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The Mechanism of Injury Often Misunderstood
(Ankle Sprain)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article published on page 32 in the March 21, 2012 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Injured ankles are perhaps the commonest injury we see in the emergency department.

The mechanism of injury is often misunderstood.

A typical scenario involves a parent whose child continues to complain about ankle pain several days after accidently twisting it. The concerned parent brings the child into the emergency after several days of limping requesting an urgent x-ray.

The ankle is a unique universal ball-type joint. Most injuries involve the ligaments that hold the bone apparatus in the joint, and explain why you can limp on the injury. If the youngster is able to limp on their own into the facility and the ankle is not swollen like a balloon, shooting a dose of radiation through it is probably not the best choice.

X-rays basically look for breaks in the bone structure and miss the injury. The majority of ankle joint x-rays are normal, but this does not suggest absence of an injury.

Most kids sprain their ankle in what is known as an inversion injury. They ankle gets twisted inwards and weight applied by forward motion of the body.

The ligaments around the joint that serve to hold the bones in place get strained. When ligaments stretch beyond their limit, the fibers within them stretch, tear or can even rupture completely. This is the cause of swelling and sometimes the bruising seen a few days later.

Clinically, we grade the degree of injury as a 1, 2 or 3. If your childís x-ray comes back normal, all it means is that the bone is not chipped or broken.

The injury is still there and needs to be treated accordingly. In the first few days after an ankle sprain producing swelling occurs, treatment is usually ice, elevation, rest and ibuprofen.

It is now considered better to get those minor sprains moving sooner than later. As soon as the pain recedes and walking is comfortable, stretching and building exercises should commence, and a brace should be worn. The value of a brace cannot be overemphasized, since it limits motion of the healing tendon. Most ankle braces fit into shoes and can be worn during sports such as volleyball, basketball and running.

The ankle joint is pretty amazing. It supports the whole body and can tell where your centre of balance is and prevent tipping over by respond with movement instantaneously.

It employs thousands of receptor cells on the inside surfaces to accomplish this effectively. These huge array needs to be reset and retuned as the ankle heals. As many older people have learned the hard way, if you donít take good care of that sprained ankle, it will heal with scarring and slight lengthening, which leads to a feeling of instability later on.

Related resources:

Sprained Ankle from Orthoinfo, American Academy of Orthopaedic Surgeons (AAOS). How It Happens, Mechanism of Injury, Grades 1, 2, 3 Sprains, Diagnosis, Symptoms, Treatment (Non-surgical and Surgical Treatments), Rehabilitation, Prevention, Is It Acute or Chronic?
How to Treat a Sprained Ankle. YouTube video, 2:42 min.
Ankle Sprain. Causes, Symptoms, Diagnosis, Treatment and Prevention, from eMedicine Health.
Sprained ankle from Wikipedia.
Ankle Sprain What is a sprained ankle? By Jonathan Cluett, M.D., About.com Guide
Ankle Sprain from Sports Injury Clinic. Ankle sprain symptoms, treatment, rehabilitation and prevention tips as well as how a professional may treat the injury.

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