It is very difficult to distinguish between a sprained ankle and a broken ankle. Whenever your ankle gets hurt, the primary concern is about having an ankle sprain or an ankle fracture. Today, in this article, we are going to discuss sprained ankle vs broken ankle & how they can be treated?
Let’s discuss both of them one by one:
What does a sprained ankle mean?
A sprain is a term that denotes injury to the ligaments. A sprained ankle is an injury to the ligaments of the ankle. Ligaments of the ankle help to hold your bones of ankle together & help in stabilizing the joint.
The ligaments of the ankle are injured when a plantar-flexed foot is forced suddenly into inversion (lateral ligament) or eversion (medial ligament). Lateral ligament injury is the most common.
We are going to discuss the lateral ankle sprain into three categories: Acute sprain, chronic sprain, & complete rupture.
ACUTE ANKLE SPRAIN
This injury is common in sports activities such as pole vaulting, cross-country running, and hiking. It is also quite common when a person slips off the pavement or walks on an uneven surface.
Clinical features-
History- The patient will describe ‘going over’ at the ankle.
Pain- There is sharp pain just below and anterior to the lateral malleolus at the time of the injury. Passive stretching and weight-bearing will increase the pain.
Swelling– Swelling will be present from the lateral border of the tendo Achilles, over the lateral malleolus along the dorsum of the foot. In severe injuries, the swelling may spread to the dorsum of the toes and up the leg.
Bruising– This will appear under the lateral malleolus and over the dorsum of the foot.
Loss of function– All weight-bearing will be painful so the patient cannot run & has a gait with a very short stance phase on the affected foot.
Treatment–
IMMEDIATE TREATMENT
Application of cold- The foot and leg may be immersed in ice-cold water to mid-calf level for 20 minutes. Alternatively, the leg may be placed in elevation and a towel wrung out in icy water, wrapped around the foot and ankle for 20 minutes.
Compression and support- A minor sprain may be treated with a crepe or elastic bandage, which may have reinforcing zinc oxide strips. There may be walking in a minor injury but running, jumping, and such activities must not be for a few days.
SUBSEQUENT TREATMENT
After 2-3 days, the treatment should be as follows:
Ultrasound- over the site of the injury to limit the adhesion formation by moving inflammatory exudate. It also stimulates the repair of collagen.
Massage- It should be in the form of kneading and effleurage to soften and clear edema.
EXERCISES
Free active exercises are helpful in acute ankle sprain which we will discuss further in this article.
CHRONIC ANKLE SPRAIN
Clinical Features-
Pain– Dull ache over ligament which may become sharper during prolonged walking or running.
Swelling– Thickened swelling is often present under the lateral malleolus and along the tendo Achilles.
Loss of movement– Plantar flexion with inversion will limit and feels tight.
Instability– Balancing on the affected leg will be difficult.
Treatment-
Aims of treatment are as follows:
- To mobilize the ligaments from underlying structures.
- To restore the flexibility of the ligament.
- Strengthen the muscles related to the ligament.
- To re-educate proprioception
Mobility of the joint is regained by soft-tissue manipulation to reduce swelling and restore mobility. Active exercises are essential. When pain is the restricting factor, pulsed electromagnetic energy, or interferential treatment may be helpful.
The flexibility of the ligament can be regained by using transverse frictions, passive stretching, ultrasound, and active exercises.
Strengthening of the muscles is achieved by active exercises resisted manually or mechanically.
Proprioception can be achieved by PNF techniques, weight-bearing activities, and by balance (wobble) boards.
COMPLETE RUPTURE
A violent force that produces plantar flexion, inversion, and adduction of the foot may be the cause of this. Often the patient falls with the foot twisted under the body weight.
Clinical features-
Pain– Severe pain over the ligament area.
Swelling– Immediate swelling denoting severe injury will occur on the lateral side of the ankle and over the dorsum of the foot.
Instability– There is an excessive range of inversion and adduction.
Loss of function– The patient is unable to walk or to take any weight at all on the foot.
Radiograph– Abnormal sideways tilt of talus showing on X-ray
Treatment-
There is usually a surgical repair of the ligament followed by a below-knee plaster cast for 6-8 weeks to immobilize the ankle. Immobilization alone may also be helpful for 6-8 weeks.
Physiotherapy Exercises For Ankle Sprain
What does a broken ankle mean?
Ankle fracture or a broken ankle is an interruption in the continuity of the bone which may be a complete break or an incomplete break or crack.
The ankle joint consists of 3 bones- the tibia, fibula, and talus. Break or crack in any one or more bones around your ankle joint causes ankle fracture.
Usually, they occur as a result of twisting force or sometimes from a direct vertical compression force.
Clinical features-
The features will vary depending on the cause and nature of the injury. If the injury is severe, the patient may feel unconscious. In other cases such as fatigue fractures, the patient may be able to use the limb although complaining of pain.
Generally, the following features will be present:
- Shock- This will vary according to the extent of the injury, the position of fracture, the age of the patient, and the circumstances of the trauma.
- Pain
- Deformity
- Edema
- Marked local tenderness
- Muscle spasm
- Abnormal movement and crepitus
- Loss of function
Treatment-
In fractures without displacement, a below-knee plaster cast for 3-6 weeks is applied. When there is displacement, it is important to ensure that reduction establishes the normal relationship at the ankle joint. After the reduction, a below-knee plaster cast application for 8-10 weeks is helpful.
If the reduction is not attaining, then it may be necessary to have an open reduction and use of screws to maintain a good position of the fragments. After that, a below-knee plaster cast is applied.
Physiotherapy management-
DURING IMMOBILIZATION:
Initially, the aim is to reduce the edema. The patient has to maintain his limb in elevation for most of the time. Some movements should be there such as hip and knee movements in the lying position. This will assist in the reduction of the swelling as well as maintaining the movements at these joints.
Toe movements and static ankle muscles contraction exercises during immobilization help to prevent wasting of muscles. Sometimes, the patient may start non-weight bearing exercises using crutches progressing to partial and then full weight-bearing.
AFTER REMOVAL OF FIXATION:
Fractures with no displacement will mobilize quickly and need very little physiotherapy. However, displaced fracture and fracture that remain immobile for longer periods present with stiff foot and ankle.
The physiotherapist must assess the range of motion of these joints and the strength of muscles. There may be flattening of the arches supporting the foot and strengthening of the muscles supporting them should be there.
Sprained ankle vs broken ankle: How to differentiate?
SIGNS OF ANKLE SPRAIN:
- Ability to bear some weight
- Mild to moderate pain
- Some swelling and bruising
- Unstable ankle
SIGNS OF BROKEN ANKLE:
- Unable to bear weight
- Moderate to severe pain
- Immediate swelling and bruising
- Ankle deformity
To figure out sprained ankle vs broken ankle, you need to ask some questions to yourself:
Was there any noise when the injury occur?
Sprains usually occur without any noise. If there is a popping sound, then it may be a fracture of your ankle.
How severe is your pain?
If you are feeling severe pain immediately after the injury, then there are more chances of a broken ankle. Pain in ankle sprain usually gets severe after some time.
How did you get the injury?
If there is twisting of your ankle, then you have more chances of getting a sprain. But if it is a direct blow to your ankle, then it may be a fracture.
At which part of your ankle you’re feeling pain?
If pain is over the bone, then it may be due to a broken ankle and if it is hurting over your soft tissues, then you may be dealing with only a sprain.