Q: What sports are most likely to result in ankle injuries ?
A: Ankle injuries are the most common joint injuries seen by Sport Medicine doctors. Sports with a high need for 'turning', 'cutting', or 'pivoting' movements are particularly likely to cause ankle injury.
In North America, Volleyball, Basketball, Football, and Raquetball are the most common causes of ankle injury. In the past, before rigid plastic ski-boots became common, ankle injury often resulted for downhill skiing accidents.
When the ankle is injured, it is usually a strain, or sprain of the ligaments. Usually the ligaments of the lateral side are injured, the "anterior talo-fibular ligament, posterior talo-fibular ligament, or the calcano-fibular ligament". The stronger deltoid ligament on the medial side is usually not injured.
Q: When I injured my ankle and went to the Emergency room, the X-ray was normal, but the doctor said I had probably "sprained" my ankle. Shouldn't he have been able to see that on the X-ray ?
A: Ankle sprains are due to stress or rupture of the 'ligaments' of the ankle. The ligaments are tough, fibrous bands of tissue which extend from bone to bone, in hopes of keeping the whole ankle in one piece. During an ankle sprain, the ligaments are forced beyond their capabilities, and either stretch or rupture in response.
The ligaments themselves cannot be seen on X-rays. Therefore, an X-Ray itself can never say for sure that a sprain did not occur.
On the other hand, in some cases, there may be co-existing damage to the bones which may be seen on X-ray. Likewise, if the ligaments are torn completely, it may be possible to see on the X-ray that the joint is clearly unstable and displaced.
Thus, although it may be possible at some times to see evidence of a sprain on X-ray, this is not always so. Furthermore, an X-ray that appears normal does not say for certain that no sprain occured.
The Ottawa ankle rules dictate when an X-ray is neccessary only when there is pain in the ankle and one of the following...
Bone tenderness at the distal 6 cm of the posterior fibula or tip of the lateral malleolus.
Bone tenderness at the distal 6cm of the posterior tibia or tip of the medial malleolus.
Inablity to wt bear for 4 steps both after the injury and upon presentation to the physician.
However, the Ottawa Ankle Rules do not apply if....
Age is less than 18
You are intoxicated
If you have multiple painful distracting injuries
You are pregnant
You have a head injury
You have a neurological deficit (stroke or diabetes)
Q: How are ankle sprains treated?
A: Like most muscle and ligament injuries, the RICE acronym is usually followed.
R: Rest
I: Ice
C: Compression
E: Elevation
For ankle injuries there is evidence that passive joint mobilization (3 sets of 60 second small-amplitude oscillations) may be helpful. Athletes using this protocal have been found to require fewer therapy sessions, although time to return-to-sport was not changed.