Ankle Sprains

Ankle Sprains

The most common type of ankle injury is a sprain. A sprain results from the stretching and tearing of small ligaments (fibrous bands connecting adjacent bones in a joint). There are many ligaments surrounding the ankle that can become damaged when the ankle is forced into an unnatural position. Although ligament damage frequently occurs during athletics or exercise, ankles are just as often injured stepping off a curb, into a pothole, or onto uneven ground.
The most frequent type of sprain occurs when weight is applied to the foot when it is on an uneven surface, causing the foot to 'roll in' or 'turn' (inversion). This places the sole of the foot in such a position that it points inward as force is applied, so the ligaments stabilizing the outside part of the ankle become stressed. Many people report hearing a 'snap' or 'pop' when an injury of this type occurs. Following such an incident, one experiences difficulty walking and, in a short time, the outside aspect of the injured ankle begins to cause pain and swells, sometimes so excessively that people believe it is broken.

Upon physical examination, the ankle will exhibit swelling and discoloration (black and blue) over the outside part of the joint. Touching of the area will result in a variable amount of discomfort. Frequently, there is instability notes on the drawer test as the heel structures are moved forward and back as the leg is stabilized. Range of motion (ROM) in the ankle can be limited due to pain and swelling, but strength is not usually affected. X-rays are essential, as the possibility of a fracture must be ruled out.


Degree of Severity of Ankle Sprains:


Grade 1
Mild sprain, mild pain, little swelling, and joint stiffness may be apparent
Stretch and/or minor tear of the ligament without laxity (loosening)
Usually affects the anterior talofibular ligament
Minimum or no loss of function
Can return to activity within a few days of the injury (with a brace or taping)

Grade II
Moderate to severe pain, swelling, and joint stiffness are present
Partial tear of the lateral ligament(s)
Moderate loss of function with difficulty on toe raises and walking
Takes up to 2-3 months before regaining close to full strength and stability in the joint

Grade III
Severe pain may be present initially, followed by little or no pain due to total disruption of the nerve fibers
Swelling may be profuse and joint becomes stiff some hours after the injury
Complete rupture of the ligaments of the lateral complex (severe laxity)
Usually requires some form of immobilization lasting several weeks
Complete loss of function (functional disability) and necessity for crutches
Usually managed conservatively with rehabilitation exercises, but a small percentage may require surgery
Recovery can be as long as 4 months

Q angle

The Q angle is the angle formed by a line drawn from the anterior superior iliac spine to the midpoint of the patella, and a line drawn through the midpoint of the patella and the tibial tuberosity. A large Q angle has been suggested by some investigators to predispose to patellofemoral pain syndrome and has been used to explain the female predilection to the syndrome; a larger Q angle may create lateral hypermobility, resulting in abrasion of the patellar cartilage.

A 'normal' Q angle varies from 10 to 22 degrees, and measurements vary from physician to physician. In addition, several studies have found similar Q angles in affected and nonaffected legs. Thus, the importance of the Q angle in the pathogenesis of patellofemoral pain syndrome is unclear.