Traumatic causes
A typical mechanism is the foot turning inward, which affects the outer ligaments. Pain, swelling and bruising appear in front and below the outer ankle; walking is painful, but more often it is possible. More severe injuries are accompanied by instability and a feeling that the leg is twisting again. Fractures of the ankles, avulsion of a bone fragment and damage to the ligament between the bones of the leg cause sharp pain, severe swelling and the inability to exercise. A separate situation is a rupture of the Achilles tendon: a person feels a blow to the back of the shin, hears a click and cannot stand on his toes.
- Stretching and tearing of external ligaments
- Ankle fracture
- Damage to the ligament between the bones of the leg
- Dislocation and subluxation of the joint
- Achilles tendon rupture
- Repeated injuries leading to instability
Pain without injury
If there was no obvious damage, the range of reasons is different. Achilles tendinitis is characterized by pain and thickening at the back of the heel, which gets worse as you begin to exercise. Arthrosis of the ankle is usually secondary and develops years after a fracture or repeated sprains, causing pain when walking and stiffness. Gout causes a sudden attack at night with sharp pain, redness and swelling, usually in the first toe, but sometimes in the ankle. Rheumatoid and reactive arthritis affect the joint with inflammation and morning stiffness. Overload with flat feet and excess weight causes chronic aching pain.
- Achilles tendonitis
- Arthrosis of the ankle joint
- Gout
- Rheumatoid and reactive arthritis
- Flat feet and foot deformities
- Stress fracture due to running loads
- Edema in diseases of the veins, heart and kidneys
What to do in the first days after injury
In the first 48 to 72 hours, the goal is to reduce swelling and pain. The leg is unloaded, and crutches are used if necessary; apply cold through the cloth for 15–20 minutes several times a day; Apply an elastic bandage and keep the leg elevated above the level of the heart. Heat, rubbing with warming ointments, hot baths and alcohol are contraindicated during this period: they increase swelling and hemorrhage. You shouldn’t completely immobilize the joint for a long time - early, gentle movements speed up recovery. If it is impossible to step on the foot or there is pain in the bone protrusions, an x-ray is needed.
- Unloading and rest in the first days
- Cold through the fabric for 15–20 minutes
- Elastic bandage or orthosis
- Elevated leg position
- Do not heat, do not rub, do not steam
- Painkillers according to instructions
- X-ray if it is impossible to load
Survey
The decision to take an x-ray is made based on clinical signs: pain when pressing on the posterior edge of the ankles or the base of the fifth metatarsal bone and the inability to take several steps immediately after the injury and at the appointment indicate the need for an x-ray. Ultrasound examination clearly shows the ligaments, Achilles tendon and fluid accumulation. MRI is used for persistent pain, suspected cartilage damage, occult fracture, and when planning surgery. If there was no injury, tests are added: uric acid if gout is suspected, indicators of inflammation and rheumatological tests.
- Inspection and palpation of bony landmarks
- X-ray of the ankle joint
- Ultrasound of ligaments and tendons
- MRI for persistent pain and suspected cartilage damage
- Uric acid
- Inflammatory indicators and rheumatological tests
Recovery and prevention
Even with a normal sprain, full recovery requires more than just rest. After the acute pain subsides, exercises on range of motion, strength of the peroneal muscles and, most importantly, balance training on one leg are included: this is what reduces the risk of repeated twisting. The return to sports occurs gradually, when there is no pain and swelling, and the support is confident. Comfortable shoes with a stable heel, orthopedic insoles for flat feet, weight loss and warming up before exercise are useful. For chronic instability, repeated twisting and cartilage damage, an orthopedic surgeon may suggest surgery.
- Exercises for range of motion and muscle strength
- Balance training on one leg
- Gradual return to exercise
- Comfortable shoes and insoles for flat feet
- Weight loss when a joint is overloaded
- Warm up before training
- Surgery for chronic instability