Ankle injuries: Ensuring the right diagnosis and treatment
Athletes place enormous pressure on the ankle during exercise and injuries are common among those who compete in jumping and running events, discus throw, javelin, cycling, football, water polo, and judo. In this two-part article we look at the presentation of ankle injuries, diagnosis, and the correct steps to follow for initial treatment, as described in the Map of Medicine’s evidence-based pathway.
An injury may present in a variety of forms with over 70% of ankle injuries in athletes being sprains of the lateral ligament complex. Injuries also incorporate ankle fractures of the medial, lateral, or posterior malleolus, Achilles tendon ruptures, and osteochondral lesions. For athletes, and exercise enthusiasts alike, high-impact and high-energy injuries can often mean severe trauma and require emergency treatment. If left untreated, individuals may be left with debilitating injuries that result in long-lasting problems such as early-stage arthritis.
There are many reasons why athletes get ankle injuries. Women in sport are at higher risk of osteoporosis and therefore may also be at higher risk of injury. Other factors such as muscle strength, oxygen uptake and joint range of movement, may severely affect an individual’s susceptibility to injury in high-impact activities.
Diagnosis – “Crackling, snapping, and popping”
The diagnosis, and subsequent treatment plan, of ankle injuries may be determined by assessing any pain and swelling, inability to weight-bear, and grating, crackling, or popping sounds with range of movement, along with other clinical assessment tools.
Radiographs help to determine the degree of the injury by defining any fractures, or osteochondral injury. Osteochondral fractures occur in up to 50% of acute ankle sprains yet only a small number are visible on plain x-rays.
Rupture of the Achilles tendon is also a common injury in athletes due to the extensive pressure exerted, particularly for individuals playing football and racquet sports. Most Achilles ruptures are quite easy to diagnose, Consultant in Trauma and Orthopaedics, and contributor to the Map of Medicine ankle injury care map, Jim Barrie explains;
“The athlete complains of sudden pain in the lower calf and difficulty walking, and the clinician examining the athlete can feel a tender gap in the tendon. The foot hangs differently from the other foot and squeezing the affected calf doesn’t produce the normal foot movement. However, sometimes the ankle is so painful and swollen, it is difficult to examine, or the athlete feels the ankle is twisted, so the clinician is more concerned about a ligament injury. It is important for clinicians to always examine the Achilles tendon when assessing ankle injuries. In a few athletes, ultrasound scanning is the best way to be sure whether the Achilles tendon is torn.”
Treatment – “PRICE”
By following the correct steps at the time of injury, intervention procedures aim to help protect the ankle. Map of Medicine’s evidence-based Ankle injury care map suggests following the PRICE rule:
- Protect and support the ankle
- Rest (consider the use of crutches)
- Ice for 2-3 hours following injury
- Compress with a simple elastic bandage
- Elevate to control swelling
A severe injury that requires surgery or extensive rehabilitation may be the result of a malleolar fracture or a complex and/or recurrent ankle injury. Make sure to check back soon to read part two on complex ankle injuries.For the latest guidance, please see the Map of Medicine’s Ankle injuries care map.