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Instability of the ankle joint

The ankle joint, due to its structure and the loads placed on it, is one of the most vulnerable joints in the lower limb. 

Ankle instability: The legs of the Lord who runs in the stadium

Despite the prevalence of ankle injury, its diagnosis and therapy are still neglected, which in 20% of cases results in chronic instability in the future. We then speak of “the habitual ankle sprain”.

It has also been proven that 80% of degeneration cases arise from late complications of a sprain.
The structures protecting the joint include muscles with their tendons and proprioreceptive fibers contained in them informing about the position of the joint / body in space. Damage to them (permanent or impermanent) contributes greatly to their instability.

The mechanism of the injury seems to be obvious and the therapy is simple, however, it is worth remembering that during the sprain, the damage to the mechanoreceptors of the articular capsule, which results in such consequences as disturbed perception of the foot position, weakening of the muscle strength of the sagittal group, neurological deficits.
The most common type of sprain is inversion (lateral) sprain, resulting in varying degrees of damage to the anterior talofibular ligament (ATFL). Injury may be due to the sudden placing of your foot on an uneven surface during sports (or walking), an incorrect jump landing, or loss of control and unfortunate stride.

Common ailments include:

-pain, especially when you try to walk,
-edema,
-hematoma,
-reduced range of motion in the joint.

The patient, after an untreated injury, reports problems in functioning during standard activities. A moment of inattention causes incorrect “stomping” and recurrence of the injury. If you suspect a reoccurrence of a sprain, it is worth using several tests to facilitate diagnosis. It will include joint range of motion test, Romberg test, tibial muscle strength test, ankle drawer test. X-ray examination showing changes taking place within the injury may also be useful.

Treatment depends largely on the extent of the damage, but the standard protocol that works well in the event of a sprain is the P.O.L.I.C.E, that is:
  • P (protection) – protection
  • O.L (optimal loading) – gradual activation and loading of the joint
  • I (ice) – cooling
  • C (compression) – oppression
  • E (elevation) – elevation

In the initial phase, it is also worth introducing analgesic therapy.

In addition to pharmacological agents in the case of chronic instability of the ankle, analgesic therapy includes manual techniques, dry needling, soft tissue therapy, and shank muscle rolling.

It is worth remembering that an untreated state of chronic instability may necessitate surgical intervention. In the case of advanced degenerative changes, arthroplasty is the only solution. Therefore, let’s not underestimate even minor injuries and use the possibility of visiting a specialist.

Bibliography:

  • Boruta P.M., Bishop J.O.,Braly W.G., Tullos H.S. Acute lateral ankle ligament injuries: a literature review. Foot Ankle, 1990, 11 (2): 107–13
  • Yanyu Chen “Diagnosis and Treatment of Chronic Ankle Instability”. IntechOpen 2019
  • Stolarczyk A., Śmigielski R., Adamczyk G. Proprioception in the aspect of sports medicine. proprioception in the aspect of sports medicine. Medycyna Sportowa, 2000, 107: 23–26
  • Li, Lu et al. “Function of ankle ligaments for subtalar and talocrural joint stability during an inversion movement – an in vitro study.” Journal of foot and ankle research vol. 12 16. 18 Mar. 2019, doi: 10.1186 / s13047-019-0330-5

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