What to do with an ankle injury?

In Germany alone, over 22 million people exercise regularly. Sometimes, injuries or signs of wear and tear of the joints occur. Ankle injuries are prevalent. We spoke to the Stuttgart orthopedist, Dr. Christian Mauch, about causes, risks, and consequences.

Ankle injuries are prevalent in athletes. Why?

Dr Mauch:  Because the joint is stressed in many sports and has a complicated structure, It consists of the lower and upper ankle joints and is stabilized by three outer and two inner ligaments. A typical injury is a  torn ligament. The lateral ligament tear is the most common human injury and usually occurs after twisting. Most of the time, the foot bends inwards at the upper ankle joint.

 

How do I recognize an ankle injury?

First of all, of course, because of the severe pain in the outer ankle area. After that, a sickle-shaped bruise forms, and the foot can hardly be moved.

Now it happened. So what?

See a doctor! Even seemingly harmless injuries must be treated by an orthopedist. Compression cooling is recommended as first aid. The affected joint should be cooled with ice and stabilized with a pressure bandage. This will prevent ankle swelling. And, of course, the joint should be stressed as little as possible.

 

How is an ankle injury usually treated?

The lateral ligament tear is always treated conservatively, i.e. without surgery. The most straightforward measures are also necessary: relieve and protect the foot. The ligaments usually heal completely within four to six weeks with a special bandage with a removable splint (aircraft) and simultaneous physiotherapy.

But what if you still complain about ankle instability and pain after a long time?

This can have several causes. Either the ligaments have not grown together optimally, the ligaments are looser, the ankle joint is unstable, or scar tissue has formed. The first choice is special physiotherapy. If this does not lead to the desired success, it is advisable, especially for competitive athletes, to have the ligaments surgically reconstructed using the so-called periosteal flap plastic.

And what happens in this operation?

This surgical technique separates a strip-shaped part of the periosteum from the lower leg via a skin incision. This strip is then cut in half, folded over, and anchored to the lower attachment points of the stretched or torn ligaments as a replacement ligament. Thus, the ligament structure of the ankle is restored.

 

Sounds complicated…

… but it is not. Periosteal flap surgery is a relatively routine and effective treatment for ankle instability. Even patients who have suffered from chronic ligament injuries for a long time are fit again in a few weeks thanks to this technique. After the operation, the joint must be immobilized for three weeks. After another six weeks of exercise therapy, the new ligament has healed, and the joint is stable again.

They warn against not taking a torn ligament seriously. What are the risks?

In the worst case, instability of the joint leads to cartilage damage in connection with arthrosis. In addition, the joint remains restricted in its movements for a long time and can only be fully loaded with pain. This is particularly bitter for athletes. After all, this always involves longer training breaks.

So, what would you recommend athletes with such an injury?

An ankle injury is often taken lightly. But it is often forgotten that the joint is critical in almost every sport. Therefore, it is crucial to heal the torn ligament completely. The following rule of thumb applies: the ankle can only bear total weight again four weeks after the injury.