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Ankle sprains common, annoying--but very difficult to prevent.

There probably are no handball players who haven't sprained their ankles.

Usually spraining an ankle at your local club means no more handball for a while. Spraining the ankle during a match will usually result in a default and take you out of action for a while.

The ankle joint is composed of three bones. The distal tibia and fibula are joined by a strong set of ligaments and make up a mortise, or an upside-down three-sided box that holds the talus bone. Sprains that affect the connection between the tibia and the fibula are called syndesmotic sprains or high ankle sprains and are a separate injury from the typical ankle sprain. We won't discuss them, as they are rare, usually involving surgery and a long recovery.

On the outside or fibula side of the ankle are two ligaments. A ligament by definition maintains its length throughout the ankle's range of motion. The most important of these outside ligaments is the anterior talofibular ligament connecting the fibula to the talus. The other lateral ligaments are the calcaneofibular ligament, connecting the fibula to the calcaneus, and the posterior talofibular ligament.

The majority of sprains involve the lateral or outside part of the ankle. These occur when we invert the ankle and roll over the outside of the ankle. There is immediate pain and swelling.

The primary injury is a stretching or tearing of the anterior talofibular ligament. We classify these as Grades 1, 2 or 3. A Grade 3 is a complete tear, Grade 2 is an incomplete tear and Grade 1 is a mild sprain with no tear, but the ligament has been significantly stressed.

Treatment of an ankle sprain can involve many forms. Some athletes with mild sprains may be able to walk it off, take antiinflammatory medication, rest a few days and resume their game. Some sprains may be painful with swelling and the inability to walk. These usually end up in the emergency room, where X-rays are taken to exclude a fracture. Then a temporary splint or boot may be applied, crutches issued and a referral made to the orthopedist.

In an orthopedic office the doctor will examine the ankle and try to stress it to determine the degree of injury. For a suspected Grade 3 complete tear, an MRI may be ordered. It is rare in our country that a complete tear would be acutely surgically repaired, but in Europe Grade 3 tears are often repaired specially in high-performance athletes as it is felt the recovery and return to sport will be faster and more predictable.

In the U.S. the philosophy is to immobilize only to allow pain and swelling to resolve and then to get the patient into therapy for early motion and weight-bearing. Most studies show that early motion allows the fibers within a ligament to assume their pre-injury state more quickly and heal without permanent damage.

After a sprained ankle is treated, a small percentage of patients may still experience pain and instability. This may be from misdiagnosed cartilage damage or a ligament that did not heal completely and is permanently stretched. Although rare, arthroscopic ankle surgery sometimes combined with repairing or reconstructing the ligament may be required.

What about preventing ankle sprains? No exercise truly can prevent a sprain. Professional athletes have trainers available to tape ankles before practices or games. Some elastic supports or lace-up ankle supports are available commercially. A high- or mid-cut handball shoe can also help.

By Bob Snyder
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Title Annotation:HEALTH
Author:Snyder, Bob
Date:Nov 1, 2018
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