Treatment of Ankle Sprain, Ankle Fracture

Ankle sprains //

An ankle sprain can range in severity from very mild to a severe disruption of ankle ligaments and even fractures. Mild sprains will settle with some physiotherapy and RICE. Moderate and Severe Ankle Sprains are best investigated and then treated appropriately.

WHAT IS USUALLY INJURED WHEN AN ANKLE IS SPRAINED?

The common ankle sprain is an 'inversion injury' or in other words rolling over the lateral border of the foot and ankle. Done with enough force the ligaments which should protect the ankle from inversion injury will rupture. The common ligaments to be injured are the ATFL and the CFL. The ATFL is the anterior talofibular ligament. The CFL is the calcaneofibular ligament.

LIST OF POSSIBLE INJURIES:

Lateral Ligament Rupture (Grade III Ankle Sprain)
High Ankle Sprain (Syndesmosis Disruption)
Osteochondral Lesion of Ankle (OCL)
Peroneal Tendon tear
Peroneal Tendon Dyslocation
Peroneal Tendon Rupture
Achilles Tendon Rupture
Talus Fracture
Ankle Fracture
Navicular Fracture
Base of 5th Metatarsal Fracture
Cuboid Fracture
Spring ligament Rupture
Tibialis Posterior Tendon Rupture
Avulsion of Accessory Navicula
CRPS
Midfoot fracture dislocation

Foot and ankle fractures //

RICE

Rest, Ice, Compression and Elevation are the best immediate treatments for a sprained ankle. If you can walk on your ankle it may be that RICE and some expert physiotherapy is all you need.

XRAYS & URGENT APPOINTMENT IF:

If you can't walk on your ankle you need to attend A&E for xrays to look for a fracture. (If you can't walk on your ankle please don't let the junior doctor or specialist nurse send you home without crutches.)
If your ankle won't move normally you need an urgent appointment
If you heard a loud snap and your ankle is extremely swollen you also need urgent review

WHAT WILL HAPPEN IN CLINIC?

You will have a detailed history and examination, specialist Xrays and most likely an MRI scan.
You may need to go into a plaster or a walking boot.
Many in fact most injuries do not require surgery.
Whenever possible I will produce a list of the structures that have been injured and a plan for rehabilitation for you

Broken bones in the foot and ankle can range in severity from very mild to a severe disruption and fracture.

If you have had a stable injury this means that the injury should heal with the structures in your foot being able to function again. Stable injuries often need time in a splint or even plaster, crutches, and physiotherapy.

If you have an unstable injury it is much more likely than you will need surgery and you must prepare yourself for a longer recovery. If the broken bones can be held in the right position you may have the option of being treated in plaster but you will also need to be on crutches not putting any weight through the leg until the bones heal.

Most unstable injuries to the bones of the foot and ankle require surgery. ORIF stands for Open Reduction Internal Fixation. Open means a surgical incision so the surgeon can access the broken bone. Reduction means the surgeon will align the bones back together (as perfectly as possible). Internal fixation means the surgeon will then hold the bones back together while they heal with an implant. Normally the implant is a metal plate and screws but many other implants are becoming available.

Vitamin D deficiency is common in the winter months. There also is some evidence to support higher dose Vitamin D supplementation to improve fracture healing. There are many supplements available at the chemist. Look for one containing:
Vitamin D D3* 1000 IU (25 µg)