Sprained Foot: Causes, Symptoms, and Treatment

Sprained foot refers to an overstretching of the ligaments of the foot or the joint capsule of the ankle joints. The ligaments of the foot are connections between the bones of the foot and those of the lower leg. Just like the joint capsule, they stabilize and secure the ankle joint by providing the physiological range of motion of the joint through their limited extensibility, so that the foot can only be bent to a limited extent. Although this gives the bony joint a certain degree of protection, it is precisely because of this limited extensibility of the ligament structures that trauma can lead to their overstretching (sprain) or, in the worst case, even to their tearing (torn ligament, rupture). The term “sprain” is misleading because the underlying injury mechanism is not a compression of the foot but a stretching of the ligaments. The sprained foot is a very common injury among sports injuries.

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Causes of the sprained foot

A sprained foot is one of the most common sports injuries that involve jerky movements and thus a high risk of overstretching ligaments.

The cause of a sprained foot is usually a movement that goes beyond the physiological and intended extent, such as when the foot is bent. This causes the ligaments that stabilize the joint to be overstretched, which is then referred to as a sprain of the foot. A typical injury pattern for a sprained foot is the so-called supination trauma. The supination trauma (twisting of the foot) was named after the underlying movement, supination. Here, the ankle joint bends over in such a way that the inner edge of the foot is lifted and the outer edge of the foot is lowered, causing the outer ankle to deviate outwards. This causes the outer ligaments of the foot to be overstretched and the ligament most frequently affected is the talofibular anterior ligament, i.e. the anterior ligament that connects the ankle bone (talus) with the fibula of the lower leg. The ligament connecting the calcaneus with the fibula can also be overstretched and is therefore called the calcaneofibular ligament. Only rarely is the posterior ligament connection between the ankle bone and the fibula (Ligamentum talofibular posterius) affected by a sprain.

As one of the most common sports injuries, a sprained foot often occurs in sports where jumps are necessary and one can therefore easily bend over when hitting the ground, for example in basketball. Other sports in which a sprained foot can quickly occur are running, such as jogging, but also hiking, especially on uneven ground where it is easy to twist and turn. Often, however, even minor traumas during everyday movements can lead to a sprained foot, such as bending over at a curb.

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However, it is not only excessive and unphysiological movements of the foot that lead to the sprain, but also external forces acting on the ankle or foot, which can occur in an accident, for example. It is also easier to get a sprained foot if you have a history of sprains. In this case, the ligamentous apparatus of the foot can be worn out by the repeated overloading and stretching to such an extent that it can no longer regenerate completely and thus can no longer reliably perform its stabilizing function on the joint. As a result, even a slight stretching of the ankle joint can lead to renewed spraining of the foot more easily due to the lack of ligament tension (ligament insufficiency).

A sprain is also more likely to occur due to existing foot malpositions, such as a hollow foot.

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Symptoms of the sprained foot

Immediately after a trauma that has led to a sprain in the foot, the pain usually occurs. Although this is triggered particularly by the movement of the foot and when stepping on the floor, it often persists even when at rest. Usually, within minutes after the sprain, a swelling occurs due to an injury to surrounding blood vessels and consequent bleeding under the skin. In addition, bruising (hematoma) often occurs a few hours after the trauma for the same reason, making the sprained area appear bluish. Since the ligaments are still intact in an ankle sprain and thus still perform their stabilizing function at least partially, the typical movements typical of the joint can still be performed, at least theoretically, which, in contrast, would only be partially or not at all possible in the case of a torn ligament or broken bone. In the case of a sprained foot, however, movement can still be restricted, but this is due to the pain associated with it.

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Since a sprain of the foot, i.e. the stretching of the stabilizing ligament apparatus, causes similar symptoms as a torn ligament, a doctor should be consulted in order to be able to initiate an adequate therapy quickly in the case of a torn ligament or other accompanying injuries which have a worse prognosis if left untreated. The doctor will first ask about the exact symptoms and the course of the accident during the anamnesis consultation, which often already provides information about the injured structures. For example, the accident mechanism of supination trauma is typical for an injury to the outer ligament (ligamentum talofibular anterius). This is followed by an examination of the foot, during which typical symptoms such as swelling and bruising are looked for. The doctor also checks whether a pressure pain can be triggered over the affected area. Specific ligament tests are used to determine whether the foot is abnormally mobile, which is more likely to indicate a torn ligament or even a broken bone. In order to rule out these mentioned injuries, an X-ray of the foot and ankle joint is often taken. In rare cases, other imaging measures such as an MRI (magnetic resonance imaging) or a CT (computed tomography) are necessary to exclude further accompanying injuries of bone or cartilage.

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Therapy of the sprained foot

A sprained foot heals by itself. However, this process can be decisively supported and the healing time can be shortened. An important guideline for the initial treatment of a sprained ankle is the so-called PECH rule (P=Pause; E=Ice; C=Compression; H=High). Immediate cessation of the load on the foot immediately after the trauma is crucial for rapid healing, as is resting for one to two weeks after the sprain (P). This can be supported by a bandage made of elastic material, which on the one hand has a stabilizing effect on the ankle joint, whereby the ligaments are then relieved and can heal at rest. On the other hand, the bandage contributes to the protection of the foot by minimizing the immobilization of the joint while still maintaining the mobility of the foot.

Cooling the ankle (E) is also important in the first days after the sprain. This can be done with the help of a cool pack or with ice cubes wrapped in a towel, for example, to avoid direct skin contact and thus frostbite. Cooling relieves the pain and also reduces the swelling of the sprained foot faster. The compression of the ankle joint with the help of elastic bandages is also an important pillar in acute care after trauma (C). This compression reduces the space into which the injured blood vessels can bleed so that an attempt is made to counteract the development of bruising.

In addition, a decongestant and pain-relieving ointment can be applied. The decongestant effect of the sprained ankle is additionally promoted by elevating the foot, as this is both gentle on the foot and because less blood flows into the foot due to gravity, which could cause bruising or swelling. After these initial measures, a doctor should also be consulted quickly to rule out accompanying injuries that could be treated differently in order to avoid consequential damage. If necessary, he can also prescribe painkillers for very severe pain of the sprained foot. In summary, the treatment of a sprained foot without concomitant injuries is conservative, i.e. without surgery.

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A simple sprain without accompanying injuries such as fractures has a very good prognosis and the stretched ligaments usually take only one to two weeks to heal. However, the period of time until the foot is fully able to bear weight is considerably longer, since after healing has taken place, the foot should only gradually begin to bear weight again and this should only be increased slowly. In most cases, however, the ankle joint will be fully resilient again three months later.

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An important aspect of the prevention of foot sprains is a strong muscular apparatus of the leg, which additionally supports the joint-stabilizing function of the ligamentous apparatus. Also prophylactically, it is recommended to warm up before sporting activity, i.e. on the one hand stretching the strained muscles and ligaments, on the other hand only slowly increasing the intensity of the strain. In addition, coordination exercises designed to train the sense of balance help to prevent falls that could potentially lead to a sprained foot. The risk of the foot buckling can also be reduced by wearing shoes that go beyond the ankle, or the forces caused by buckling can be absorbed well by these shoes. This is especially important for sports activities such as hiking, where you can quickly buckle on uneven ground, and also for basketball. In addition, athletes who have had frequent sprains of the foot in their history use stabilizing bandages to prevent further sprains of the foot.

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