‘Different Grades of High Ankle Sprain’
As discussed in last week’s article there are 3 grades of High Ankle strain damage that occur from traumatic twisting or landing movements.
High Ankle Ligament Grade 1
Mild tenderness over the front of the ankle joint, patient can often pinpoint this tenderness. Injury consists of a straining of the Anterior Tibiofibular ligament with often no damage to the interosseous membrane (also known as syndesmosis as illustrated) overlying interosseous ligament and ligament that sits between the tibial and fibula bones of the lower leg. Patient can have some Pain on walking and standing but is generally able to walk painfree without crutches after 2-3 days.
High Ankle Ligament Grade 2
Tenderness noted from the front of the ankle joint extending upwards along the outside border of the shin bone. The Patient is unable to stand or walk on the ankle for up to 1-2 weeks and will often require the aid of crutches for approximately 7 days until they can commence partial weight bearing on the ankle joint. This grade of injury will involve disruption of the Interosseous membrane and a tear to the interosseous ligament with a significant tear to the Anterior Tibiofibular ligament.
High Ankle Ligament Grade 3
Significant Pain and tenderness is present with complete inability to weight bear on the ankle joint. The following ligament damage can occur, tear to the deltoid ligament on the inside of the ankle joint, excessive separation or parting of the adjoining tibia and fibula bones which is known as Diatasis. This results in significant tearing of Interosseous membrane, the overlapping Interosseous Ligament and tearing of the Anterior & Posterior Tibiofibular ligament. In addition a fracture can occur to outer fibula bone approximately 2 inches above the ankle joint. X-ray of the ankle joint is hugely important in determining the extent of ligament & bone injury. In cases of grade 2 & grade 3 interosseous membrane (also known as syndesmosis as per illustration) tearing where there is significant tearing instability, a surgery may be the best option for a speedier return to sport etc.
Management & Treatment
Initial management involves the Physical therapist with the assistance of x-ray diagnosing the grade of High Ankle sprain. Icing, rest, and bandage compression in required to reduce inflammation with the patient discontinuing using crutches once walking becomes painfree. The patient progresses to a strengthening program of staged progressions under the Physical therapists guidance. In addition manual mobilisation on a graded level is required to increase mobility in what is a restricted ankle joint.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles.
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