Understanding Ankle InjuryAuthor: Simon Moyes
Around 1 in 10,000 people sustain an ankle injury each
day and about 5% do not fully recover. Generally, the typical sorts of
ankle injuries fall into two categories: acute sprains or overuse
Some specialists prefer a two to three week period immobilising the injured ankle in a walking plaster cast to reduce chronic instability and further problems. In either event after six to twelve weeks, around 95% of these injuries make a full recovery.
During any game of sport, the ankle is subjected to enormous pressure. Over time a variety of injuries can occur. When repetitive minor injuries occur to the Achilles tendon swelling, inflammation and partial tears to the collagen fibres are produced. This condition, known as chronic Achilles tendonitis is very difficult to cure. Treatment often involves long periods of rest, physiotherapy, the use of ultrasound, and the modification of footwear.
In mildly arthritic or worn ankle joints, small pieces of bone may break off. This can present with pain, swelling, locking, a sensation of instability and occasionally the joint can give way.
For those who have injured themselves whilst playing sport, it is best to stop playing immediately as continuing can further aggravate the injury. Pain is, after all, the body's way of telling us that something is wrong. Similarly if joints are regularly locking, clicking or giving way, this is an indication that something may be amiss. During exercise the body secretes its own morphines which can mask the pain arising from a damaged joint, muscle or tendon. Athletes or sports enthusiasts who ignore pain are more likely to develop further problems later on. Resting, applying ice and or locking in their ankle really should be referred to a specialist for treatment.
Until five to ten years ago, surgery in this area of the body was a lengthy and painful ordeal. Surgery required the patient to stay in hospital, certainly overnight and more usually for two or three days. Accessing the joint meant making a fairly large incision which, combined with the effects of the general anaesthetic added to the recuperation period. What's more, the patient left hospital on crutches, often in plaster, with a sizeable scar.
In practice, very few ankle injuries could be treated and the results of surgery were often unsatisfactory. The joint was just too small for the instruments available and for surgeons to see inside the joint.
Ankle Surgery Today
Technological developments have led to ankle arthroscopy or keyhole surgery, which has transformed the treatment of ankle injuries. Two or three tiny holes are made around the ankle, into which 2mm wide fibre optics are fed. Surgeons are able to carry out the intricate range of repairs and procedures whilst watching the operation on-screen. This type of surgery can usually be undertaken as a day-case procedure. Patients typically experience very little postoperative pain and are able to walk out of hospital with no difficulty.
Results are better, there is less discomfort involved, shorter hospital stays, lower complication rates and shorter recovery times. The cosmetic results are better too - very often just a couple of tiny scars that are barely visible or quickly fade.
Rest and elevation of the limb is becoming a very important tool in the sporting world, and is helping to extend the professional careers of some athletes and sports professionals.
Another surgical instrument development which is very useful in an area such as the ankle is the ArthroWand which is used for 'coblation' - a new technique for removing damaged soft tissue rapidly and precisely with minimal damage to surrounding tissue.
The method disintegrates tissue layer by layer, giving the surgeon excellent control to remove tissue whilst leaving the healthy tissue intact.
As a result the coblation wand improves operative precision and efficiency for the surgeon. The patient enjoys reduced postoperative pain, less bleeding, reduced surgical time and a speedier recovery.
However good today's technology has become, prevention is always better than cure. For those who lead an active life or are involved in regular sport, joint flexibility and regular stretching programmes are key. Stretching calf muscles, hamstrings and quads really is the main route to preventing foot and ankle problems. The muscles act as shock absorbers for the skeletal system and short, tight muscles have less shock absorbing capacity.
Today there seems to be training shoes for every combination of sport and good footwear is really valuable in avoiding injury. Well fitting shoes with a shock absorbing system built in will help. However, be aware that these sort of shoes lose their shock absorbing capacity after about three month of use. Sorbathane rubber insoles may extend the life a little.
Mr Simon Moyes is a Consultant Orthopaedic Surgeon at the Wellington & Devonshire Hospitals, London and webmaster of www.simonmoyes.com which is the source of this article.
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