Sprained ankle
The outer band of the ankle joint is composed of three bands (the " lateral ligaments " ): talofibular ligament anterior and posterior ligament and fibulocalcaneare. When twisting inward ( supination ), it usually comes to strain or tear ( rupture) of the lig. fibuolotalare anterior and / or the lig. calcaneofibular, the complete rupture of all three bands is rare ( ligaments ).
Diagnostics
In case of breach of the lateral ligaments of the ankle is due to choosing the right therapy especially the important question, whether it is a ligament or a torn ligament. Experienced investigators succeed in this distinction, according to expert opinion in 90 % of cases alone with the drawer test, ie without the making x-ray images or the use of other equipment medical examination methods: The patient lies in a supine position for it. The examiner grasps with one hand from underneath the heel, with the other hand is pressed soulful from the top to the shin. If only one strain of the front outer band before, no drawer movement. In contrast, the foot can be pushed out of the joint with a crack significantly compared with the tibia and fibula forward ( upward in a supine patient ). Since the normal drawer movement in the ankle joint to person is very different in the healthy condition of man, it is important that you first perform the investigation on healthy ankle of the other leg. In this way it is possible to find out what degree of drawer movement when affected people is still to be regarded as not torn.
In addition, imaging techniques such as X-ray can be useful to rule out a fracture ( fracture ) of the adjacent bone. In rare cases, may also be useful magnetic resonance imaging.
Very fall under criticism are at diagnosis to the standard some time ago called " held x-rays ." It is held on a radiograph, how far the joint can be opened with a defined force. From the opening angle, which can be located in the X-ray image was then closed to the degree of injury. The reason for the criticism is that can be checked in particular the average outer band with such recordings held, the tears, but only very rarely in isolation, but almost always. , Only in combination with the front outer band As for the choice of therapy in particular the important question is whether there is a crack or a strain, but not whether one or two strips are torn, the tray test, which examines the front outer band enough in most cases as the sole study from.
Treatment
While a few years ago the Außenbandruptur was stitched regular way, today is equally good treatment results, the conservative treatment by splinting the ankle for six weeks standard. Only in case of complete rupture of all three ligaments and surgery wish (eg professional athletes ) is still recommended surgical treatment.
It is sometimes also prescribed for approximately the first eight days, a gap in plaster downright position until the swelling has subsided somewhat.
If the joint swelling not ( no longer), are often / like (often the Aircast rail) used so-called orthotics. These have two functions: the joint is secured so that the torn ligaments may not be loaded; the mobility of the joint in the horizontal direction ( " up / down" = flexion / extension ) but is hardly limited. Thus, for example walking or cycling more possible. The bands grow together rather meet load requirements, problems with a stiffened joint as in complete fixation does not occur. Be particularly favorable in this case so-called modular orthotics have been proven possible to adapt the ability to move with Orthes to the healing process.
Swell
- Best R, et. al. " Current and new concepts in the management of acute lateral ligament injuries of the ankle ", in German Journal of Sports Medicine Volume 62, No. 3 (2011 ), pp. 57/62 http://www.aerztekammer-bw.de/10aerzte/20fortbildung/ 20praxis/47sportmedizin/1103.pdf
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