Ankle distorsions part I; what exactly is an ankle distorsion?

A Swedish doctor named Per Renström, with a specialty in the subject of ankle injuries, lectured on the topic in the Sports Medicine course I most recently participated in. He was up to date on the latest research in the area; there is some research, but mainly on the general population. Some information about this;

• Ankle sprains is still one of the most common injuries athletes encounter - does not matter if you are into recreational sports or an elite athlete.
• Functional training of the ankle is a successful rehabilitation. But studies have shown that about 20% have residual problems after rehabilitation.
• In addition to these 20%, many people do not take care of their ankle sprains, or do not go through the whole rehabilitation.

A common sight of a quite severe
injury that wasn't taken care of
immediately.

I will focus on the more common kind of the distortion – the lateral distortion (outside of the ankle).

However, an ankle sprain is not so bad...!? Must I rehabilitate it? You just jump in and continue to play / train, right...? Well, not always, depends on how much has been damaged - and if the player still has the good function of the foot. I’ll return to the subject of good function later. There is a risk of greater damage, and the damage which already occurred could worsen - and when the swelling is allowed to expand, the healing time is much longer. (If you haven’t read the post, "Take care of your acute injuries!", I advise you to do so).

An ankle sprain is simply a dislocation, where the person often steps down with the whole weight on one foot that is entirely on the side. The trauma this causes depends on the force directed downward and how long it lasts. One can step a little crooked, but get the foot back to the normal position quickly - not such a big trauma, but if you land on the foot when it is in the wrong position - major trauma.

The damage occurs then on several tissues;

1. There are two exterior ligaments that can be damaged, if the trauma is great, often both ligaments are damaged - which of course provides greater anatomical instability. If unlucky and the tear is from the ligaments’ attachments to the bone; small bone fragments can detach and cause pain until found and removed or resolved/decomposed by the body.
2. Inside the ligaments, we have a joint capsule. This joint capsule encloses the entire ankle joint from all sides, encloses the lower legs and covers down to the bone parts in foot. The joint capsule could be damaged and stretched - and if there is a discoloration of the foot, it has also often been torn.
3. The ankle consists of several joint surfaces. Above all, it is the top that can be affected. The upper ankle joint consists of three parts; the two lower legs that create a dome, and the Talus. When the foot is situated laterally, the Talus hits the dome roof above in two different places. It can be a gentle force so that it does not create a big reaction in the ankle and cartilage, but it can also be a nasty blow that damages the cartilage, and can (although it is quite rare) cause a tiny sliver detachment of Talus’ edge.
4. Dislocation of the Fibularis muscles tendons, which lifts the foot outward, and are functionally stabilizers of the foot laterally. The tendons starts sliding over the outer malleolus instead of being stuck behind the ankle - which both hurts and degrades the functional stability.
5. Many more things can happen, but som more unusual than the last two points. Among other things, one can encounter syndesmosis injury inte the lower leg, avulsion fractures in the foot, compression injury to the inside of the foot, nerve damage / irritation on the outside of the foot due to the stretching.

Bony parts of the upper ankle
joint.

How do you know the severity of the injury, and when the athlete can return to sports? Well, that is not easy, but I'll do my best to go through it in the next post...