Ankle Sprain (एड़ी में मोच): Management, Recovery time and Ankle Ligament Surgery

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Ankle Sprain (एड़ी में मोच): Management, Recovery time and Ankle Ligament Surgery

In this video SimpliHealth expert Dr. MS Narula, Senior Consultant Orthopedic Spine and Joint Replacement at Apollo Clinic and City Hospital, Chandigarh, is talking about ankle sprain (एड़ी में मोच), its management, recovery time and ankle ligament surgery. 

Our experts talks about the most missed entity, a Muscle tear. People oftent miss it because often, thay ignore this condition; and the ankle ligament injury is not correctly diagnosed. And more importantly, we either overlook its treatment or treat them wrongly, and a few times, there is a delay in treatment. So it’s a nagging injury that may seem harmless, but it is not very pleasant. And it may last for years.

Almost every day, patient come in with a twisted ankle. They say they twisted their ankle six months ago, but now they are having muscle tears, swelling, and pain. The ankle has become unstable, which might irritate the patient for years. That’s why it is a missed entity. So we call this condition an ankle sprain. 

WHAT IS AN ANKLE SPRAIN?

The Ankle sprain is a ligament injury. Ligaments are soft tissue, but these are our elastic and intricate structures that connect our bone to another bone. We call them ligaments. And they hold significance in the legs because they connect our leg bone to the ankle. As you can see in this model, here is our foot, and this arrow is our leg. These ligaments connect our legs to our ankle and hold great importance; since they provide movement and stability to the ankle. 

A tear in a ligament happens to be very painful for the patients. Most patients come to us and say that they twist their ankles while walking on uneven surfaces or women wearing heels, and this condition is very common in sports. 

Complete or partial ligament tear 

As mentioned earlier, ankle sprains occur when you miss your step while running, jumping, and skipping. Also, we twist our ankles while climbing the stairs upwards or wearing heels. So the ankle twists slightly inside. So all these things lead to slight movement of the ankle towards the inner side. And when they twist inside, there is a tear in the ligaments. 

It can be a partial or complete tear or a simple sprain. So as mentioned, these are the elastic structures that contract, but if we stretch beyond the limit, they will break. It will allow movements like a rubber band, but it will break if you try to push beyond its limit. Similarly, a tear in ligaments is commonly called an ankle sprain.

HOW CAN WE DIAGNOSE IT?

Often patients with twisted ankles complain that they have sore ankles, difficulty in putting pressure, and there is swelling outside the ankle. Naturally, they are in much pain. 

Unfortunately, we can’t visualize these ankle sprains or ligament injuries in X-Rays. Only bones are visible in X-Rays, due to which these injuries are either ignored or overlooked. Often patients get X-Rays from local areas, and then they say that the X-Ray doesn’t show any bone injury. They think it is not a big deal if we do not have any bone injury. 

Please note that the ankle or knee is our weight-bearing joint, and this ankle is a tiny joint that has to bear all the body’s weight throughout the day. The ligament delicately balances the ankle joint. If there is an injury in the weight-bearing joints, it will hurt more than the fracture. Fractures may heal, but the damage to the ligaments is bothersome. After ligament injury, please don’t sit at home.

The doctor usually applies crepe bandages for two days, thinking it will be fine and the patient can go back to work. Untreated ankle sprain might irritate you for months to years. What you do in the first three weeks matters the most. We mostly don’t need an X-Ray, but we advise the patient for an X-Ray to rule out the possibility of a fracture. So this is a clinical diagnosis where we examine the patient’s activity, ankle movement, and whether there is a complete tear or a partial tear. Ligament injury is a clinical assessment, and an X-ray can’t diagnose this condition. After diagnosing an ankle sprain, the second step is its treatment. 

ANKLE SPRAIN TREATMENT

The treatment depends on the extent of the injury and whether there is a partial or a complete tear. How much is the pain and swelling at the same time? Remember that you must follow RICE treatment wherever there is a muscle tear, or you have some injury. If we follow RICE treatment for initial 24-48 hours, all the symptoms will reduce. R stands for Rest, I for Icing, C for Compression, and E for Elevation. 

After any muscle injury or similar injury, you may start RICE treatment by yourself within 24 hours of injury before coming to the doctor. RICE treatment will reduce the course of injury and symptoms. It is necessary to rest in this, and if your ankle is hurt, then the only way to relax is to either sit on the bed or rest on the chair so that it doesn’t bear the body’s weight. 

As mentioned before, I stand for Icing; it is the most critical factor to reduce your pain and inflammation. No amount of pain reliever can help you ease the pain compared to icing. One should do icing for at least 48-72 hours. The next question is how long we should do the icing.

HOW LONG SHOULD WE DO ICING?

One should never apply direct icing to the injury. You can either use ice wrapped in cloth or ice packs readily available in the market. Direct ice application may cause skin burn, so you must use ice packs or ice wrap in cloth for 10 to 15 minutes, and repeat this four to five times. You can do it six to seven times on the first day of injury. 

Otherwise, repeat for 4 to 5 times for 10 to 15 minutes; you will get much relief. As mentioned, R stands for rest, I stands for icing, and now C stands for compression; otherwise, we can also use a splint. 

Usually, the patient may apply a crepe bandage after injury before going to the Doctor. And they can use braces too. E means Elevation. The more we keep the ankle elevated, it will reduce the swelling. The idea of ​​​​elevation is to keep it above the level of the heart. You can keep two pillows below the ankle. So if you do all these things for 48 hours, it can shorten the symptoms upto a great level. 

WHEN SHOULD WE SEEK THE DOCTOR?

Ideally, you shouldn’t ignore any ankle sprain. As the doctor said earlier, this is a missed injury. You must always consult a doctor. Initial treatment will remain the same, i.e., RICE which we can do at our respective homes. In today’s era, we treat ankle sprains just like fractures. We advise the patient to take a plaster because we need to immobilize it. 

Like instructed, I in RICE stands for icing, but there is immobilization also. If you broke something, then it is necessary to keep it in one place; if the same thing keeps on moving, if you keep putting on weight, then an injury that would cure in three to 4 weeks might take 3 to 4 months to fix and  even longer. Either you can use a brace or ankle splint.

In most cases, the doctor does recommend plaster for 3-4 weeks. And these days, there are fiber cast plaster which allows a little weight so we can even walk easily with the help of a walker. So if you do all these things, you can treat ankle sprain to a much greater extent. 

HOW LONG IS THE ANKLE SPRAIN RECOVERY TIME?

It depends on the muscle tear; is it a partial or complete tear. According to the doctor, we can’t diagnose ligament injury by X-ray. However, you can interpret this by MRI, but there is no need to do MRI in every case. At first, the doctor does plaster, but if it is not working, the pain has not receded in the first 3 to 4 weeks, then he feels that there is a pervasive injury in which the ankle has become unstable. 

Then the doctor does MRI, but the MRI is not required as much. These ligament injuries heal in a few weeks if they are partial or minor injuries, but it may take more than three months or even years to recover. For three months, you have to take care of yourself; even if the plaster is removed, you need to take care of yourself, walk properly, and exercise. 

WHAT IS THE FUTURE TREATMENT?

When we put plaster for 3 to 4 weeks, it is not that we can immediately put weight on it; we advise them to do gradual strengthening exercises. Just like I gave an example of a rubber band. While stretching, we break the rubber band; then it will recover in an extended position; if it does not get the rest, then our rubber band will remain loose; so the same thing happens with our ligament. 

If the ligament remains loose, they either will not join again or might join in an extended position that will be painful. So this type of ligament will lead to two things: pain or swelling, or the ankle will remain unstable and may twist every 2-3 weeks. So after we remove the plaster, you should do some ankle strengthening exercises to avoid this recurrent ankle twisting.

WHEN DO WE NEED THE SURGERY?

Only 2% of the cases require surgery for an ankle sprain. However, where there is an extensive ligament tear or ankle stability, even after plaster and exercise, the pain is not receding, then we recommend surgery in 5% of cases. 

But in most cases, it can be healed by the RICE treatment followed by plaster and exercise. So please don’t ignore your ankle sprain; we can cure it very well if it is treated well in time, and anytime you feel that there is a muscle tear, you must seek the  Doctor who will advise you correctly. Follow their advice.

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