ANKLE SPRAIN, GRADE 3 (Severe or 3rd Degree Ankle Sprain)
DEFINITION--A severe injury to the ankle in which one or more ligaments are stretched and totally torn. A severe sprain may include a temporary or lasting dislocation. A two-ligament sprain causes more disability than a single-ligament sprain.
BODY PARTS INVOLVED
Ligaments that support the ankle joint.
Three main bones of the ankle joint--the talus (heel bone), and the tibia and fibula (lower leg bones).
Blood vessels, nerves, periosteum (covering of bone) and other soft tissue close to the injury.
SIGNS & SYMPTOMS
Severe ankle pain at the time of injury.
A feeling of popping or tearing in the outer or inner part of the ankle. Sometimes there will be a sensation that the ankle joint is dislocated or was temporarily dislocated and popped back into joint.
Severe tenderness at the injury site.
Loss of function. The injured person usually falls and has great difficulty walking. The joint loses its stability.
Looseness in the joint if the foot is forced in the direction of pain.
Immediate, generalized swelling throughout the ankle and foot.
Bruising that appears immediately or soon after injury.
CAUSESStress imposed from either side of the ankle joint, temporarily forcing or prying the ankle or heel bone out of its normal socket. The ligament or ligaments that normally hold the joint in place are stretched and torn.
RISK INCREASES WITH
Previous ankle injury.
Any sport in which sideways displacement of the ankle is likely. Runners, walkers and participants in such sports as basketball, soccer, volleyball, skiing, distance jumping and high jumping are prone to ankle sprains. They often accidentally land on the side of the foot.
Use of shoes with inadequate support to prevent sideways displacement when stress occurs.
Poor muscle strength or conditioning.
Inadequate strapping prior to participation in contact sports.
Walking or running on rough surfaces, such as roads with potholes.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape the ankle from midfoot to midcalf before practice or competition. If you cannot use tape, wrap the ankle with elastic bandages or use an elastic brace.
Wear proper protective shoes.
Provide the ankle with substantial support during sports activities for 12 months following any significant ankle injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Application of a walking cast, and taping of the ankle when the cast is no longer needed.
Physical therapy after the cast is removed.
Hospitalization for surgery (sometimes) to repair the torn ligaments.
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas to assess total injury. Grade 3 sprains are often accompanied by fractures of the ankle bones.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic ankle joint following repeated injury.
PROBABLE OUTCOMEThe full extent of injury cannot be determined for 12 to 24 hours. Third-degree ankle sprains require an average of 12 to 16 weeks to heal completely. If this is a first-time injury, proper care, surgery and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDThe goal is to prevent further injury to the torn ligaments. See a doctor immediately for proper diagnosis and care. Follow instructions for R.I.C.E., the first letters of REST, ICE,
COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor may apply a stirrup-boot splint from below the knee to the toes. Stirrup boots are less likely to cause problems with swelling than an immediate cast may cause. This will support the joint effectively enough to walk on crutches, but you should not bear weight on the injured ankle.
When the swelling subsides in several days, any sutures will probably be removed and the splint replaced by a walking-boot cast for 10 to 21 days. You may walk on the walking cast immediately.
After the cast has been removed, ankle taping will be necessary for a minimum of 6 weeks.
After cast removal, use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
Apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Keep the foot elevated whenever possible to decrease swelling.
Massage the ankle gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Non-prescription medicines such as aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Injection of procaine and hyaluronidase to decrease pain soon after injury.
Stronger medicine for pain, if needed.
ACTIVITYWalk with crutches until your surgeon applies the walking cast. See Appendix 3 (Safe Use of Crutches). Resume your normal activities gradually. Don't drive until healing is complete.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and 10 minutes after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a third-degree ankle sprain.
Ankle pain, swelling or bruising increases despite treatment.
You notice numbness or discoloration of the toes when the walking cast is in place.
You develop signs of postoperative infection (increased pain or drainage from the surgical wound, or fever).