Update: December 2018
Since the ankle takes over the whole mass of a person and has
a specific structure quite often occurs his injuries
This is especially true of the muscular-ligamentous apparatus. Damage it
ligaments, of varying degrees, occur in one way or another
man throughout his life.
Ankle injuries are quite common, most often
sprains or partial damage to the ligaments occur. On самом
Deal can not stretch the ligaments, they are torn.
Therefore, ankle sprain is considered a partial
(single fibers) or complete rupture of tendon bundle fibers with
damage to microvessels and nerves, providing its trophism.
Ligament apparatus of the ankle represented by three groups of these
- Связки межберцового синдесмоза:
- Rear bottom
- Anterior lower interebral
- Onружно-боковая связка;
- Deltoid ligament (internal-lateral).
Each of these ligaments performs an important stabilizing
the function of this joint and even with the slightest damage to one of them
it is largely disrupted. It should be noted that each
the anatomical structure of the ankle has a good blood supply and
pronounced innervation (supply of nerves to tissues).
Onдрыв связок происходит при беге или ходьбе по неровной
terrain, when wearing high heels, while playing sports
(athletics, football, alpine skiing), in situations where
limit increases the load that the ligaments are able to withstand. They
may be damaged when the foot is folded inward (tibial,
or deltoid group of ligaments) or outward (peroneal group),
most often there is a strain of the outer group.
|Predisposing causes of damage to the ligament apparatus:||Productive causes:|
It is also important to highlight the degree of sprain:
- Grade I is characterized by a slight tear of individual
microscopic fibers or their bundle. Symptoms are mild,
the damaged joint is palpable, and the volume of movement in it
almost not broken. The victim may not come for a long time
- Grade II is different from the previous one in that there is a gap
already more significant amount of tendon fibers. Symptoms
damage is more pronounced, the victim barely steps on his foot, and
pain syndrome can mimic a fracture of tubular bones.
A person’s ability to work is impaired for at least 5-7 days.
- Grade III is the most severe and is characterized by complete
separation of one or more bundles. The clinical picture reminds
fracture of the bone components of the ankle, and in some cases
exceeds it. The function of the foot is completely impaired, the emphasis on its
impossible not only through pain, but also due to
changes in the anatomical ratio of the elements of the joint.
Symptoms растяжения голеностопного сустава
You should be aware that a broken ankle may be mistaken for
a stretch of 2-3 degrees, therefore it is imperative immediately after any
ankle injuries refer to the orthopedic traumatologist
(см. отличие ушиба, перелома, вывиха, stretching).
When stretching the ligaments of 1 degree, the damage may not
immediately disturb the victim, the symptoms are not pronounced and at the same time
It does not reduce physical activity. On следующий день из-за
increase in edema, progression of hematoma, post-traumatic
inflammation, the victim has complaints. Man can and
lean on your leg, and move independently, but limping,
as movements in the joint cause pain. Bruise appears
(hemorrhage into subcutaneous tissue), an increase in local
At 2.3 degree of stretching:
Severe pain occurs immediately after injury and
its intensity may exceed even a fracture of the tubular bones.
Intense pain lasts for an hour, but gradually decreases.
and occurs only when trying to focus on the injured limb.
In mild stages, the victim can move independently,
and in case of heavier ones, due to severe pain. One of the factors
causing pain, is swelling. During his
spreading it squeezes the nerve endings and vascular
Edema является основным признаком повреждения связок и возникает
both lateral and medial ankle. Edema при такой травме
almost never covers the whole foot or lower leg. is he
lasts for one week and when it decreases it begins
Hematoma is also an indirect sign of sprains. AT
the end of the first week it extends to the entire ankle with
damaged side. After a few weeks, the hematoma goes down in
bottom to the plantar part of the foot. It is important to know that throughout
at a specified time, the hematoma changes its shades from dark blue and
to yellow (due to the gradual breakdown of blood cells).
Impossibility of self-movement
Impaired function of the foot at 2 and 3 degrees is manifested by the fact that in
the first days it is impossible to completely rest on the foot and even more
Sprain ankle, usually heals after 10-14
- Radiography must be performed before treatment.
sprained ankle and is the primary method
differential diagnosis between fracture of joint elements and
stretching. It is a mandatory study for such
damage and is performed in both straight and side
- Ankle ultrasound is an additional study and may
be prescribed for both normal edema and hemarthrosis. Also with
Using this method, an experienced ultrasound diagnostician can detect and break
- MRI is used only in the most severe cases to determine
guidelines of surgical intervention. This method is great
shows the joint in more favorable projections. MRI diagnosis
is the “gold standard” with a combination of torn ligaments,
syndesmosis and bone elements.
In case of such damage, properly rendered first aid can
greatly affect the recovery time of joint function and
регенерацию микроскопических fiber bundles.
- Attach a cold to the injured area of the ankle for 10-15
minutes, repeat after half an hour. Such an event does not possess
only an anesthetic effect, but also does not spread edema
due to reflex vasoconstriction. To do this, wrap
in a towel ice or frozen product from the freezer or
Attach a container with very cold water.
- Provide rest for injured leg, before diagnosis
You can not fully rely on the foot. Fix the bottom
limb stationary to the knee joint with
transport or homemade tires, dressings. Specified area
must be fixed before being examined by a surgeon or a traumatologist.
- Give the foot a sublime position with a roller.
- If possible, administer an anesthetic (injection or
Mild to moderate degree of ankle sprain is treated in
home conditions. The treatment indicated below is considered to be conservative.
and be carried out only on stage I or II.
- During the first day after injury, the victim should
apply a cold on a limb regularly (5-6 times 10-15 times
- It is also important to know that the foot must be fixed elastic.
a bandage (bandage) in the form of a sock with an open heel and toes or
plaster cast, depending on the degree of damage to the ligaments. On
night the bandage is removed, the duration of wearing the bandage 7-10
- In the case of a plaster cast, the victim should not
is in it for more than 7 days, as it may develop
unpleasant complication – joint instability. This is due
so that even injured ligaments should take tone already
after 5-8 days, which is not possible in a plaster cast.
- On протяжении всего лечебного процесса травмированный
ankle must be lubricated with anti-inflammatory ointments NSAIDs
(long, diprilif, diclofenac, dolobene). Last not only
relieve inflammation at the site of injury, but also provide anesthetic
- If you save edema or hematomas need to be processed
damaged area with blood supply ointments, see
direct acting anticoagulants (heparin, indovazin).
- The first few days after the ankle injury
is in an elevated position. Thanks to this swelling passes
faster and at the same time this situation also has a positive effect on
reduction of pain.
In stage III, the resulting complete rupture of the ligament or its separation from
bone foundation needs to be scheduled
interventions. The essence of the latter is to restore
ligament continuity with tendon and bone suture.
- In the postoperative period, the victim wears a plaster longev.
for 1 month.
- Also in the postoperative period, the victim is carried out
conservative therapy aimed at improving the blood supply in
lower limbs and enhancing regeneration processes.
- For this purpose, venotonics are used, as well as drugs,
expanding the lumen of the arterial vessel (detralex, tivortin,
venorutinol). In addition to these properties, these medicinal
funds reduce postoperative tissue edema.
What not to do when stretching
- In no case can not rub the injured limb
- Any thermal procedures (dry heat, hot baths,
steaming) in the first week after injury.
- Use elastic bandage during sleep.
- You can not try to massage, “develop” the joint through
pain in the first few days after injury, should be observed
sparing orthopedic mode.
Rehabilitation measures depend on how long heals
sprained ankle, the degree of their damage and what
violations occurred after injury.
- The use of ultrasound – this procedure improves not only
microcirculation in the damaged area, but also accelerates the outflow of lymph.
After its implementation, medicinal drugs are much better absorbed.
funds in the form of ointments. In addition to these effects occurs
accumulation of therapeutic drug in tissues.
- UHF is used to accelerate reparative processes and reduce
inflammation of local tissue. Due to dilation of vessels improves
- Paraffin therapy is also an indispensable physiotherapeutic
event. Its main effect is the elimination of inflammatory
processes in injured ligaments and anesthesia. Can
be used both in the first hours after injury and in the remote
- Magnetic therapy greatly improves the flow of blood and
lymph, and also reduces inflammation and increases absorption
medicinal substances. Read more about the indications of magnetic therapy.
- Electrophoresis with novocaine or non-steroid
anti-inflammatory drug. Due to the expansion of blood vessels and
improve microcirculation has anesthetic and
anti-inflammatory effects. More about testimony
Gymnastics exercises aimed at strengthening the ligament
ankle apparatus, can be performed only in a remote period
(after about 1-3 months, depending on the severity
- Walking on the toes for several minutes
Daily 6 months.
- Walking on the inside and outside of the foot.
- Flexion and extension in the ankle joint.
- Circular rotation foot.
- Running on sand or small pebbles.
- Walking on the heels.
- Jumping rope.
- Fixation of both feet with rubber with an attempt to rotate, bend and
extensions, information and breeding.
- Skating bottle foot.
- Toes collect small items from the floor.
Also during the recovery period, swimming is recommended for patients.
classic style and exercise on the stationary bike.
Complications and prognosis
Complications of damage to the ankle are divided into those that
arise in the early post-traumatic period and occur in
late. The first are:
- Dislocation (subluxation) of the joint. Especially often this is observed when
- Onгноение гематомы в области травмированного сустава или его
- Hemarthrosis (accumulation of blood in the joint cavity).
In the late period (2 months-5 years) arise:
- Joint instability – manifested by frequent dislocations in
- Flatfoot – occurs with frequent injuries of the ligament apparatus
- Osteoarthritis – characterized by irreversible changes in the cavity
- Arthritis – periodic accumulation of inflammatory fluid in
As a rule, stretches of 1 degree heal without residual
phenomena. In case of damage of 2 and 3 degrees in some cases
further, the patient has tingling, chronic pain in
joint, especially under load. It is associated with the involvement of nerve
tissues in the process of scarring, and with the formation of small
Since the restoration of the ligamentous apparatus occurs due to
scar formation, it is clear that in the future injured ligament
Will be the least resistant to damage. For the prevention of repeated
injuries better use special calipers during class
sports. The prognosis after injury to the ligamentous apparatus depends largely
not only on the degree of damage, but also on remedial measures,
rehabilitation and lifestyle of a person, but in general he