What to do if an ankle injury?

In Germany alone, more than 22 million people exercise regularly. There are sometimes injuries or signs of wear of the joints. Especially common are ankle injuries. We talked to the Stuttgart orthopedist dr. Christian Mauch on causes, risks and consequences.

Ankle injuries are particularly common among athletes. Why?

Dr. Mauch: Because the joint is loaded in many sports and is additionally complicated: It consists of the lower and upper ankle and is stabilized by three outer and two inner bands. A typical injury is the torn ligament. Incidentally, the outer ligament tear in humans is the most common ligament injury and usually occurs after a buckling. Mostly the foot bends inwards in the upper ankle joint.

How do I recognize a hock joint injury?

First, of course, the severe pain in the ankle area. After that, a crescent-shaped bruise forms and the foot can hardly be moved.

Now it happened. So what?

In any case, go to the doctor! Even harmless-looking injuries must be treated by an orthopedist. As initial care, a compression cooling is recommended. This means that the affected joint should be cooled with ice and stabilized with a pressure dressing. This prevents the swelling of the ankle. And of course, the joint should be loaded as little as possible.

How is an ankle injury normally treated?

The outer ligament tear is always treated conservatively, ie without surgery. The two simplest measures are at the same time the most important: relieve the foot and protect. With a special bandage with a detachable splint (Aircast) and simultaneous physiotherapy, the ligaments usually heal completely within four to six weeks.

But what if after a long time you still complain about instability in the ankle and pain?

This can have several causes. Either the ligaments are not optimally grown together, the ligaments are simply looser and thus the ankle is unstable or scar tissue has formed in the joint. First choice is definitely a special physiotherapy. Should this not lead to the desired success, it is recommended, especially in competitive athletes, an operative reconstruction of the ligaments by means of the so-called periosteal valve plastic.

And what happens during this operation?

In this special surgical technique, a strip-shaped part of the periosteum is separated from the lower leg via a skin incision. This strip is then halved, folded over and anchored as a ligament replacement at the lower attachment points of the stretched or torn ligaments. Thus, the ligament construction of the ankle is restored.

Sounds complicated ...

… but it is not. Periosteal flap plastic surgery is a more routine and very effective treatment for instability in the ankle joint. Even patients who have suffered from chronic ligament injuries for a long time will be fit again in a few weeks thanks to this technique. After the operation, the joint must be immobilized for three weeks. After another six weeks of exercise therapy, the new band has healed and the joint is stable again.

They warn against taking a torn ligament seriously. What are the risks?

In the worst case, instability of the joint leads to cartilage damage associated with osteoarthritis. In addition, the joint remains tedious in its movements and is only fully loaded with pain. This is especially bitter for athletes. After all, this is always associated with longer training breaks.

So what would you recommend to athletes with such an injury?

Often an ankle injury is taken lightly. But one often forgets that the joint is enormously important in almost every sport. Therefore, it is crucial to completely cure the torn ligament. The rule of thumb is: only four weeks after the injury, the ankle is fully loaded again.

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