Ankle displacement

The ankle joint, being the main supporting compound of the body, consists of three main bones. The ankles (bone “cones” on the side of the foot) are outgrowths of the lower leg bones, connecting at the bottom, they form a kind of “fork”. The support for them is the talus bone – outwardly it is almost invisible, but occupies a central significance on the foot due to its location and importance.

In everyday life, everyone has experienced minor ankle injuries, such as sprains and bruises. As a rule, their treatment does not require special skills and first aid is feasible at home. But there are more serious injuries in which medical care is necessary and mandatory.

Dislocation of the ankle joint

This injury is characterized by the displacement of the bones that form the joint, due to the impact on it of significant strength. There is pressure on the connecting bones, which leads to rupture of the joint capsule and surrounding tendons. Features such as the inactivity of the ankle and the strength of its ligaments cause rare cases of domestic injuries.

Subluxations are most common – they are characterized by incomplete displacement. Complete dislocations develop only with fractures of the bones of the lower leg surrounding the joint bag.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

I have been treating joints for many years. I can say with confidence that the joints are always treatable, even in the very ripe old age.

Hondrostrong is an innovative drug that is created to combat joint diseases. It helps with arthritis, arthrosis and other diseases. Thanks to the use of cream, joint mobility quickly returns. Damaged cartilage tissue is regenerated, which prevents the further development of the problem.

Hondrostrong gel for joints

Our medical center was the first to receive certified access to the latest drug for osteochondrosis and joint pain - Hondrostrong. I confess to you when I heard about it for the first time, I just laughed, because I did not believe in its high efficiency.

But I was amazed when we completed testing: 4567 people were completely cured of diseases of the organs of the musculoskeletal system, and this is more than 94% of all subjects. 5.6% felt significant improvement, and only 0.4% did not notice any improvement.

Hondrostrong cream allows you to forget about back and joint pain in the shortest possible time, literally from 4 days, and even very difficult cases can be cured within a couple of months. In addition, the manufacturer of this product is now offering a 50% discount of the full cost of Hondrostrong cream.

Causes

The basis is always indirect damage – the active forces are body weight and a blow to the joint. In life, trauma occurs after the following actions:

  • jump on an elongated and tense leg;
  • falling on a bent and tucked foot;
  • hitting the lower leg while standing.

Subluxation causes a sharp contraction of the muscles, which exacerbates the displacement. Almost always, it is combined with a fracture or crack of the ankles, as well as tendon ruptures.

Ev >

Suspension of ankle dislocation is possible immediately after damage. Symptoms appear instantly and simultaneously.

  1. The appearance of a characteristic “crunch” in the joint at the time of a fall or impact.
  2. A sharp, unbearable pain that intensifies when you try to move your leg.
  3. A change in the position of the foot (it can deviate to the side), blueness and swelling of its skin.
  4. A sharp protrusion under the skin of the ankles.
  5. Complete lack of mobility.

The subluxation includes the same symptoms, but in a lesser severity and while maintaining a slight mobility. They are distinguished by the results of radiography (incomplete displacement with subluxation), and also exclude a fracture.

Treatment

First aid for subluxation should begin with anesthesia. An injection or administration of analgesic tablets is performed, after which a fixed position for the limb is created. It is best to apply a crossed bandage with an elastic bandage and make an impromptu cane or crutch.

After these procedures, you must immediately go to the emergency room.

Conservative help

Treatment of dislocation of the ankle joint includes reduction, creation of immobility and subsequent recovery (exercises, massage).

  1. The reduction is performed after additional analgesia by novocaine injections around and inside the joint. After muscle relaxation, the doctor takes the foot by the front surface and the heel. Sipping his leg on himself, he returns it to its usual place in the direction opposite to the direction of damage.
  2. After this, to prevent displacement, it is necessary to apply a plaster cast to half the thigh (with a subluxation of 2, a dislocation of 3 weeks). After removing the plaster, use a bandage-scarf or orthosis for 4 weeks.
  3. The gradual development of movements with subluxation begins a week after the injury. After a month, it is allowed to fully rest on the leg. For a period of up to 3 months exercises of physiotherapy exercises and massage are prescribed.

Operative therapy

In case of untimely treatment or lack of treatment, a long-standing or habitual subluxation is formed. In the first case, contracture is formed – limitation of mobility in the joint. Regularly repeated dislocation with self-regulation is considered habitual.

Operations are performed on the joint capsule and ligaments in order to restore them. Further, the complex of treatment is the same – plaster cast immobilization, strengthening exercises and massage. But the rehabilitation period is increased to 6 months.

Ankle fracture

This fracture of the ankle joint is more common with indirect damage, when the effect of a person’s own weight and the turn of the foot outward are combined.

Symptoms of pronation fracture

It is considered an injury in a typical place. A characteristic feature is the position of the foot turned outwards.

  • There is edema around the ankle joint (often of considerable size).
  • The pain spreads along the inner ankle and lower leg.
  • Externally, you can see the displacement of bone fragments under the skin and their mobility when trying to move a leg.

Symptoms of supination fracture

Occurs after a significant limb injury (hit with a heavy object). From the point of view of anatomy, in this case, a fracture of both ankles occurs.

  • There is a displacement of the foot inwards and forwards.
  • A swelling appears around the ankle joint.
  • Bilateral pain in the ankles and the roughness of their contour under the skin is externally determined.

Regardless of the signs of a particular fracture, first aid should be provided to the victim and sent to the emergency room on time.

Treatment

The first aid for these fractures is the prevention of displacement of fragments. As soon as possible, the following measures must be taken:

  • The victim should be reassured, give a pill of painkiller.
  • Of great importance is giving the limb a fixed position, carried out using improvised means.
  • If there are wounds on the skin, it is necessary to cover them with a clean cloth or bandage.

After these events, you urgently need to go to the emergency room.

Conservative help

The hospital provides adequate analgesia using injections of analgesics or novocaine anesthesia. After that, the fragments are compared manually, so that healing and restoration take place much faster. If the comparison was successful, then a control x-ray is taken to assess the position of the bones. As a result, a plaster cast is applied to the lower third of the thigh.

Wearing gypsum is indicated for up to 10 weeks, but after a month you can shorten its length to the knee. This is done to enable the strengthening exercises and massage. But it is worth remembering that non-compliance with the regime and excessive self-confidence lead to a repeated displacement of fragments.

Medical rehabilitation begins already from 2 weeks – a complex of therapeutic exercises, massage, dry heat, electromyostimulation is prescribed.

Surgery

It is usually recommended only in 2 cases: with a two-time ineffective comparison and with repeated displacement of fragments. The essence of the operation is to attach a bone fragment using metal rods (screw, spoke). After the intervention, gypsum is also applied for up to a week. You can get up already for 5 days.

Therapeutic exercises can be started from day 7, performing flexion of the foot in the sole. Gradually increase the volume of movements to the maximum possible. Additionally, foot and lower leg massage, ozokerite applications are prescribed. In the future, it is recommended to continue the exercises, as well as use orthopedic shoes and insoles-arch supports.

Talus fracture

This fracture of the ankle joint is rarely encountered singly – a combination with fractures of the lower leg and thigh is characteristic. It occurs in car accidents, falls on straight legs, hit with heavy objects on a bent knee.

Cracks may appear in the anterior, central, or posterior part of the bone. Their occurrence depends on excessive extension in the foot, or, conversely, flexion. This fracture is often complicated by subluxation and compression of vessels passing nearby. Violation of blood flow leads to the death of surrounding tissues.

Symptoms

They are specific and even without an X-ray examination, they suspect an ankle fracture. These include:

  • The occurrence of edema and hemorrhages around the joint (more in front).
  • Bending the fingers inward and the position of the foot as when walking “on toes” is noted.
  • Trying to stretch your fingers or touch the sole causes severe pain.
  • Change in the shape of the foot – an anterior bone fragment protrudes anteriorly under the skin.

In identifying these symptoms, it is urgent to seek medical help, since increasing edema reduces the flow of blood to the foot.

Treatment

First aid measures include cold and peace.

  • At the place of damage, apply a bag or heating pad with ice for 30-40 minutes, after wrapping them with a towel.
  • Then make a cross dressing on the foot.
  • The fixed position of the limb is attached by attaching the boards from 3 sides to the lower leg. Having firmly fixed them with a bandage on the leg, you must go to the hospital.

Conservative measures are different – they do not make a comparison, but immediately apply a plaster cast. It also has its own characteristics: it is very accurately modeled on the sole and done only until the middle of the lower leg. This is aimed at the prevention of flat feet after removal of gypsum (after 3 months).

Partial load rehabilitation is only possible after 2 months. Start with physiotherapy and massage. After 4 weeks, therapeutic exercises begin with a gradual increase in load.

Treatment of dislocation and fracture of the ankle joint

The ankle joint, being the main supporting compound of the body, consists of three main bones. The ankles (bone “cones” on the side of the foot) are outgrowths of the lower leg bones, connecting at the bottom, they form a kind of “fork”. The support for them is the talus bone – outwardly it is almost invisible, but occupies a central significance on the foot due to its location and importance.

In everyday life, everyone has experienced minor ankle injuries, such as sprains and bruises. As a rule, their treatment does not require special skills and first aid is feasible at home. But there are more serious injuries in which medical care is necessary and mandatory.

Dislocation of the ankle joint

This injury is characterized by the displacement of the bones that form the joint, due to the impact on it of significant strength. There is pressure on the connecting bones, which leads to rupture of the joint capsule and surrounding tendons. Features such as the inactivity of the ankle and the strength of its ligaments cause rare cases of domestic injuries.

Subluxations are most common – they are characterized by incomplete displacement. Complete dislocations develop only with fractures of the bones of the lower leg surrounding the joint bag.

Causes

The basis is always indirect damage – the active forces are body weight and a blow to the joint. In life, trauma occurs after the following actions:

  • jump on an elongated and tense leg;
  • falling on a bent and tucked foot;
  • hitting the lower leg while standing.

Subluxation causes a sharp contraction of the muscles, which exacerbates the displacement. Almost always, it is combined with a fracture or crack of the ankles, as well as tendon ruptures.

Ev >

Suspension of ankle dislocation is possible immediately after damage. Symptoms appear instantly and simultaneously.

  1. The appearance of a characteristic “crunch” in the joint at the time of a fall or impact.
  2. A sharp, unbearable pain that intensifies when you try to move your leg.
  3. A change in the position of the foot (it can deviate to the side), blueness and swelling of its skin.
  4. A sharp protrusion under the skin of the ankles.
  5. Complete lack of mobility.

The subluxation includes the same symptoms, but in a lesser severity and while maintaining a slight mobility. They are distinguished by the results of radiography (incomplete displacement with subluxation), and also exclude a fracture.

Treatment

First aid for subluxation should begin with anesthesia. An injection or administration of analgesic tablets is performed, after which a fixed position for the limb is created. It is best to apply a crossed bandage with an elastic bandage and make an impromptu cane or crutch.

After these procedures, you must immediately go to the emergency room.

Conservative help

Treatment of dislocation of the ankle joint includes reduction, creation of immobility and subsequent recovery (exercises, massage).

  1. The reduction is performed after additional analgesia by novocaine injections around and inside the joint. After muscle relaxation, the doctor takes the foot by the front surface and the heel. Sipping his leg on himself, he returns it to its usual place in the direction opposite to the direction of damage.
  2. After this, to prevent displacement, it is necessary to apply a plaster cast to half the thigh (with a subluxation of 2, a dislocation of 3 weeks). After removing the plaster, use a bandage-scarf or orthosis for 4 weeks.
  3. The gradual development of movements with subluxation begins a week after the injury. After a month, it is allowed to fully rest on the leg. For a period of up to 3 months exercises of physiotherapy exercises and massage are prescribed.

Operative therapy

In case of untimely treatment or lack of treatment, a long-standing or habitual subluxation is formed. In the first case, contracture is formed – limitation of mobility in the joint. Regularly repeated dislocation with self-regulation is considered habitual.

Operations are performed on the joint capsule and ligaments in order to restore them. Further, the complex of treatment is the same – plaster cast immobilization, strengthening exercises and massage. But the rehabilitation period is increased to 6 months.

Ankle fracture

This fracture of the ankle joint is more common with indirect damage, when the effect of a person’s own weight and the turn of the foot outward are combined.

Symptoms of pronation fracture

It is considered an injury in a typical place. A characteristic feature is the position of the foot turned outwards.

  • There is edema around the ankle joint (often of considerable size).
  • The pain spreads along the inner ankle and lower leg.
  • Externally, you can see the displacement of bone fragments under the skin and their mobility when trying to move a leg.

Symptoms of supination fracture

Occurs after a significant limb injury (hit with a heavy object). From the point of view of anatomy, in this case, a fracture of both ankles occurs.

  • There is a displacement of the foot inwards and forwards.
  • A swelling appears around the ankle joint.
  • Bilateral pain in the ankles and the roughness of their contour under the skin is externally determined.

Regardless of the signs of a particular fracture, first aid should be provided to the victim and sent to the emergency room on time.

Treatment

The first aid for these fractures is the prevention of displacement of fragments. As soon as possible, the following measures must be taken:

  • The victim should be reassured, give a pill of painkiller.
  • Of great importance is giving the limb a fixed position, carried out using improvised means.
  • If there are wounds on the skin, it is necessary to cover them with a clean cloth or bandage.

After these events, you urgently need to go to the emergency room.

Conservative help

The hospital provides adequate analgesia using injections of analgesics or novocaine anesthesia. After that, the fragments are compared manually, so that healing and restoration take place much faster. If the comparison was successful, then a control x-ray is taken to assess the position of the bones. As a result, a plaster cast is applied to the lower third of the thigh.

Wearing gypsum is indicated for up to 10 weeks, but after a month you can shorten its length to the knee. This is done to enable the strengthening exercises and massage. But it is worth remembering that non-compliance with the regime and excessive self-confidence lead to a repeated displacement of fragments.

Medical rehabilitation begins already from 2 weeks – a complex of therapeutic exercises, massage, dry heat, electromyostimulation is prescribed.

Surgery

It is usually recommended only in 2 cases: with a two-time ineffective comparison and with repeated displacement of fragments. The essence of the operation is to attach a bone fragment using metal rods (screw, spoke). After the intervention, gypsum is also applied for up to a week. You can get up already for 5 days.

Therapeutic exercises can be started from day 7, performing flexion of the foot in the sole. Gradually increase the volume of movements to the maximum possible. Additionally, foot and lower leg massage, ozokerite applications are prescribed. In the future, it is recommended to continue the exercises, as well as use orthopedic shoes and insoles-arch supports.

Talus fracture

This fracture of the ankle joint is rarely encountered singly – a combination with fractures of the lower leg and thigh is characteristic. It occurs in car accidents, falls on straight legs, hit with heavy objects on a bent knee.

Cracks may appear in the anterior, central, or posterior part of the bone. Their occurrence depends on excessive extension in the foot, or, conversely, flexion. This fracture is often complicated by subluxation and compression of vessels passing nearby. Violation of blood flow leads to the death of surrounding tissues.

Symptoms

They are specific and even without an X-ray examination, they suspect an ankle fracture. These include:

  • The occurrence of edema and hemorrhages around the joint (more in front).
  • Bending the fingers inward and the position of the foot as when walking “on toes” is noted.
  • Trying to stretch your fingers or touch the sole causes severe pain.
  • Change in the shape of the foot – an anterior bone fragment protrudes anteriorly under the skin.

In identifying these symptoms, it is urgent to seek medical help, since increasing edema reduces the flow of blood to the foot.

Treatment

First aid measures include cold and peace.

  • At the place of damage, apply a bag or heating pad with ice for 30-40 minutes, after wrapping them with a towel.
  • Then make a cross dressing on the foot.
  • The fixed position of the limb is attached by attaching the boards from 3 sides to the lower leg. Having firmly fixed them with a bandage on the leg, you must go to the hospital.

Conservative measures are different – they do not make a comparison, but immediately apply a plaster cast. It also has its own characteristics: it is very accurately modeled on the sole and done only until the middle of the lower leg. This is aimed at the prevention of flat feet after removal of gypsum (after 3 months).

Partial load rehabilitation is only possible after 2 months. Start with physiotherapy and massage. After 4 weeks, therapeutic exercises begin with a gradual increase in load.

Dislocation of the ankle joint: Dislocation of the ankle joint

Dislocation of the ankle joint is a pathological condition in which there is a complete displacement of the articular surfaces of the bones that form the ankle joint. Complete dislocation of the ankle joint is rare and is usually observed in combination with an ankle fracture. In everyday life, a dislocation is often called sprains, tears and tears of the ligaments of the ankle joint, in which a subluxation can be observed – a partial displacement of the articular surfaces. Dislocation and subluxation of the ankle joint usually occur when the patient tucks his foot on a slippery or uneven surface. Accompanied by pain, swelling, impaired movement and support. The diagnosis is established taking into account the data of examination and radiography. Sometimes CT or MRI is additionally prescribed. The treatment of subluxations is conservative. With a complete dislocation, an attempt is made to close the reduction, if it is impossible to compare the articular surfaces and bone fragments, an operation is performed.

Dislocation of the ankle joint

Dislocation of the ankle joint – displacement of the articular surfaces of the tibia, talus and fibula relative to each other. Complete dislocations of the ankle joint are rare, are severe trauma, are combined with intraarticular and periarticular fractures. Incomplete dislocations (subluxations) can occur when the ligaments are damaged (both isolated and with simultaneous ankle fractures). Usually the cause of injury is turning up the leg. Less commonly, dislocation occurs in industrial accidents, road accidents and falls from a height. When tucking in, isolated damage is usually observed, with other mechanisms of injury, a combination with fractures and dislocations of skeleton bones, open wounds, chest damage, blunt abdominal trauma and head injury is possible. Treatment is carried out by traumatologists.

The ankle joint is a complex blocky joint formed by three bones: the talus, fibula and tibia. The lower surface of the tibial epiphysis is adjacent to the upper part of the talus. The outer ankle, which is a continuation of the tibia, as well as the inner ankle, formed by the distal part of the tibia, cover the talus from the sides, forming a kind of fork that limits the mobility of the joint in the lateral direction. Movements in the joint are carried out mainly in the frontal axis (extension and flexion of the foot). At the same time, despite the fork bounding the joint, there is also slight mobility in the sagittal direction (abduction and adduction of the foot).

Bones are held by the joint capsule and ligaments located on the lateral surfaces of the g / foot joint. On the outer surface there is the calcaneofibular, as well as the posterior and anterior tibial fibular ligaments. Damage to these ligaments occurs when the foot is tucked inward. The deltoid ligament is located on the inner surface of the g / foot joint, which may be damaged when the foot is turned outwards. The mechanism of damage to the bones is similar to the mechanism of damage to the ligaments, however, for the occurrence of fractures of the bones of the lower leg and fractures-dislocations, a more intense impact is required.

Damage to ligaments

There are three degrees of ligament damage:

1 degree – sprain. In fact, the ligaments are inelastic and cannot stretch. At the 1st degree, microfractures of the ligament (damage to individual fibers) occur. However, the phrase “sprain” is so densely accustomed to everyday life that it is sometimes used not only by patients, but also by representatives of official medicine. With such an injury, slight swelling and swelling appears over the damaged ligament. The support is kept, the movements are moderately limited. Palpation is painful.

2 degree – tear of ligaments. It manifests itself as severe edema on the outer or inner surface of the joint. Swelling increases rapidly, within a few hours or the first day, bruising usually occurs over the damaged ligament. Pain remains at rest, aggravated by movement. Support and movement are difficult but possible.

Grade 3 – ligament rupture. Swelling and bruising spread along the lateral surface of the ankle joint, cover the back and plantar of the foot. Sharp pains at rest are noted. Reliance is impossible, movements are sharply limited.

If such symptoms appear, it is necessary to apply cold to the affected area, give the leg an elevated position and immediately deliver the patient to the emergency room so that the traumatologist can conduct an examination, exclude more serious injuries (fractures, fractures) and prescribe appropriate treatment. The diagnosis is made on the basis of external signs and radiography data of the ankle joint. To clarify the degree of damage to the ligaments of the patient, they are sometimes referred for MRI of the ankle joint. Treatment of degrees 1 and 2 of the ligament damage is carried out on an outpatient basis, with degree 3, hospitalization is required.

When sprains, the patient is recommended to limit the load and apply tight bandaging for walking time. At rest, the bandage should be removed. In the first two days, cold should be applied to the affected area, then dry heat is indicated. The patient is issued a sick leave and sent to UHF. With tearing the ligaments, the application of a plaster cast, walking on crutches, as well as UHF is shown. Complete rupture of ligaments is an indication for surgical treatment in a hospital setting.

Subluxation and dislocation of the ankle joint

Four types of dislocations and subluxations of the ankle joint are distinguished:

  • Outer. The most common. Usually combined with an external ankle fracture.
  • Interior. It is usually observed in combination with an ankle fracture.
  • Rear. It is usually combined with a fracture of the posterior edge of the tibia.
  • Front. It is rarely observed, can be combined with various joint injuries and a fracture of the lower third of the tibia.

It should be borne in mind that with subluxations, and especially with dislocations of the ankle joint, severe combined injuries often occur: two and three ankle fractures, tibiofibular syndesmosis, multiple tears and ligamentous tears, as well as joint capsule ruptures. With incorrect or untimely treatment, such injuries can lead to serious consequences in the form of impaired support, constant pain when walking and the development of ankle joint arthrosis. Therefore, if a subluxation or dislocation of the ankle joint is suspected, it is strictly forbidden to attempt self-reduction. It is necessary to fix the leg with a tire, apply cold to the damaged area and immediately deliver the patient to specialized honey. institution.

Examination and treatment are carried out in a trauma unit. The patient complains of sharp pain. Significant swelling and blueness of the soft tissues is revealed in the joint area. Bruising is possible. With subluxations, moderate deformation is determined, with complete dislocations, a gross violation of the anatomical ratios is observed. Reliance is impossible. Palpation is sharply painful, with fractures crepitus and pathological mobility can be determined. With subluxations, movements are sharply limited due to pain, with complete dislocations are impossible, when trying to passive movements spring resistance is revealed.

To clarify the diagnosis, an x-ray of the ankle joint is performed. According to the indications, MRI and CT of the ankle joint are prescribed. Then make a closed reduction and impose gypsum with mandatory subsequent x-ray control. Five days later, x-rays are repeated to make sure there is no secondary displacement, gypsum circulate. The period of immobilization is determined by the type of damage. Two unsuccessful attempts at closed reduction, as well as the inability to hold the fragments in the correct position, are an indication for surgical treatment. Depending on the nature of the lesions, along with open reduction, osteosynthesis of the posterior edge of the tibia, restoration of the distal tibiofibular syndesmosis, osteosynthesis of the external ankle with a plate, osteosynthesis of the external and / or internal ankle with screws, and transarticular fixation of the ankle joint with knitting needles can be performed. In the postoperative period, exercise therapy and thermal procedures are prescribed.

Fractures of the ankle joint with and without displacement, cracks, closed and open fractures

Among the injuries of the joints of the lower extremities, an ankle fracture is one of the most common injuries. The ligamentous apparatus of the joint is naturally strong, developed, but, despite this, the ankle joint experiences significant loads. With a fracture, a violation of the integrity of bone tissue occurs.

In some cases, the injury is complicated by the displacement of bone fragments, rupture of ligaments. According to statistics, the proportion of fractures of the ankle joint is 10-15% of the total number of fractures. The ankle is formed by the bones of the lower leg and the talus, which is covered above and below by the tibia.

A joint fracture is sometimes observed against the background of the tibia, such a state according to ICD 10 is encrypted with the code S82.5. If the root cause was a violation of the integrity of the fibula, the state receives code S82.6. The fracture of the ankle joint itself is encrypted as S82.8.

Causes of ankle fractures

Most, namely 90%, violations of the integrity of the ankle bones occur due to indirect exposure. For example, if a person falls while running, walking, two conflicting phenomena are observed simultaneously – fixation of the hindfoot (heel) and continued movement of the anterior. A fracture of the ankle joint with a shift is observed as a result of a fall from the stairs, while rollerblading or skating, skiing, parachuting.

Cracked bones and fracture – what’s the difference

During injury, a bone fracture does not always occur. In cases where the degree of external mechanical impact is not much higher than the strength of formation, the surface of the bone is covered with cracks. Often this is observed if flat bones are injured.

Symptoms of an ankle crack in traumatology are formulated as follows:

  • pronounced pain is felt in the area of ​​violation of the integrity of the bone surface. Unpleasant sensations are amplified when performing rotational and other movements with a limb, touching a bruised area. At rest, the pain syndrome acquires a dull, slightly muffled character. Some patients complain of mild tingling sensations, a sensation of pulsation. Doctors explain this condition by the fact that the periosteum, the surface of which is covered with a large number of pain receptors, is included in the process. They send the brain many impulses about injuries;
  • the development of edema is rapid, changing over a short period of time. This part of the clinical picture begins to fade after a day;
  • the presence of a hematoma due to mechanical rupture of the vessels that feed the periosteum. If the blow was strong, the bruising is extensive;
  • until the edema and pain are eliminated, limb mobility is limited.

The clinical picture may be absent. Often this is the basis for refusing to visit a doctor, which, in turn, causes the development of serious consequences.

Cracks in the ankle bones are often found in children of the first year of life. They also have these disorders complicated by a violation of the integrity of the vessels and, accordingly, the formation of a bruise. Whereas in adults, such components of the clinical picture practically do not appear. Children are characterized by damage, which was called the “green twig” among traumatologists – only bone, but not periosteum, is diagnosed.

To diagnose a crack, radiography is often not very informative, especially in the case of trauma to small bones of the foot.

More often prescribed computed tomography and magnetic resonance imaging. These types of hardware examinations allow you to accurately determine the location, as well as the depth, to which the damage has spread.

Types of pathology

An ankle fracture, due to the complexity of the structure of the ankle, is an extremely difficult type of injury. The nature of the damage directly depends on what position the foot occupied at the time of the injury – flexion (pronation) or support on the fingers (supination). In the first case, damage to the outside is more often observed, and in the second, respectively, inside.

Traumatologists distinguish the classification of pathology according to the type of displacement:

  • external-rotational – often observed when the foot is subjected to torsional force, which violates the integrity of the ankle’s inner part, and the joint itself moves back or out;
  • abduction-eversion – with this type of fracture, the foot bends and turns outward in the area of ​​connection with the ankle, the fibula is damaged;
  • the adduction-eversion – foot is in the position on the toes, due to which, in conjunction with the ankle, it turns inside, and the calcaneus is also twisted;
  • Pott fracture – the supine foot in conjunction with the ankle joint is inverted towards the outside, a lateral fracture is later diagnosed in the back of the ankle.

Fractures are also classified by severity:

  • closed – violation of the integrity of soft tissues is not diagnosed;
  • open – the skin is damaged, because of which an open wound is formed, bone fragments go outside. With this type of pathology, the risk of developing an inflammatory process is high.

Important: closed fractures are diagnosed more often. Traumatology distinguishes two subtypes – with and without displacement. Symptoms are similar.

The clinical picture of pathology

The signs of an ankle fracture can be formulated as follows:

  • severe pain syndrome, the nature of which is determined by the degree of damage. For example, acute, even burning pain is a sign of an open fracture. With the closed type, the limb aches, the pain is especially worse when trying to move the foot;
  • rapid formation of edema. However, its growth is not as fast as in the case of a crack;
  • the ankle region is noticeably deformed;
  • the victim loses the ability to rely on a damaged limb.

Important: some cases are accompanied by the formation of bruising, fever, both local and general. This is especially common in children.

Diagnosis and treatment tactics

Confirmation of the diagnosis of an ankle joint fracture is possible using radiography. Pictures are taken in two projections – side, front. For complicated injuries, MRI and CT are used.

Treatment of pathology

The choice of treatment tactics is determined by the type of fracture. For example, with an open form, the main task is to stop bleeding and disinfect the wound. If bias has been confirmed, the doctor performs a reposition, i.e. reduction of bones. Then the wound is sutured. The patient must be prescribed analgesic injections in the damaged area and cast.

Closed fracture in most cases requires conservative treatment. The exception is the presence of bias, which entails the mandatory conduct of surgical intervention.

Rehabilitation

Treatment and rehabilitation of an ankle fracture takes a fairly long period of time. Restorative therapy is started after the doctor removes the plaster cast. As a rule, it includes massage, physiotherapy exercises. How long each of the events will last is determined by the doctor, based on the degree of complexity of the pathology.

Some time after removal of the plaster cast, the patient should move using a cane. This will evenly distribute the load on the ankles of both legs. Movement without assistive devices begins 14-21 days after the start of the rehabilitation program. The soreness that appears at this time, puffiness should not scare.

How long it takes to fully restore motor function depends on a large number of factors. Namely:

  • age – it has been confirmed by practice that in people under 35 years of age, bones heal faster than in older patients, traumatologists;
  • lack of chronic forms of bone apparatus diseases;
  • how strictly the patient complied with all the doctor’s recommendations;
  • fracture complexity – for example, rehabilitation after ankle fracture with a displacement will take much longer than recovery with a milder form of pathology;
  • completeness of medical and rehabilitation measures, regularity of their execution.

A good diet affects positively the speed of recovery. It should contain foods rich in calcium and amino acids. The list should include:

  • milk products;
  • meat;
  • a fish;
  • eggs (preferably quail) and others.

Not only exercise therapy, proper nutrition, but also massage has a positive effect on the restoration of the functions of specialized massage. It is optimal that the sessions should be carried out by a highly qualified specialist. Naturally, during the procedures the patient will feel pain – during the wearing of the plaster cast and as a result of the trauma, the muscular and ligamentous apparatus of the limb contracted and lost its natural form.

To reduce the activity of pain, it is recommended to use gels, ointments with an anesthetic effect. Subsequently, when the discomfort is completely gone, the massage is carried out without these funds.

The duration of the massage is determined by the severity of the fracture. As a rule, this is from 5 to 10 days, provided that the procedures will be carried out twice a day.

Self-massage is possible. However, due to inexperience it is difficult to comply with the recommended strength of the impact. Each massage session ends with the application of a tight bandage using an elastic bandage.

Massage helps to reduce swelling of the damaged joint, restore impaired or weakened blood supply. Also, the procedures accelerate the restoration of natural functions, normalize metabolic processes.

As a means of rehabilitation should be considered and wearing shoes with orthopedic soles and insoles. Women will need to abandon high heels and narrow models.

Dislocation of the ankle joint – theory and practice in the diagnosis and treatment of this disease

In the structure of traumatic injuries of the foot and lower leg, dislocation of the ankle joint is not as common as other types of injuries. But in its severity and methods of elimination, this disease requires special attention. Indeed, on the ankle joint, the basic function of the support is closed when walking. If the joint is turned off from this process, then in fact the foot, which is able to perform its function, cannot realize it.

The mechanism of occurrence of insidious dislocation

The ankle joint is a rather complex structure, which is well strengthened by the ligaments, tendons of large muscles and a powerful capsule. The volume of movements, in this regard, has its own clear limitations. This leads to the fact that dislocation in this joint occurs quite rarely. The main causes of dislocation of the lower leg are sports injuries. Their character can be divided into:

  1. Sudden excessive back flexion (upward movement of the foot).
  2. Strong plantar extension of the foot in the ankle.
  3. Pathological rotational foot movements with a fixed knee joint.
  4. Turning the foot to the outer or inner surface from its center.

The video tells about how an ankle dislocation occurs:

In this case, injuries of the ankle joint can be either isolated or combined. In the second case, they arise a second time, due to the loss of one or more fixing supports of the joint, which are the ankles.

For the occurrence of an isolated dislocation, the actions of the traumatic factor must be very strong, which is possible only when falling from a height and a road injury.

Fractures are the most common type of dislocation of the ankle, due to the fact that it can occur under the influence of ordinary factors and stresses associated with everyday life. During dislocation, the talus is displaced with the entire foot relative to the fixing fork formed by the ankles and the articular surface of the tibia. In this case, rupture or extension of the capsule and tendons of the joint is inevitable.

Manifestations and Symptoms

Common symptoms for all types of ankle dislocation are pain, swelling, deformation, and the inability to perform its basic functions. About everything and in order.

  1. Pain syndrome. It is characterized by the appearance at the time of injury. It is accompanied by a specific crunch in the affected joint. Immediately after this, its decrease is noted due to overexcitation of pain receptors and their relative insensitivity. After some time, the pain intensifies again, especially with the slightest foot movement.
  2. Edema. It is always progressive in nature, spreading around the entire circumference of the ankle, ankles, lower leg and foot. It can occur instantly in the form of a hematoma and blueness of the skin.
  3. Joint deformation. Depends on the type of dislocation and the degree of displacement of the foot relative to the articular fork of the lower leg. With subluxations of the deformation visible to the eye, it is not determined. In the case of a complete dislocation of the foot, it can be completely bent in one direction or another.
  4. Violation of function is manifested not only by impaired walking and support. In the case of a complete dislocation, even active and passive movements are impossible. The foot freezes in the wrong position.

Swelling of the ankle

Dislocation of the ankle in a child is manifested by the same symptoms. Their even rarer development in childhood is characteristic, which is associated with the elasticity and softness of bone formations.

Diagnostic procedures in determining the type of dislocation

Clinical data are indicative enough to make the correct diagnosis. But in any case, all patients with suspected ankle injury are shown an x-ray of the ankle joint in two projections. This event will help establish concomitant ankle fractures and the type of dislocation.

  1. Lateral dislocation of the foot. They are never found in isolated form. Always combined with ankle fractures (external, internal, or a combination thereof).
  2. Subluxations of the foot, accompanied by incomplete mismatch of the articular surfaces in the ankle, which is possible with rupture of the syndesmosis (joint) between the tibia.
  3. Front dislocation. It is rare.
  4. Back dislocation. It is possible with a combined fracture of the rear ankle – a bone outgrowth of the tibia that keeps the foot from the rear over extension.
  5. Habitual dislocation. It can occur as a result of an improperly treated or initially severe dislocation of the foot with ruptures of the capsule and tendons. In this case, there is an absolute instability of the joint with the possibility of repeated dislocations with minimal loads.

How to defeat the disease in medical battle

The video tells how to restore ligaments after an ankle injury:

What to do with dislocations of the ankle joint should know, if not every person, then every doctor is certain:

  1. Strict immobility of the joint by immobilization in the position in which it is after dislocation. This is achieved by applying ladder tires or improvised tools that mimic them. Patients should be transported to the nearest emergency room.
  2. Local exposure to low temperatures. Reduce pain and progression of edema.
  3. Adequate analgesia with any painkiller.

Apply ice to an injured joint

In a medical institution, after examination by a specialist and carrying out diagnostic measures, further tactics of treatment of ankle dislocation are determined. Specific manipulations may be suggested.

  1. Closed reposition of ankle fractures with simultaneous reduction of dislocation. This is the most favorable treatment option, if possible. Manipulation is performed under general anesthesia. By traction (traction) dislocated foot produce its reduction. In this case, ankle fractures can independently stand in the right place. After reposition, an ointment is applied to accelerate the healing of damaged tissues in the area of ​​the damaged joint and reduce pain. The method is not feasible with a rupture of the tibiofibular syndesmosis.
  2. Prompt reduction of dislocation. It is indicated for complex fractures with concomitant complications and damage to this area. In this case, using one or two incisions, fractures are exposed. Joint dislocation is corrected, as in the case of a closed reposition. The difference is that fractures and tears of the tibial joint are strengthened with the help of special plates or screws. This will reduce the recovery time after a dislocation and ensure the fixation of the ankle for a long time.

The video shows restorative massage for injuries of the lower leg and foot:

After reposition of the dislocation, regardless of its method, physiotherapeutic treatment, exercise therapy, massage, water procedures are performed.

Chronic lateral instability of the ankle

Many people experience leg tucks. Most are treated at home without going to the doctor for help.

However, visiting an orthopedic traumatologist is still recommended. After all, if the injured area is not treated correctly, over time you may encounter instability of the ankle joint!

Schematic representation of ankle instability.

Joint anatomy

The ankle joint is a complex anatomical formation consisting of three bones. It includes the greater- and fibula, as well as the talus. Due to this articulation, the load is transferred from the whole body to the foot, depreciation is ensured when walking, running, jumping and a number of other intense movements. It is also thanks to him that a person boasts high mobility of the foot and, as a result, good maneuverability.

Normally, the ankle joint is a joint whose stability is ensured by the ligaments. Ligaments are located not only on the external, but also on the internal surfaces of the joint. Thanks to them, not only the stability of the joint is ensured, but also the connection with the bones of the foot.

The structure of the ankle: bones, muscles and ligaments.

With dislocations, those ligaments that are located on the outer surface mainly suffer. Damage to the ligaments of the ankle joint and leads over time to its instability.

Causes of the disease

The main reason for damage to the ligaments, ensuring the stability of the ankle, is tucking of the foot. If tucking occurs inside, then the talus-fibular and heel-fibular ligaments suffer. If the foot is tucked out, the deltoid ligament may be damaged. However, it is not common, since the ligament is very strong and thick.

After trauma, the ligaments are unable to perform their functions. In this case, instability develops. It is understood as an involuntary change in the position of the foot in the joint area, which appears during walking, running, jumping. The most pronounced complaint of displacement becomes when trying to move on an uneven surface.

Sprain does not lead to instability in all patients. If the correct treatment has not been organized, up to 30% of injured patients face it on average.

Symptoms of pathology

For damage to the ankle region, a number of the following symptoms are usually characteristic:

  • soreness, which tends to increase with prolonged physical exertion;
  • articulation even with a visual examination differs from a healthy one on the other leg, with palpation, soreness can be detected;
  • injured ligaments of the foot no longer fulfill their fixing function, and therefore even a light load leads to subluxation (pain);
  • there is a restriction in movements;
  • after an acute injury or amid physical exertion, the area of ​​the damaged joint may swell, bruising, and a local increase in temperature are possible.

Chronic instability of the ankle joint develops gradually. There are 3 stages of the disease.

StageSymptoms
Stage 1Joint function is preserved, pain in the problem area is poorly expressed.
2 stageFunction is broken. The patient complains of severe swelling, limited movement, pain not only during exercise, but also at rest.
3 stageThe ligaments are completely broken. The patient complains of severe pain when trying to make a movement, the joint is swollen.

Diagnostic methods

In order to correctly diagnose and begin adequate treatment, it is necessary to consult an experienced doctor and use modern instrumental examination methods. If you suspect a disease, you can contact Dr. Petrosyan. The doctor has extensive experience in the diagnosis and treatment of ankle injuries, and the equipment of the clinic allows you to make the correct diagnosis using modern techniques.

Diagnostic search begins with a survey. The doctor specifies when the injury was received, under what circumstances and how it happened. After the inspection of the damaged foot. The doctor draws attention to swelling, redness of the skin, the presence of hemorrhages, joint deformation.

After the examination, the doctor may ask the patient to perform several tests that will help to understand exactly what type and form of instability the patient suffers from. Usually asked to perform certain movements in the ankle, evaluating the behavior of the joint at rest and in the case of a load.

Additionally, a study on the plantoscope is performed to determine how the load is distributed in the footsteps. An MRI scan is often required to determine how badly the ligaments and cartilage of the ankle are damaged.

Treatment

Treatment of damage to the ankle ligaments is not recommended to be carried out independently, so as not to face the development of joint instability in the future. It is better to consult a doctor who can not only make a diagnosis, but also select adequate therapy.

We have extensive experience in dealing with injuries of the ankle joint of varying complexity. Depending on the severity of the pathology, A. Petrosyan selects a conservative or surgical treatment for the patient.

Conservative methods

If trauma to the ligaments of the ankle joint has occurred recently, preference should be given to conservative methods of treatment. Immediately after injury, it is recommended that you proceed as follows:

  • for three days of the injured limb, rest is ensured;
  • it is recommended to apply a pressure dressing on the affected area, take NSAIDs;
  • ice can also be used to combat soreness and swelling.

Under the supervision of a physician, early activation can begin. The range of motion increases gradually.

During the entire recovery period, the patient is shown wearing an orthosis or brace. An alternative could be taping the ankle joint. Orthoses and other orthopedic devices will help to fix the joint correctly. Also, their use will prevent re-injury.

Operational approaches

As practice shows, even timely conservative treatment can not always protect against developing instability. If it was not possible to avoid the disease, it can be corrected using surgical techniques.

There are many options for surgery on the ankle joint. Conventionally, they are divided into open and minimally invasive, performed using an arthroscope. Dr. Petrosyan, like all progressive orthopedic surgeons, prefers surgery with an arthroscope. After all, this method is less traumatic, and recovery after it is much easier.

Arthroscopic reconstruction of the ligaments can be carried out either using the patient’s own ligaments, or using grafts using special fixatives. Completely torn ligaments are not stitched, but replaced with new ones. The transplant replacing the natural ligaments is made from the tendons of the semitendinosus muscle (or others) and is fixed either with the help of absorbable screws or with the help of special titanium buttons.

Schematic representation of operations.

Principles of Postoperative Recovery

Since the technique of arthroscopic reconstruction is considered minimally invasive, recovery is much easier than with open surgery. The patient can get up and move the next day, and the seams from the limb are removed on average after two weeks.

The rehabilitation program is developed for each patient individually. This takes into account his age, physical fitness, concomitant diseases that can complicate rehabilitation and other individual characteristics. Recommended:

  • take a course of physiotherapy exercises under medical supervision to return mobility to the joint;
  • use orthoses and other orthopedic fixators during the entire recovery period so that the joint is in the correct position during healing;
  • subsequently wear special orthopedic shoes (insoles), which will prevent the development of flat feet and protect the joint from new injuries.

Ankle instability is an unpleasant complication of ligament damage in this area. Pathology can reduce the quality of life of the patient, depriving him of motor activity.

Only timely and complete treatment with an experienced doctor will help to avoid problems with the ankle joint in the future.

An appeal to a traumatologist-orthopedist Petrosyan will restore the function of the joint, and the equipment of the clinic will make it possible to cope even with complex cases of the disease!

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

Expertnews