Ankle ligament strain, ICD

S93.2 Torn ligaments of ankle and foot.

Sprained ankle ligaments - what are the risks if left untreated?

An ankle ligament strain is a tear in the ankle caused by trauma. When injuries occur, they cause acute pain. This is followed by swelling and hematoma. Minor injuries are treated with conservative methods (ointments, gels, physiotherapy and orthopedic aids). Surgery may be recommended for severe injuries.

Most foot dislocations occur when the foot is rotated inward. This is the direct cause. However, there are also factors that increase the likelihood of injury:

• Abnormal development of the musculoskeletal system;
• joint diseases;
• Insufficiently protected sports equipment;
• changes in the joints that occur with age;
• uncomfortable or unstable footwear;
• Obesity;
• weak ligament system;
• Trauma;
• Excessive load.

symptoms of an injury

The symptoms associated with a dislocation are directly related to the severity of the injury. The higher it is, the more intense and noticeable are the symptoms.

Slight sprain

These are microcracks in individual fibers. This violation is characterized by:

• mild ankle pain;
• Slight swelling (may be absent);
• The ability to move independently.

Proper first aid can avoid serious treatment.

Moderate sprain

A moderate sprain (complete tear of multiple fibers) is characterized by

• Sudden onset of severe pain when trying to move your foot;
• a marked swelling of the ankle;
• the appearance of a small bruise;
• Difficulty walking independently (walking is only possible with improvised aids).

The injured leg must be rested and immobilized for at least 5 days. During this time, the intensity of the pain will decrease and the swelling will go down. The ankle fully recovered after three to four weeks.

Severe sprain

A severe sprain (tear of one or more ligaments in the foot) is characterized by

• Severe pain that does not go away even when the leg is immobilized;
• inability to move independently;
• Severe swelling of the ankle;
• blue skin

This is the most severe form of foot dislocation. Untreated dislocations can have consequences that last more than six months.

ICD-10

Ligament sprains are one of the most common injuries. Along with bruises, they top the list of the most common reasons for visiting a trauma clinic. They can occur in patients of any age and gender, and are particularly common in athletes and people with an active lifestyle. Ankle, knee, shoulder, and wrist sprains are the most common. Active treatment usually lasts 3 to 5 weeks, while full recovery takes 8 to 9 weeks.

In most cases, sprains are isolated injuries, but they can also involve injuries to other structures, often in the same anatomical area. For example, in the case of joint fractures and dislocations, the ligaments in the area of the injured joint can be sprained and pulled. Less often, sprains are combined with injuries to other anatomical areas: pelvic, spinal and extremity fractures, blunt abdominal trauma, CMT, chest trauma, etc. Dislocations are treated by orthopedic traumatologists.

causes

In everyday life, dislocations most often occur as a result of tripping, falling or falling. For example, an ankle sprain can be caused by walking in high heels or by slippery surfaces such as ice, rolling snow, or slippery floors. Wrist ligament sprains are caused by falling onto the hand under the same circumstances.

In athletes, ligament injuries are sport-specific. Ice skaters and cross-country skiers often suffer ankle injuries caused by excessive internal rotation of the foot when braking. Basketball, volleyball, shot putter, and tennis players can dislocate shoulder ligaments from a sudden swing or throw. People who compete in powerlifting and bodybuilding can sometimes sustain upper-limb ligament injuries from heavy weights, bench presses, or shoulder thrusts.

Obesity, uncomfortable shoes, clothing or sports equipment as well as pathological changes in the joint structures due to arthrosis, previous injuries and infectious diseases are factors that can cause ligament injuries at home or during sports. Congenital or acquired abnormalities that disrupt normal anatomical relationships and load distribution between the limbs (eg, flat feet) also increase the likelihood of ligament injuries.

Ankle sprain: severity and treatment

An ankle sprain is a partial or complete tear of one or more ligaments. In most cases, it is caused by a misalignment of the leg (traumatic pronation) and is accompanied by severe pain in the ankle.

Ligaments are made up of strong connective tissue. They are usually stretched to some extent and then return to their normal state. With a severe sprain, the ligament tears and you may feel or hear a pop or pop.

Sprained ligaments in the ankle are a common injury. Reverse collateral ligament injuries account for about 85 % of all cases. According to statistics from the beginning of 2020, the incidence is highest between the ages of 15 and 19. Half of all ankle ligament sprains occur during sports activities such as basketball (41.1 %) and soccer (9.3 %). Based on all sports injuries, they occur in 77-83 % of cases.

The most common risk factor is a previous dislocation. It can compromise the strength and integrity of the stabilizers and disrupt sensitive nerve fibers. Gender, height, weight, limb obesity, postural abnormalities, and foot anatomy are internal risk factors that can also affect the likelihood of injury. External causes include the location of the protective systems, the type of footwear, the duration of the competition and the intensity of the activity.

In addition to sports injuries, ankle injuries can also result simply from improper foot positioning. For example, when a person stumbles and stands on the side of the foot instead of the sole of the foot. This can happen when climbing stairs or running.

severity and healing time

Ankle sprains are classified according to their severity:

Most sprains take between 4 and 6 weeks to heal. It can take several months to recover from a serious sprain.

When the ligamentous apparatus is damaged, the following symptoms appear:

• increase in body temperature below 37.5 °C;
• chills and fever;
• weakness and dizziness;
• Local swelling around the wound;
• Hyperthermia - the ankle is hot on palpation;
• Local hyperthermia;
• Pain on palpation and movements in one or more directions, and when walking.

With a complete rupture of a ligament, in addition to the above symptoms, there are the following:

• Excessive mobility in the joint projection;
• inability to stand on the affected leg;
• loss of consciousness;
• pain shock;
• Circulatory disorders, which are manifested by cyanosis of the fingers, numbness and tingling in the projection of the lesion.

Even if the clinical picture is benign, a traumatologist should be consulted. He will help to choose treatment tactics and restore joint and ligament function.

signs

Diagnosing a sprain is not difficult as the signs of injury are all too clear. Because nerve endings and blood vessels run through the ankle, a common symptom of all sprains is pain, the intensity and duration of which depends on the severity of the tear and the difficulty in moving the foot. Other symptoms of an ankle sprain that may not be as severe are swelling and bruising.

A sprain can have symptoms similar to a dislocation, but with a sprain, the pain prevents you from stepping on your foot.

There are three types of ankle sprains.

1. First degree sprain. The damage is minor (torn fiber, trauma to the foot). A slight pulling pain that is not necessarily accompanied by swelling is characteristic. Treatment consists of rest and then slight movement of the injured ankle.
2. 2nd degree sprain The injury is more severe. It is characterized by severe pain, tenderness and sharpness, which increases with every movement of the leg. It may be accompanied by swelling and hematoma. Treatment consists of resting the ankle for several days.
3. Tertiary sprain. The ligaments are badly injured, even to the point of tearing. Pain can be sudden and severe, including pain shock and loss of consciousness. The foot is no longer resilient, the joint is unstable. If the sprain or tear is associated with a broken ankle, there can be extensive bruising and swelling, and the foot can be in an unnatural position. First aid should be given immediately. Ensure the injured leg is completely immobilized, with a splint if necessary, until the ambulance arrives. Be careful not to restrict blood flow to the ankle. To avoid further swelling of the limb and a larger hematoma, elevate the leg and cool it with an object. The cold will partially relieve the pain. The treatment consists of permanently stabilizing the injured ankle with an orthosis, stopping the pain, removing the blood from the joint if necessary and preventing renewed swelling. During treatment, you should rest the foot and avoid moving it and wiggling your toes.

First aid

Ankle ligament sprains, of any degree, must be treated immediately. Ligaments are permanently damaged from a sprain, let alone a tear. The recovery time can be long. Timely action prevents further damage to the tissue structures of the ligaments and adjacent muscles. Delay can lead to complications and treatment will take longer because more than one dislocation needs to be treated.

What should you do first?

1. Free the injured foot from the shoes, take off the socks. Make sure the skin is intact and there is no fracture.
2. Rest the leg and elevate it.
3. If necessary, put on an ankle splint and make sure that it does not impair blood circulation.
4. Keep the injured area of the lower leg cool. This can be done with a cold towel or with ice dampened with cold water. Never place the ice directly on the skin to avoid tissue necrosis from frostbite. Alternate chilling and fracturing every 20 minutes.
5. If the pain is severe, take a pain reliever.
6. If the skin is injured, treat it with an antiseptic.

Symptoms of an ankle ligament injury

The patients suffer from acute pain in the ankle, which severely limits its function.

The joint and the rear part of the outer surface of the foot are swollen. Extensive bruising occurs on the 2nd or 3rd day after the injury. Palpation reveals pain on the anterolateral surface of the ankle and foot, with pain intensity increasing when palpation is performed with simultaneous slight flexion and extension of the foot. Active and passive movements in the joint are severely restricted by the pain. Excessive inward and plantar side deviation of the foot is noted after anesthesia. Upward pressure on the heel bone (axial loading) does not cause pain.

Patients limp, rotate the limb outward when walking, and support themselves only on the heel. Tight bandaging of the joint reduces pain and makes the limb easier to use.

Laboratory and instrumental studies

X-rays may show a tear in the cortical layer where the ligament attaches.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

What should be examined?

Conservative treatment of ankle ligament injuries

Conservative treatment of ankle ligament injuries is used in fresh cases. After procaine blockade of the injured site (1%ige solution, 10-15 ml), a circular plaster cast is applied from the upper third of the tibia to the ends of the toes. The foot is set up at a 90° angle and turned outwards (hypercorrection, valgus). The duration of the immobilization is 6 weeks. After that, reconstructive treatment is indicated. The joint is immobilized with an 8 mm thick gauze bandage for 1-2 months.

Surgical treatment of ankle ligament injuries

In the case of chronic tears, the ligaments are usually repaired using the Watson-Jones method. The short fibula tendon is used as the material. The duration of the immobilization is 2 months. Postoperative management of ankle ligament injuries is the same as conservative management.

treatment of a sprain

After the first aid, the patient must be taken to the physiotherapy department. The therapeutic strategy depends on the severity of the injury. If most of the ligament fibers are torn, surgical intervention is indicated. All other cases are treated at home.

Medication

In acute pain, intramuscular injection of NSAIDs (Movalis, Orthophen, Ketorolac) is performed. More often, however, taking Nimesulide, Ibuprofen, Diclofenac, Ketoprofen, Celecoxib tablets is enough to make the injured person feel better.

Even 'neglected' joint problems can be treated at home! Just remember to swab once a day for this purpose.

Within a week, the pain sensations stop. However, they are quite mild, so one can get rid of them by applying topical NSAIDs to the foot. These include Fastum, Voltaren, Arthrosilen, Dolgit gels and ointments.

External vein-protecting agents - Lyoton, Troxevasin, Troxerutin, Heparin - are used to quickly dissolve hematomas.

Physiotherapy and massage

Physical therapy for sprains is used in the rehabilitation period to reduce the recovery time of injured ligaments. Patients are prescribed 5-10 sessions of magnetotherapy, laser therapy, UHF therapy, shock wave therapy. Applicants also use paraffin and ozokerite, electrophoresis or ultraphonophoresis with B vitamins, chondroprotectors, calcium salt solutions.

Complications of dislocations

Even after appropriate conservative or surgical treatment, fibrotic lesions form in certain areas of the ligament that are nonfunctional. This leads to a weakening of the connective tissue structures. In the future, these injuries can lead to frequent dislocations and sometimes flat feet. Left untreated, torn ligaments predispose to the development of arthritis and osteoarthritis of the foot.

ICD-10 code

The ankle absorbs the weight of the body when walking. The ankle has a unique structure and the fact that we frequently injure it can be explained by our lifestyle. We don't move much, and that's why the ligaments of the ankle tear even with small falls. The severity of the injury always depends on the age. The older a person is, the greater the risk of injury. The injury can be caused by walking in high heels or by certain types of sports: running, jumping. Some people just have a special structure of the ligaments that they stretch.

[7], [8], [9]

Symptoms of a ruptured ankle ligament

Torn ankle ligaments are associated with pain, swelling and instability in this area. Even if there is no severe swelling, treatment is necessary. If injured again, there may be no swelling, but the feeling of instability will increase. When the ligament is completely torn, the pain is unbearable and walking becomes impossible. Swelling of the ankle and hemarthrosis - bleeding into the joint - occur. X-rays can show bits of bone that fall off when a ligament tears. A complete ligament tear is often associated with subluxations and dislocations of the ankle. After a minor injury (second degree partial tear) it is possible to walk, but the patient has mild pain when walking and limps.

Partial tear of the ankle

As the name suggests, the ankle connects the foot to the lower leg and allows the patient to walk upright. If you suspect a partial ankle tear, you should immediately apply ice to the injured area. Treatment of a partial ankle ligament tear should begin immediately after the injury. The duration of treatment is usually up to three weeks. Surgery to repair the ligament is not necessary. Wearing an elastic bandage or splint is sufficient. Try to elevate the leg as high as possible, for example on some pillows. This relieves the pain. You should not go to the sauna or bathe during the treatment. During the rehabilitation period, massage and physiotherapy are indicated. In the case of a grade 1 fracture, this begins after just one day. For grade 2 fractures, training should begin after 2 to 3 days. NSAIDs should not be taken for more than 10 days. Diclofenac and ibuprofen increase the risk of stomach ulcers. 100-150 mg Diclofenac tablets should be divided into 2-3 doses. For children, the dose is calculated at 1-2 mg/kg of the child's body weight. This dose should also be divided into 2 doses.

symptoms of dislocations

The first symptom that indicates an injury is severe pain. This occurs immediately after microtrauma of the ligament. When the injury occurs, there is a distinctive sound that some describe as a popping sound. After some time, the patient feels the following symptoms:

The pain of the sprain constantly bothers the sufferer. It can increase when trying to move the joint. The intensity of the pain depends on the severity of the injury. With a mild sprain, the sufferer may step on the leg and even move slowly. If the tissue is completely torn, trying to stand up or put weight on the injured limb causes excruciating pain. A severe dislocation is also accompanied by

• a local swelling of the limb;
• local fever;
• bruises and..;
• crepitations (crunching when moving).

Dislocations are often accompanied by damage to other structures. So this injury sometimes occurs in combination with intra-articular fractures and dislocations. In rarer cases, injuries to the spinal cord, limbs, pelvis, and thoracic spine involve dislocations.

causes

Injuries are always caused by increased loads that exceed its elasticity and strength. When a ligament becomes dislocated, part of its fibers tear and the ligament loses its function. Athletes are most commonly affected by this type of injury. Ankle ligament strains are often caused by a sudden twisting of the foot during sudden braking. This injury is therefore very common:

A violent swing of the arm can lead to a dislocation of the ligaments in the shoulder joint. People who play basketball, shot put, volleyball and tennis are at risk of injury. Such injuries can also be caused by shoulder strain. Bodybuilders and powerlifters are particularly at risk for this reason.

Specialists point out that the real causes of dislocations can be hidden. For example, pathological changes in the patient's body can provoke such an injury. The damage occurs as a result of arthrosis, osteochondrosis, endocrine disorders and certain infectious diseases.

Dislocations can be caused by falls or bumps. For example, in women, the problem occurs when the foot rolls up when walking in high-heeled shoes. Obesity and an uneven load on the limbs are also triggers.

Which doctor can help?

Specialist help should not be underestimated. If the ligaments don't heal properly, the sufferer can have serious problems. The patient then suffers, for example, from chronic pain and constant inflammation of the joint. The deterioration of blood circulation in the injured area leads to tissue dystrophy. It is therefore important that the treatment of a serious sprain is carried out by a qualified person:

symptoms of injury.

A sprained leg can vary in severity. This determines the clinical picture of the injury. In the first stage of a sprain, for example, it is accompanied by almost imperceptible pain. Only a few fibers are damaged. Such a condition usually requires no treatment and resolves on its own after a few days. A more serious sprain is a foot sprain where symptoms worsen. The patient complains of pain:

Over time, the ankle begins to move poorly. Some people confuse this symptom with a fracture. When the joint is palpated, the pain increases and imprints of the toe may be left on the skin. There may be an increase in body temperature. All of the above symptoms should be a cause for concern and warrant a doctor's visit. You should never run with an injured leg, as a ligament injury compromises the ability of the joint to protect itself from trauma and heavy loads. It is therefore very important that the dislocation is treated in a timely and correct manner.

Causes of foot sprains

Damage to the ligaments of the foot can be caused by many situations. The most common include:

It is not uncommon for sprains to occur during intensive sports training. This puts a lot of strain on your feet. Sprains occur when, in some people, the strength of the muscles exceeds the breaking point of the ligaments. Some of the most traumatic sports are:

Sprains often occur when a person is moving at high speed and braking too hard. This can happen while skating or inline skating. The causes mentioned above are considered to be the most common. In addition, there are other factors that significantly increase the risk of dislocations. Obese people and people with congenital flat feet are more prone to these types of injuries. It is also important to note that instability in the joints from infection, other injuries, or abnormalities in the body can also cause a sprain.

Which doctor should you see?

If you experience any discomfort in the foot area, you should go to a trauma center immediately. A sprained ankle requires the immediate intervention of a qualified specialist. Doctors responsible for diagnosing and treating this type of injury include:

• How do you treat a sprained ankle?.
• The ankle bruise is where the picture is taken.
• ankle where.
• Treatment of torn ligaments in the ankle.
• dislocation of the ankle.
• How to distinguish a fracture from an ankle sprain.
• The bone where the ankle is located.
• Injury to the ligaments of the ankle.