Ankle sprain (OSG distortion)

The ankle joint, which is made up of the upper ankle joint (OSJ) and lower ankle joint (USG), is responsible for the mobility of our foot. The upper ankle joint connects the tibia and fibula of the lower leg with the ankle bone and is responsible for the flexion and extension of the foot. In the lower ankle joint, the heel bone, ankle bone and navicular bone are connected to each other, which enables the foot to turn inwards and outwards. The ankle joint is also stabilized by a pronounced external and internal ligamentous apparatus.

Ankle sprains, also known as ankle sprains, can occur in the event of twisting trauma. This injury is probably one of the most common sports injuries and mainly affects young people. The outer ligament apparatus is particularly susceptible to injuries, such as partial tearing or complete tearing of ligaments. Injuries to the inner ligaments are rare.

OSG sprains are divided into three degrees of severity:

• Grade I: In the majority of cases, the twisting movement only causes overstretching of the ligament structures. The foot can be loaded.
• Grade II: Ligament structures are partially torn.
• Grade III: This is a complete tear of the ligaments. The foot can no longer bear weight.

Signs of an ankle sprain can include

• Pain, especially on the outside of the ankle joint
• Pressure pain
• Movement restrictions
• Swelling and bruising
• Subjective feeling of instability

Immediately after an ankle sprain, sufferers often experience severe pain, which is often localized on the outside of the ankle joint and intensifies when the foot is put under weight. Depending on the severity, the foot can only be loaded slightly or not at all. The pain can also be triggered by pressure on the affected area.

In addition to bruising, swelling of the ankle joint and its surroundings can occur within a very short time. In some cases, patients experience a feeling of instability in the ankle joint.

Typical complications of an ankle sprain range from chronic instability, which manifests itself in repeated ankle sprains and pain, to premature joint wear in the ankle joint (ankle arthrosis).

Causes of an ankle sprain include

• Ankle sprains

Typically, ankle sprains occur during twisting movements during sporting activities, but also in everyday life. Supination trauma, in which the inner edge of the foot is lifted, is the main cause. The consequences are overstretching and overloading of the outer ligaments. This accident mechanism can occur, for example, when landing after a jump or in sports with rapid changes of direction, such as soccer.

Known risk factors include insufficient foot and ankle muscles and unsuitable footwear.

Our certified sports physician Dr. med. Tarek Schlehuber will talk to you in detail aboutthe cause of the accident and any existing complaints. This is followed by a thorough physical examination of the foot and ankle. Initially, the blood circulation, motor function and sensitivity of the skin will be tested to rule out vascular and nerve injuries. The foot is then examined with regard to its mobility.

If additional bone fractures or ligament tears are suspected, an X-ray is essential. Injuries to the syndesmosis, a connective tissue connection between the tibia and fibula, require an MRI scan.

Conservative therapy:

As a rule, conservative therapy is sufficient to treat OSG sprains. Conservative treatment is superior to surgery even in the case of a complete tear of the collateral ligament.

The following conservative therapies are possible:

• Initial therapy:
  • PECH rule:
    • Break: rest, relief
    • Ice: Cooling pads
    • Compression: pressure bandage using an elastic bandage
    • Elevation
  • Painkillers
• Follow-up treatment:
  • Ankle orthosis
  • Physiotherapy if necessary
  • Infiltration if necessary

The so-called PECH rule (rest, ice, compression, elevation) is used as initial therapy after accidents or sports injuries. The affected part of the body, in this case the ankle joint, should be immobilized and rested immediately. Depending on the severity of the injury, the period of immobilization can range from a few days to a few weeks. Cooling should also be applied to reduce swelling and alleviate pain. This can be achieved by using a cooling pad wrapped in a kitchen towel. Compression of the body area can be applied using an elastic bandage and should reduce any bleeding. In addition, elevating the foot facilitates the return flow of blood.

Painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) can be used in the short term to reduce pain.

For patients suffering from severe pain or a subjective feeling of instability, the use of an ankle orthosis for four to six weeks after the initial treatment can have a positive effect.

Subsequently, targeted physiotherapy treatment can be started to strengthen the leg and foot muscles in order to achieve sufficient stabilization of the ankle joint. This should be done especially in the case of existing instabilities and/or recurring sprains.

Operation:

Surgery for OSG distortion is rare, but may be indicated if the following factors are present:

• Additional existing bone fractures
• Injuries to the syndesmosis (connective tissue connection between the tibia and fibula)
• Chronic ankle instability after failure of conservative measures
• Competitive athlete

Patient-specific factors, in particular sporting activity in everyday life, should always be taken into account when weighing up conservative treatment versus surgery. In the case of competitive athletes, surgical measures are generally used more generously in order to achieve the quickest possible return to sport.

Our certified sports physician and trauma surgeon Dr. med. Tarek Schlehuber performs the surgical treatment of an OSG distortion with arthroscopic assistance. Arthroscopy is a minimally invasive surgical procedure in which a camera with a light source and a working instrument are inserted into the upper ankle joint via several small incisions in the skin. This allows the ankle joint to be assessed in detail, concomitant injuries to be identified and therapeutic intervention to be carried out at the same time. The surgical technique depends on the stability of the ankle joint and the accompanying injuries. At the Orthozentrum Freiburg , ligament plastic surgery of the outer ligament apparatus is offered. These can be performed using a classic suture technique or an artificial tape.

Our orthopaedic surgeons at the Orthozentrum Freiburg will be happy to advise you further in this regard and clarify any unanswered questions with you.

OP at a glance:

• Operation time: 30-60 min
• Anesthesia: General anesthesia
• Hospitalization: outpatient
• Able to work: 3-6 weeks (depending on profession)
• Return to sports (RTS): after 3-5 months

Aftercare varies depending on the surgical method used. In general, the foot should be elevated and cooled (e.g. with a cooling pad) for the first few hours after the operation. If pain occurs, painkillers from the group of non-steroidal anti-inflammatory drugs can be taken.

To check the wound, you should see your orthopaedic surgeon or family doctor again soon after the operation, ideally on the first day. The stitches can be removed from the 10th day.

As a rule, it is essential to wear an orthosis for 4-6 weeks after the operation. During this time, you may only put partial weight on the foot. Your doctor will prescribe thrombosis injections to prevent the formation of blood clots (thrombi) during the period of partial weight-bearing. These injections are usually injected into the subcutaneous fatty tissue near the navel.

Subsequent physiotherapy serves the purpose of mobilization and strengthening.