoot, such as cavus-varus foot, or pathologies related to the Achilles tendon.
- Overweight.
- Muscle atrophy or lack of training.
- Chronic instability or patients who suffer from recurrent sprains.
- Type of sports activity: explosive sports or those requiring rotational movements.
- Type of footwear.
Quin tractament es recomana?
El tractament en la fase aguda de l’esquinç ha canviat en els darrers anys, prioritzant cada cop més la càrrega precoç i la mobilització controlada del turmell. En aquest sentit, durant la fase aguda es recomana aplicar el protocol POLICE (protection, optimal load, ice, compression, elevation):
- Protecció: consisteix a realitzar embenats funcionals o fins i tot ortesis de turmell que limitin el moviment durant la fase aguda.
- Càrrega òptima: cada cop som menys partidaris del repòs absolut, que ha demostrat no ser beneficiós en el tractament d’aquest tipus de lesions. El que recomanem és realitzar una càrrega òptima, que variarà segons cada pacient, i un repòs relatiu en lloc de repòs absolut.
- Gel: l’aplicació de gel local o crioteràpia ajuda a reduir el dolor i la tumefacció, sobretot durant les primeres 72 hores. Recomanem l’aplicació de gel local 3-4 vegades al dia durant uns 15-20 minuts.
- Compressió i elevació: la compressió amb l’embenat funcional, així com mantenir l’extremitat elevada quan estiguem en repòs, afavoreix la disminució de la inflamació i, per tant, millora la simptomatologia i la recuperació.
El tractament quirúrgic d’aquestes lesions es reserva per a casos d’inestabilitat del turmell o dolor persistent secundari. No obstant això, aquest tractament no sol realitzar-se en el moment agut, excepte en lesions molt complexes o en aquelles en què el tractament conservador hagi fracassat.
How can we prevent an ankle and foot sprain?
