Ankle joint is a modified hinge joint. Socket comprises of distal articular surfaces of tibia and fibula, the tibio-fibular ligament and the malleoli. Superior articular surface of talus articulates with this socket. This strong syndesmosis along with the malleoli makes ankle a strong and stable joint. Ankle joint being capable of a wide range of movements and subjected to tremendous wear-and-tear is also greatly subjected to Injury
Osteoarthritis of the ankle is not very common, as are the infections. It does rarely get affected in gout or polyarthritis of rheumatoid.
Painful conditions of the ankle by and large are due to trauma. Injury to ankle is mainly because of sprain of the foot, thanks due to uneven surface to walk upon and ill fitting footwear. Being a stable joint and specifically due to the malleoli pure dislocation of ankle is not possible, it generally results in avulsion fractures of either of the malleoli.
The ankle joint has two main ligaments, the medial and the lateral collateral ligaments, medial being stronger than the lateral. Lateral collateral ligament thus is affected in sprains. Any one of the following movements of ankle when occur accidentally and forcefully has the potential to injure the joint
Cases where fractures occur have to be dealt with depending upon the extent or position of the fracture. Understanding Sprained ankle is of paramount importance as once the patient (in many cases doctors too) realizes that there is no bony injury, all caution is thrown to the wind and they start limping and weight bearing. One must understand that sprains also must be treated by immobilization and rest either by strapping or POP casts.
As already pointed out Left collateral ligament gets sprained more often than the Right one. Clinically there is history of twisting injury to the ankle with pain and swelling over the injured ligament. Weight bearing gives rise to severe pain. In cases of complete tears, patient gives a history of something giving way at the time of injury.
X-rays are usually normal. In cases stress X-rays may be used to judge the severity of sprain. A tilt of 20 degrees on forced movement on the side of the sprained ligaments suggests complete tear.
Treatment depends on the degree of sprain. Mild ones may be immobilized for 2 weeks before mobilization. Moderate may need 4 weeks of immobility whereas severe ones may require 6 weeks of immobilization. Complete tears of the ligament are usually handles surgically.
It is necessary to learn (& teach) the right way of using an elastic bandage. Use of NSAIDs and enzymes is indicated in the initial phase for symptomatic relief. Patient must be explained the need for rest and immobilization of the joint inspite of no fracture.