Ankle sprains, which have the highest incidence of all sports injuries, account for more than 16% of all sports injuries, with one ankle sprain in about 10,000 people per day. In this calculation, there are 5,000 patients in the UK, 27,000 patients in the US and 130,000 patients in China every day.
I. Ankle sprain
As mentioned earlier, ankle sprains are the most common sports injury disease, and many kinds of injuries can occur after a sprain, including ligament damage or rupture, fracture dislocation, articular cartilage damage, tendon damage or rupture, etc. Usually, we refer to sprains as ligament injuries or ruptures, in which lateral ankle ligament injuries are predominant and medial ligament injuries are less common.
The lateral collateral ligaments of the ankle include the anterior talofibular ligament, the heel-fibular ligament and the posterior talofibular ligament, which prevent forward and backward dislocation and inward overturning of the ankle joint. A common cause of injury is inversion of the ankle joint and simultaneous inward rotation of the foot with sprain, with the anterior talofibular ligament being the first to rupture; if the violence persists, the heel fibular ligament will then rupture. Rupture of the posterior talofibular ligament is rare. The sprain is followed by lateral swelling, pain and, in severe cases, ecchymosis, with limitation of movement and even inability to walk with weight.
Examination may reveal lateral pressure pain and pain when the ankle is turned inward. Two special tests are often performed: a positive anterior drawer test indicates a complete rupture of the anterior talofibular ligament; an inversion lateral transfer test indicates a complete rupture of the anterior talofibular ligament or/and the heel-fibular ligament. x-ray examinations, especially stress position films, are meaningful in determining lateral collateral ligament injuries. Magnetic resonance imaging (MRI) can show the lateral ankle ligament more clearly and is important for diagnosis.
The medial ankle ligament, also known as the deltoid ligament, is stronger and generally not easily damaged unless there is greater violence. The diagnosis is similar to that of the lateral ligament injury, the difference being that the injury action and examination action are both ankle turning outward and foot rotating outward.
In the acute phase, ankle sprains should follow the RICE principles, i.e. rest, ice, compression bandaging, and elevation of the affected limb. In the later stage, muscle strength, flexibility and balance training should be performed. Those with simple rupture of the anterior talofibular ligament should begin functional rehabilitation after 3 to 4 weeks of cast immobilization. The treatment plan is determined according to the stability of the joint. The goal of treatment is to return the patient to the pre-injury level of motion as soon as possible and to the greatest extent possible. Surgery is required if the ankle is significantly unstable and both the anterior talofibular ligament and the heel-fibular ligament have torn. The torn ligament is surgically sutured, or if the ligament is torn from its stop and is difficult to suture directly, a ligament stop reconstruction is performed. Rupture of the medial ankle ligament (deltoid ligament)
II. Ankle fracture
Ankle fractures are usually seen in ankle sprains and car accidents. Sports that are prone to fractures include skydiving, skiing, long jump and soccer. Ankle fractures usually occur with ligament injuries and treatment needs to consider the ligament injury.
There are three conditions that can cause ankle fractures.
(i) Ankle rotation plus overturning injuries to the lateral side, which cause fractures primarily of the inner and outer ankle and can be accompanied by separation of the lower tibiofibular joint.
(ii) Medially rotated plus rotational injuries of the ankle, which produce a wedge effect. (ii) Fractures of the medial ankle can occur, and excessive violence results in simultaneous fracture of the external ankle, separation of the lower tibiofibular joint and fracture of the posterior condyle of the distal tibia.
(iii) Fractures caused by the talus impacting backward or forward on the tibial articular surface are caused by the fracture of the anterior or posterior tibia when the talus impacts the tibial ceiling when the heel is impacted by an external force, sometimes accompanied by talar dislocation.
If a fracture is suspected after examination at a sports field, the lower 1/3 of the calf and the ankle should be wrapped with cotton pads under pressure immediately, then temporarily fixed with a splint or brace and transferred to a hospital for regular treatment.
Since poorly repositioned ankle fracture will seriously affect joint function, the fracture should be repositioned anatomically as much as possible. Treatment includes conservative and surgical treatment. Conservative treatment is indicated for fractures without displacement or fractures that remain stable after manipulation and are fixed in a cast for 4 to 6 weeks. Surgical treatment is used for fractures that are difficult to rehabilitate by manipulation or are unstable after repositioning, requiring incision and fixation of the fracture with plates and screws. After the fracture is incised and repositioned, the fracture is temporarily fixed with a Clinique pin or repositioning forceps, and then an internal fixation such as a plate or screw is used.
C. Football ankle
The medical name of football ankle is ankle osteoarthropathy, also known as athletes’ ankle and ankle impingement bone warts. It is mostly seen in soccer, gymnastics, basketball, skiing, weightlifting athletes and dancers, and can seriously affect normal training and competition and improve sports performance.
The main features of soccer ankle are articular cartilage damage, osteochondral formation and chronic synovitis. The causes of morbidity are.
(i) Repeated minor trauma to the ankle joint forming repeated impingement, resulting in bone fragment formation, secondary fractures or joint free bodies.
(ii) joint instability due to ankle ligament injury, which increases the stress on the articular cartilage, causing cartilage damage and degeneration of the articular cartilage.
③Serious trauma such as fracture or dislocation directly causes cartilage damage and traumatic osteoarthritis.
The main manifestations of soccer ankle are sports-related swelling and pain in the ankle joint. The most common symptoms are are running and jumping pain and full squatting pain. X-rays and MRI can clearly show the location and extent of bone and cartilage damage.
In the early stages of soccer ankle, many athletes can still train normally, and those with large bony bulges do not necessarily cause symptoms, so conservative treatment is still very important. The first step in treatment should be to improve training to eliminate the cause of the disease and to strictly control the movements that cause ankle pain.
For example, gymnasts should control the number of high and low strokes, and soccer and skiers should suspend special training. In milder cases, it is not necessary to stop training completely, but to reduce ankle injuries and increase the stability of the ankle joint with bandages or adhesive plaster support bands. In more severe cases, physical therapy, massage or painful spot closure can be used. If conservative treatment is ineffective for more than 3 months, and if there are free bodies in the joint that affect movement or have a “stuck” appearance, surgical treatment should be performed to remove the enlarged bone and treat the cartilage damage to promote repair. For advanced and severe lesions, incisional surgery is required, including ankle fusion and artificial joint replacement.
Prevention of soccer ankle includes strengthening the muscle strength exercises of the foot and ankle to maintain the stability of the ankle joint; strictly controlling the number of gymnastics, skiing and dance training and checking regularly; strengthening the stability of the ankle joint with bandages or sticky plaster support bands during training.
Tendon rupture
There are many tendons in the foot and ankle, which together maintain the movement function of the foot and ankle, among which the most important ones are Achilles tendon, posterior tibial tendon and peroneal tendon. The Achilles tendon rupture causes the most serious dysfunction, so we take Achilles tendon rupture as an example to discuss the problems related to tendon rupture.
The Achilles tendon is one of the most powerful tendons in the human body and can withstand great tension. Except for isolated diseases, rupture rarely occurs in daily life, but it is not rare among students, athletes and actors. In recent years, due to the widespread development of sports and mass cultural activities, the tendency of Achilles tendon rupture has increased, among which gymnasts and martial artists are more common.
The causes of Achilles tendon rupture include direct external forces such as sharp cuts, impacts and indirect external forces such as cartwheels and other abnormal forces on the Achilles tendon. Indirect rupture of the Achilles tendon may be related to a pre-existing disease or injury to the Achilles tendon itself. In athletes, Achilles tendon rupture is associated with an abnormal increase in force on the Achilles tendon due to excessive dorsiflexion (hooking) of the foot.
The skin of the Achilles tendon rupture caused by direct trauma often splits and bleeds, and the Achilles tendon tissue is sometimes visible within the wound. This is easily missed if not carefully examined. The Achilles tendon rupture caused by indirect trauma is painful at the time of injury, with the feeling of being kicked or hit by a stick, and a “pop” sound can be heard, followed by ankle movement failure, inability to stand or walk, pain, numbness and swelling. The examination shows that the shape of Achilles tendon disappears and sinks, the pressure pain is sharp, and the special examination such as pinch calf triceps test is positive. Most Achilles tendon ruptures can be clearly diagnosed by examination, and if in doubt, ultrasound or MRI can be used to help clarify.
Some cases of Achilles tendon rupture treated with plaster immobilization have received good results. However, in the case of athletes, actors, young people with a lot of sports and heavy workers, non-surgical treatment is preferable to surgery, except in cases where surgery is not available or when local skin infection makes surgery inappropriate. The principle of surgical repair is to slightly suture the fibers of the severed end while reinforcing it with a tendon flap. Tendon flap reinforcement increases the strength of the Achilles tendon and reduces the possibility of re-rupture. After surgery, the long-leg cast should be fixed (from the root of the thigh to the tip of the foot), and after 3 weeks, the cast should be changed to a short-leg cast (below the knee), and after 4 weeks, the active flexion and extension of the ankle should be practiced daily in bed with the cast removed, and after 6 weeks, the ankle should be walked on the ground with corrective shoes and the heel should be gradually lowered. Most cases of partial rupture of the Achilles tendon have a history of one acute strain. However, there is no acute history in individual cases, resulting in an incorrect diagnosis. Most cases are painful when completing more intense athletic movements.
There are many foot and ankle injuries, the above is only an introduction to the knowledge of the most common types of sports injuries, wishing sports fans more joy and less injury when playing sports