Ankle instability treatment. Ankle sprain Unstable ankle
The most complete answers to questions on the topic: "signs of ankle instability."
Joints provide a person with his mobility. All movements are carried out by the musculoskeletal system. The ankle joint is the joint of three bones. This allows for complex joint movements (jumping, walking, running). Ankle instability may indicate serious pathologies. Untimely treatment of ankle injuries or their inadequate treatment leads to joint instability in a chronic form. In this case, the patient requires complex treatment.
The reasons for the development of instability
Ankle instability develops as a result of injury. A sprained or torn ligament is an injury that requires adequate treatment. Dislocation or subluxation of the ankle is possible. Only a doctor, after examining and examining the patient, can make a diagnosis.
The patient needs to ensure rest and fixation of the injured limb. If misdiagnosed, treatment may not be sufficient or consistent with the injury.
After treatment, the joint may not function fully. The patient feels some laxity in the leg. In this case, it is dangerous to wear uncomfortable shoes, especially shoes with high heels. It is undesirable to run, engage in traumatic sports without proper fixation of the limb. Special fixing shoes, tight bandages can help prevent re-injury, but do not guarantee the exclusion of re-damage. Constant trauma, twisting of the leg is the cause of chronic instability of the ankle joint.
Clinical picture
Severe pain accompanies all injuries to the ankle. There is also swelling, swelling of the joint develops quite quickly. It is difficult for the patient to step on the sore limb. Movement becomes limited. At the same time, there is a displacement of the foot, its significant instability.
Patients with injuries to the ankle complain of pain, general weakness of the ligamentous apparatus, and joint instability. As a result, the legs often twist. At the same time, painful sensations accompany any movement, support on the leg. Puffiness is also a constant companion of ankle instability.
Dislocation and subluxation is accompanied by crunching, cracking or clicking. This somewhat distinguishes the symptomatology of one injury from another (from a sprain or ligament rupture). But for accurate diagnosis, it is necessary to conduct a comprehensive examination of the patient.
Diagnostics
The condition of the ankle is determined by examination, palpation. The doctor feels, turns the foot. Based on this, a possible diagnosis can be assumed. The examination is carried out in the form of several tests for the ability to exercise. A visual comparison is made with a healthy leg.
A visual examination is also required. This is done using X-rays. With the help of X-ray examination, it is possible to diagnose bone fractures, fractures, dislocations and subluxations.
The condition of the soft tissues of the ankle joint is determined using magnetic resonance imaging (MRI). Damage to the ligaments, muscles and tendons is determined during this study.
Pathology treatment
Treatment is carried out depending on the diagnosis. Dislocation requires reduction. In case of a fracture, a plaster cast is applied to the patient for a long time. Each injury requires a lengthy rehabilitation period.
Injury to the ligaments requires tight bandaging or the use of a special orthosis. This will prevent repeated injury to the ligamentous apparatus. Physiotherapy treatment helps improve blood flow to the affected limb. For these purposes, electrophoresis, massage, diathermy, paraffin applications are prescribed. Warm baths are also useful for a sore leg.
If, after a course of treatment, the ankle is still not stable, then surgical intervention is required to restore. It is of several types. Special implants-retainers and fixators can be used to restore damaged ligaments. A more modern method of surgical treatment is the restoration of ligaments without the use of additional funds.
The rehabilitation period after surgical treatment requires the use of orthopedic braces and the wearing of special shoes. After the operation, the patient no longer suffers from pain, swelling and lack of confidence in movements disappear.
Ankle instability
Sprains of the lateral ligaments of the ankle joint usually occur during walking or landing after a jump, if the foot, at the moment of contact with the support, undergoes supination and internal rotation while simultaneously external rotation of the lower leg. If the tensile strength exceeds the bond strength, damage occurs. The likelihood of injury increases with additional plantar flexion of the foot.
The lateral (external) ankle ligaments can become stretched when walking fast or failing to land. The mechanism of injury is the leg in contact with the floor or ground surface, when, during supination, the lower leg bone is simultaneously in external and internal rotation. If the load on the ligaments exceeds the permissible threshold, their injury occurs. The likelihood of damage to the ligamentous apparatus of the lower leg increases in those moments when the foot is bent and suspended.
Features and reasons
Most often, the lateral ligament of the fibula is affected. After it, the calcaneofibular ligament is in second place in the frequency of injury. Due to the violation of the integrity of the ligaments that perform the fixing function, it happens ankle instabilityin its horizontal projection. Due to the fact that the lower leg loses its stable position, adjacent ligaments may be damaged. The lateral ligament can be damaged by trauma to the ankle joint capsule.
Ankle instability, caused by damage to his ligamentous apparatus, is mainly due to the fact that the subtalar joint is excessively mobile. People with clubfoot and flat feet are susceptible to injury, due to which the lateral ligament, when moving the leg, has a deviation in axial rotation.
The peroneal muscle prevents stretching of the ligaments of the lower leg, the contraction of which occurs until the moment the foot comes into contact with the surface. Thanks to such a well-coordinated work of ligaments and muscles, in most cases, injury can be prevented.
Ankle instability due to injury to his ligaments, it occurs more often in people with congenital or acquired curvature of the lower extremities. Factors that increase the likelihood of injury: subluxation of the leg, incorrect body position when landing after a jump.
Symptomatic picture and diagnosis
Ligament injuries and related ankle instability accompanied by a crackling or clicking sound, pain occurs, and extensive edema forms. An increase in the intensity of the pain symptom is observed when touching the leg and while walking with support on the injured limb.
During the examination, the doctor conducts a careful palpation of the leg, a physiological test is performed, the purpose of which is to determine whether the bones and cartilage have been damaged. The patient sits on a couch, legs are bent at the knees, hanging freely. The orthopedist, holding the heel, gently bends the foot to the sole, shifting the heel forward, while the tibia is pulled back. A manipulation is performed on a healthy leg, after which the results are compared.
If both limbs behave differently during this procedure, it is diagnosed ankle instabilitywith damage to the ligaments. To understand which ligament was injured, calcaneo-tibial or talus-peroneal, the doctor, holding the heel of the injured leg, turns it inward.
Another way to reveal ankle instability - the doctor presses on that part of the lower leg, which is located above the ankle joint. If such manipulation causes pain in the patient, instability is confirmed.
Instrumental diagnostic methods
X-rays are taken to confirm instability and to obtain complete information about the condition of the lower leg. The picture shows whether there were injuries in the anterior part of the heel bone, medial and outer processes of the shin bone. If you suspect a rupture of the soft structures of the ankle joint, the method of magnetic resonance imaging is used.
Therapy
At the Center for Sports Traumatology and Reconstructive Medicine, the treatment of damaged ankle ligaments is selected individually, based on the severity of the clinical case. With a timely visit to a doctor immediately after injury, a positive result in treatment can be achieved with conservative methods.
Non-surgical treatment implies immobilization of the limb by applying a tight bandage, the limb should be slightly raised. To relieve pain symptoms caused by ankle instability, the patient is prescribed anesthetic spectrum drugs. In addition, a cold compress is regularly applied to the injured limb to reduce swelling.
For the fastest recovery of the ankle ligaments, physiotherapy procedures are carried out:
- electrophoresis;
- electrostimulation method.
If there is no concomitant damage to the bone and cartilage tissue, immediately after the patient's pain has passed, they begin a recovery program. Rehabilitation includes performing exercise therapy exercises.
If a person does not experience pain when performing simple exercises, after 1-2 weeks they begin the final stage of conservative treatment - the restoration of skills such as jumping and running. To prevent re-injury of the ankle ligaments during the period of rehabilitation exercises, the patient must wear a lightweight orthosis, which is fixed on the leg with lacing.
Surgical intervention
If conservative methods do not give a positive result, or there are concomitant injuries to the bone and cartilage tissue, surgical intervention is performed to restore the condition and functioning of the ankle. Of all the methods of surgical treatment of ankle instability, the Brostrom method gives the best result, which is successfully used in the Center for Sports Traumatology and Rehabilitation Medicine.
The essence of this surgical method is that the lateral calcaneal and talofibular ligaments are fixed and strengthened by installing special extensors, they are installed on top of the ligamentous fibers. The advantage of this method is that during the operation there is no need to use the adjacent tendons to strengthen the ligamentous apparatus.
After the operation, the patient needs to wear an orthosis or a special boot made of plaster for fixing the lower leg for 4-6 weeks. After the fixing bandage is removed, a control X-ray is taken. This is followed by a rehabilitation period with the passage of physiotherapeutic procedures and exercise of physiotherapy exercises.
Full recovery of the injured limb takes 3 to 6 months, after which you can return to sports. The intensity of physical activity should be increased gradually; the first training sessions are recommended to be carried out in an orthosis.
Injuries to the ankle ligaments occur as a result of trauma - turning the foot, often during sports or in winter, with ice. Painful sensations may not arise immediately. After a short time or immediately after the injury, swelling of the ankle joint appears, its contours are smoothed out, subcutaneous hematomas (bruises) appear. Sometimes patients notice a “click” at the time of injury. Movement in the ankle joint causes acute pain, it is almost impossible to lean on the leg.
It is necessary to apply cold and fix the damaged joint, then contact a medical institution, where an X-ray of the ankle joint will be performed. Often this is not enough and a number of additional examinations may be required, such as ultrasound examination of the joint, magnetic resonance imaging (MRI) to assess the condition of the soft tissue structures (ligaments, tendons) of the ankle joint.
Conservative treatment of injuries of the ankle ligamentous apparatus
If the ligaments are partially damaged, then, as a rule, we are talking about conservative treatment - wearing a plaster or polymer bandage, special bandages, orthoses. Courses of physiotherapy and exercise therapy are prescribed.
Ineffective and incorrect treatment of this pathology can lead to serious complications such as arthrosis, chronic instability of the ankle joint, lameness and others.
Surgical treatment of injuries to the ligamentous apparatus of the ankle joint
With the ineffectiveness of all these measures - the persistence of pain, swelling, a feeling of instability in the joint, repetitive injuries, as well as complete damage to the external or internal complex of the ligamentous apparatus of the ankle joint, surgical treatment is indicated - restoration of the ligaments (ligament plastic) to prevent the above complications.
Depending on the degree of damage, one of the methods of surgical intervention is used:
- stitching the ligaments (if they are in place, but deformed)
- periosteal valve (if the ligaments are torn or not visualized)
- transplantation of tendons and ligaments, the use of plantar material, or tendons to replace 2-3 ligaments, when performing these interventions, absorbable (absorbable) materials are used for fixation
The operation is performed under arthroscopic control (with the help of a video camera inserted into the joint, its cavity is examined). Thanks to this, it is possible to diagnose and eliminate problems not only with damaged ligaments, but also inside the joint during one surgical intervention.
Immediately after the operation, the joint is fixed with a plaster cast so as not to expose it to unnecessary stress. This will lead to a speedy recovery. The stitches are removed for 12-14 days. After removing the stitches, it is possible to start restorative treatment. After 4 weeks, the cast can be replaced with a semi-rigid U-shaped ankle orthosis. Walking without crutches with full load on the joint is possible after a few weeks.
Rehabilitation treatment after injuries of the ligamentous apparatus of the ankle joint
It is very important to think over the course of rehabilitation treatment for such injuries so that the function of the ankle joint is restored to the maximum extent. Upon discharge from the hospital, the patient receives a detailed recovery plan.
Rehabilitation treatment includes a course of physiotherapy, shock wave therapy, a set of active and passive exercises aimed at strengthening and stretching the muscles with partial load on the joint, and exercises to develop joint movements.
In addition, a biomechanics laboratory has been created at the Central Clinical Hospital of the Russian Academy of Sciences on the basis of the rehabilitation treatment department, in which patients undergo rehabilitation after various injuries of the musculoskeletal system, incl. professional athletes. On its basis, various walking parameters are investigated, an optimal rehabilitation plan is developed in accordance with the data obtained.
Lack of timely treatment of fresh injuries of the ligamentous apparatus can lead to chronic instability of the ankle joint.
Such habitual dislocations and subluxations of the ankle joint are the consequences of ruptures and tears of the ankle ligaments, which at one time patients and doctors themselves took for a simple sprain of the ankle ligaments.
Examination, palpation, and routine x-ray of the ankle joint do not reveal signs that allow a correct diagnosis. In most cases, diagnose "weakness of the ligamentous apparatus of the ankle joint", "sprain", etc., appoint massage, warm baths, diathermy, paraffin applications.
Symptoms
Patients often complain of weakness, instability and uncertainty when walking due to "wobbling" and frequent twisting of the foot. They usually report that they walk carefully, are afraid to run, exercise, and wear high and narrow heels. This forces you to wear special shoes, braces, apply elastic bandage, restrict movement and sports. Swelling and pain in the area of \u200b\u200bthe external ankle are constant companions of this pathology. The use of orthopedic braces does not solve the problem, since they cannot fully stabilize the ankle joint and sufficiently restrict movement.
The objective symptom is unusual, excessive movement of the foot in the ankle joint. If you grasp the lower leg in the supraklenole region with one hand, and turn the foot inward with the other, the talus, in contrast to what happens with a normal ankle joint, shifts anteriorly and inward. In front of the outer ankle, a pronounced groove is visible. To confirm the diagnosis, this ankle displacement of the talus, caused by excessive curling of the foot, should be recorded on x-ray (stress x-ray).
In most cases, surgical treatment is necessary.
Functional condition of the ankle ligaments assessed by the nature of the gait, the ability to perform active movements. When the ligaments are in good condition, all movements in the ankle joint are physiological, free, painless, that is, there is joint stability. Functional ligament failure (sprain, rupture, inflammation) is manifested by lameness, soreness of movement, and in the event of a ligament rupture, the formation of joint instability, often anterior and lateral.
Availability stability or instability of the ankle verified using the following techniques. First, the doctor grabs the lower third with his left hand, and puts his right hand on the heel from behind. Next, he pushes the lower leg back with his left hand, and with his right hand pulls the calcaneus and talus bones towards him.
Have a healthy foot misalignment in relation to the lower leg, no, if it occurs, then this is a sign of anterior instability of the joint, caused by a rupture of the anterior talofibular ligament.
Second trick - check lateral stability of the ankle. The doctor grabs the heel from below with both hands so that the thumb of one of the hands is set at the edge of the lateral ankle. Next, carefully turn the heel inward. If the doctor's thumb at the outer ankle does not notice an increase in the gap between the ankle and the talus or calcaneus, then the lateral stability of the foot is preserved.
If slit increases, then there is lateral instability due to damage to the talofibular or calcaneofibular ligaments.
Foot
Foot - the distal part of the lower limb, which performs the supporting and spring functions. It is conventionally assumed that the upper level of the foot is on a line drawn through the tops of the ankles. In the foot, the rear, sole, and heel area are distinguished. The widest part of the foot is the tarsus, it consists of the talus, calcaneus, scaphoid, cuboid and three wedge-shaped bones. The metatarsus has 5 metatarsal bones, the toes consist of three phalanges, except for the big toe - it has two phalanges.
Talus with the help of the ankle joint it is connected to the bones of the lower leg. Between the bones of the tarsus and metatarsus, there are inactive joints, between the metatarsus and toes - movable joints. The interphalangeal joints are similar to those of the hand. In the tarsus-subtalar joint, supination and pronation within the range of 10-13 °, dorsal and plantar flexion of no more than 6 ° are possible.
Foot has a large number of ligaments: interosseous, dorsal, longitudinal. The muscles that pass from the lower leg to the foot and the own muscles of the foot also take part in strengthening it. The muscles of the sole, like the ligaments, hold the arch of the foot, which performs a spring function. The muscles in the back of the foot extend the toes when walking and running. The rear of the foot is covered by a fascia that continues from the lower leg. On the sole there is an aponeurosis that runs from the heel to the toes. The tendons of the long muscles in the area of \u200b\u200bthe foot are enveloped in synovial sheaths. The skin of the sole is thickened, fuba, from the plantar aponeurosis to it there are short, dense cords, between which cells containing fatty lobules are formed.