SPRAINED ANKLE

Tissues commonly effected

A sprained ankle occurs when there is weakness of one or more muscles on the side of the lower leg, commonly one of the Peroneus muscles. Normally these muscles should prevents the ankle from twisting, most commonly inwards, called inversion.

The talus bone moves mainly in one mode, called dorsi and plantar flexion. Up and down. When an ankle is sprained, the talus subluxates within its socket (see below), causing jamming. This is what causes the severe sharp pain of an ankle sprain. The talus may remain partly locked for years, if not correctly freed with the appropriate chiropractic adjustment, changing the whole movement pattern of the ankle, knee and hip. In Chiropractic Coalface you can read about how the Dutch national marathon champion had to stop running because of knee pain that was directly caused by an untreated ankle sprain.

The talus sits on top of the calcaneus (the heel bone) in what is known as the subtalar joint. Can you see the ankle mortice joint and the subtalar joint in the pictures below?

So many bones, so many joints, so much pain ...

The ankle joint (or, ankle mortice joint, as it is called) is formed between two leg bones, the tibia and the fibula and an ankle bone, the talus. The talus fits snugly into a socket formed by the tibia and the fibula, moving like a hinge and allowing the foot to move up and down, supported by an array of ligaments.

M = Medial (inner), L = Lateral (outer)

Careful correction of any ankle mortice and subtalar joint subuxations is a very important, and oft neglected, part of the successful treatment of a sprained ankle.

LIGAMENTS

There are ligaments on both sides of the ankle joint that hold the bones together. They give the ankle stability. Ligaments connect bones to bones while tendons connect muscles to bones.

In sprained ankle usually it is the ligaments on the outer side of the ankle that are stretched and occasionally ruptured. Bruising is a sign that there has been some tearing of the tissues.

An ankle guard may be useful during the healing phase of the damaged ligaments. Research shows that movement of the ankle, rather than total immobilisation (as in a cast) promotes faster healing in the treatment of a sprained ankle.

MUSCLES OF THE ANKLE

There are also many tendons that cross the ankle to move the foot and the toes. Tendons connect muscle to bone, enabling you to move your foot.

The muscles usually affected lie on the outer side of the lower leg. There are three of them called the peronei group, plus a few others, mainly for moving the toes.

The contraction of Peroneus Brevis may be so sudden and severe, in attempting to prevent inversion ankle sprain, that it ruptures off its attachment to the bone. This is called a Jones fracture and immobilisation in a cast is essential.

SPRAINED ANKLE

Displaced bones are often associated with sprained ankle, usually the Talus bone, the Calcaneus bone and the Cuboid bone. Correction of these subluxations is an essential part of the treatment of a sprained ankle.

The ankle ligaments may be associated with ankle sprain, with stretching and possible tearing of these ligaments. Swelling and bruising are common findings. Rupture is uncommon.

Muscle and tendon sprain may also occur. The achilles tendon and the muscle on the outer part of the leg are most frequently involved in ankle sprain.

Less commonly, bones may be fractured in a sprained ankle. Most usually the knobby on the outer side of the ankle (the lateral maleolus) and the end of a bone on the side of the foot may be involved. They are the attachments for the ligaments and tendons of the ankle which are often stronger than the bone itself (aka an avulsion fracture). Immobilisation is then essential, and occasionally a pin or plate may be necessary if a fracture has occured in your ankle sprain.

TREATMENT

ICE should immediately be applied after a sprain of the ankle. This can best be done with an ice block immediately over the effected painful area.

COMPRESSION may be important if it starts to swell. This is done with a compression bandage which should be professionally applied, but needs to be loosened regularly to allow movement of the joint (which has been shown to promote healing) and so that ice can be applied.

ELEVATION is necessary if more extreme swelling occurs.

X-RAY may be important to rule out fracture. It will then need to be cast for 6 weeks.

CHIROPRACTIC management of this very painful condition is particularly successful because it addresses subluxation of bones that usually occurs, and looks for the cause which is usually in the low back or sacro-iliac joint. Remember, it is the weakness of a muscle that allows the ankle to invert and sprain. For more information on ankle sprain treatment.
REHABILITATION of the ankle is essential. For more about ankle exercises, click here.

To return from SPRAINED ANKLE to CHIROPRACTIC CONDITIONS

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