Ankle Dislocation

The ankle is a hinge joint that transmits the pressure coming from the entire body to the foot. An ankle dislocation is a severe injury that commonly occurs in association with the tear of one or more ligaments around the ankle or fracture of the bones around the ankle. Ankle dislocation is commonly the fracture of the distal ends of the tibia and fibula and damage to the ligaments that help support the joints.

Different types of Ankle dislocations:

Ankle dislocations are based on the direction of the force and the movement of the bones.

Posterior dislocation:

Posterior dislocation is when the talus moves backward in relation to the tibia.

Anterior dislocation:

An anterior dislocation occurs when the talus is pushed forward, while the foot is fixed with the toes pointing upward.

Lateral dislocation:

Lateral ankle dislocation occurs when the ankle is twisted, inverted, or everted.

Superior dislocation:

Superior dislocation is when the talus is forced upward into the space between the tibia and fibula. 

Symptoms of the ankle joint dislocation vary and may differ from patient to patient, but a few common symptoms may be:

• Pain in the front, back, or sides of the affected ankle.
• Sudden onset of intense ankle pain.
• Numbness in the affected ankle.
• Swelling and bruising in the same area,
• Bump in the ankle,
• Deformity in the ankle,
• Difficulty to stand or walk,
• Tearing sound heard in the ankle during injury.

Ankle dislocation can occur due to many reasons such as:

• Osteoporosis,
• Sports Injuries like football,
• Fall from a height,
• External trauma during vehicle accidents,
• Bone infection,
• Malignancy, etc.

Pathology

An ankle fracture occurs when a person breaks a bone, due to an aggressive act that involves a sudden impact or due to weak bone. The broken bones may be malignant or non-malignant. Fracture in the ankle joint may damage the blood vessels, muscles, ligaments, or nerves, causing severe pain and joint function is reduced.

Physical examination:

Physical examination of the ankle is done thoroughly to check the dislocation, joint effusion, and bleeding. The patient is assessed for ankle-toe movements, etc.

X-ray:

X-ray helps to show dislocation, fracture, arthritic changes, or loose bodies.

Magnetic resonance imaging (MRI):

Magnetic resonance imaging (MRI) is a gold standard that helps to check dislocation and ligament, muscles, or tendon injury.

Medication: NSAIDs, pain killers, muscle relaxants, antibiotics, etc.

Note: Medication should not be taken without a doctor's prescription.

 Surgery: Based on the type and severity of the injury, surgery may be suggested in case of emergency. Surgery is performed to put the bones back in place and enhance the healing process. Plates and screws are used to keep the bone in place, also in some cases, blood thinners are used to prevent blood clots in the leg during the recovery period.

The R.I.C.E. protocol should be followed every couple of hours for the first 3 days on the way to the hospital, or before consulting a doctor.

Rest:

Rest is attained by not moving the ankle joint or not putting any weight on it.

Ice Therapy:

Ice therapy or cryotherapy can be applied to the ankle for 20 minutes at a time, to decrease swelling and pain.

Compression:

Compression is done by wrapping the ankle with an elastic bandage.

Elevate:

The affected ankle is placed at about the same level as the heart. An easy way to do this is by sitting in a chair and placing the injured ankle on another chair or stool.

Thermotherapy:

Thermotherapy is used to relax the muscles that in turn help to perform the exercise program.

Ultrasound Therapy:

Ultrasound is found to be effective in breaking adhesions and improving flexibility.

Transcutaneous Electrical Stimulations (TENS):

Transcutaneous electrical nerve stimulation helps to provide pain relief that may occur after performing stretching exercises.

Laser Therapy:

Laser therapy is used for the pain management of patients suffering from ankle dislocation.

Kinesio Taping:

Kinesio-taping helps to reduce the movement of the ankle joint, it holds the ankle in the proper position while the muscles around it work properly to hold the ankle in position.

Manual Therapy:

Manual therapy consists of different techniques like manipulation, soft tissue mobilization, joint mobilization, etc, that help to decrease pain and improve functional mobility of the ankle joint.

Range of motion exercises:

Range of motion exercises help to improve the contraction of the ankle muscles such as dorsiflexion and plantar flexion done by moving the foot directly up and down using the ankle joint, ankle circles are done by moving the toes in a circle using the ankle joint. These exercises are very important to improve the flexibility of the muscles and the functionality of the ankle.

Strengthening Exercises:

Once the person can perform the range of motion exercises with minimal pain and the range of motion is improved, then the patient is recommended to begin strengthening exercises like pushing the ankle up against a fixed object, counting to 10, relaxing, and repeating 5 times. Using a resistance around the bottom of the toes, hold the ends of the band with the hands and gently push the ankle down as far as possible, then bring it slowly back to the starting position and repeat 10-15 times, another example is stand using the foot of the injured ankle, hold this position for 30 seconds and repeat 3 times.

Stretching Exercises:

Stretching exercises improve the flexibility of ankle muscles. These exercises are important to ensure that each muscle group is offering the full range of mobility.

Proprioception and balance exercises:

Proprioceptive and balance exercises are also recommended to improve the stability and balance of the affected ankle joint.

Gait Training:

Gait training is started gradually with crutches and a brace to hold the joint in place. 

The patient is advised to continue doing the exercises even after the recovery. If the patient is a sportsperson, then he/ she should practice vigorous movements and exercises, but care should be taken not to perform the exercises incorrectly as it can put repetitive stress on the muscles and joints.