Ankle Sprain Treatment

The soft tissues of the ankle can be torn, partly torn or overstretched as an acute traumatic injury which can happen at any age. If it is severe, there may also be bone damage which may not be obvious at first.

Types of Ankle Sprain

Inversion and Eversion Ankle Sprain

In an inversion sprain, which is the most common, the foot and ankle turn inwards, and the lateral ligament takes the brunt of the force, sometimes cracking the fibula, and occasionally the medial malleolus too. In an eversion sprain the ankle twists outwards, straining the medial ligament, with damage to the medial malleolus and fibula in severe cases. In a dorsiflexion sprain the foot is forced upwards, compressing the structures at the front of the ankle. In a plantarflexion sprain the foot is forced downwards, and the soft tissues on the top of the ankle are strained, while those behind the ankle are compressed.

What you Feel During Ankle Sprain

When the injury happens, there may be a lot of pain, or very little. Pain and stiffness may come on later. You may still be able to walk, or at least hobble, putting your foot down. With your foot off the ground, you can usually move the foot up and down, at least a little, but rotation is painful, difficult or impossible. Swelling may develop immediately or later. Bruising may appear around the joint straight away or later. A minor crack in any of the bones may cause localised swelling and tenderness if you press on it.

The amount of pain you feel does not necessarily reflect the degree of tissue damage. If a ligament is completely torn, there may be surprisingly little pain, but the ankle feels unstable and tends to give way if you try to put weight through the foot.

Causes for Ankle Sprain

Ankle sprain can be caused by putting your foot down awkwardly, stepping on a ball or stone, catching your foot in a hole, tripping over the edge of a step or an opponent’s foot, or using sports shoes which do not fit properly, or which have too much or little grip for the playing surface. Ankle sprain happens more easily if you have stiff feet, knees or hips, or have suffered previous sprains or leg injuries which have created imbalance in the leg muscles and impaired your balance mechanisms.

Treatment for Ankle Sprain

For the first few days you may need an ankle support or firm bandaging and crutches. You should try to do frequent short walks taking a little weight through your foot.

Call +65 6471 2674 (24 Hour) to see our doctor and seek treatment regarding ankle sprain today.

Ankle Bone Traumatic Fracture

The bones around the ankle can be broken by severe twisting stress or vertical impact. This is an acute traumatic injury which can happen at any age. If the ankle joint is displaced, it is a fracture-dislocation. Damage to the bone’s cartilage surface within the joint is called an osteochondral fracture.Injury to the talus, fibula or malleoli can cause cartilage or bone fragments to break off and form loose bodies in the ankle joint. Osteochondritis dissecans is a particular type of damage in a bone’s cartilage surface, which happens especially in teenagers. In young children whose bones are still quite soft, fractures are termed ‘greenstick’.

Type-III-ankle-sprain

What You Feel When You Have Ankle Bone Traumatic Fracture

A bone fracture can be surprisingly painless at first, and may seem no worse than a sprain. You may be able to put your weight on the foot. However, in a bad break there is acute pain, usually accompanied by swelling, bruising, perhaps bleeding, and visible deformity of the leg. Walking is painful or impossible. The ankle feels weak and becomes stiff. You may have throbbing pain at night or when you sit still. In the later stages you may notice a deep aching in the bones, which is a sign that they are healing.

Causes for Traumatic Ankle Bone Fracture

A broken ankle can be caused by a fall, a wrench with the foot stuck in the ground, landing awkwardly from a jump, or a direct blow. Compression fractures happen more easily if your ankle is stiff or taped rigidly. You are more vulnerable to fracture if your bones are weakened by calcium deficiency, disease or osteoporosis.

Treatment for Traumatic Ankle Bone Fracture

You should receive immediate treatment in hospital. You may need surgery to stabilise the broken bones. Otherwise your leg may be immobilised in a plaster cast or a splint from the foot up to the knee or hip. In the early phase of healing, during the first ten days or so, the bones start the process leading to union, which normally happens after six to twelve weeks. Once the broken bone ends are joined together, the bones strengthen up and become slightly enlarged. Over the following months the damaged bones remodel themselves and gradually resume their normal shape.

Call +65 6471 2674 (24 Hour) to see our doctor and seek treatment regarding ankle fracture today.

Diagnosing Arthritis

For the vast majority of people, your doctor will be able to work out what’s wrong with you by:

  • listening to you describe your symptoms
  • examining you joints
  • examining your range of movement
  • looking at your medical history
  • looking at the medical history of your family
  • ordering certain tests (e.g. x-rays, blood test, MRI)

Putting your symptoms into words into words can be difficult. It may help you to think about how you would answer the following questions before you visit your doctor.

  • Which of your joints affected?
  • Have you noticed that your range of movement has changed?
  • Have you started to find it difficult to carry out certain tasks (e.g. buttoning up clothes) that never used to be a problem?
  • Have you experienced any swelling around your joints?
  • How often do you have pain or stiffness?
  • Do your symptoms get worse at certain times of days or after doing certain things?
  • What makes your symptoms better or worse?

Testing for Arthritis

Although there is no single diagnostic test that can confirm explicitly whether or not you have arthritis (be it osteo- or rheumatoid), there are a number of tests that can help your doctor piece together the evidence. The most common of these are blood tests and scans.

Blood Tests

There are a number of reasons why the doctor treating you may order a blood test:

  • to help them confirm that you have arthritis
  • to rule out other illnesses
  • to see how advanced your arthritis is
  • to see if your treatment is working.

Blood samples will usually have to be sent away to a laboratory for analysis and so it may take several days for the results to come in. In the laboratory, there are a number of things that can be measured, including:

Rheumatoid Factor (RF)

This is a type of antibody, a special type of blood cell that helps to fight infections. Rheumatoid factor can sometimes be used to show whether or not you have rheumatoid arthritis. The test should only be used to diagnose rheumatoid arthritis together with other pieces of evidence.

Full Blood Count (FBC)

This measures the levels of a whole host of cells and substances in your bloodstream. It can reveal anaemia or a high white cell count. Both of these are usually just part of the disease and inflammation of rheumatoid arthritis, but sometimes anaemia can be due to lack of iron and a high white count may indicate infection.

Erythrocyte Sedimentation (ESR)

This test measures how quickly your red blood cells (erythrocytes) settle down when they are spun around and then left to stand. The ESR is a means of measuring how much inflammation your arthritis is currently causing. Other tests which measure the amount of inflammation include plasma vicosity and the C-related protein (CRP) tests.

X-rays

As a disease like osteoarthritis progresses, the damage to the bone can become more pronounced, and it is at this stage that X-rays are most useful.

X-ray OA Knee

MRI scans

MRI (Magnetic Resonance Imaging) scans are relatively quick and easy ways of obtaining detailed images of the inside of the body, without having to perform surgery.

MRI scanners use radio waves (which are safer than X-rays) and high-powered magnetic field to create two- or three-dimensional images. MRI scanners in particular can distinguish between bone and soft tissue and therefore provide a more detailed picture of the state of a joint as a whole (and not just the bone).

How is Arthritis Treated?

The way in which your arthritis is treated depend on the type of arthritis that you have. However, the overall aims of any treatment programme are to:

  • reduce or relieve pain
  • reduce inflammation
  • improve your mobility
  • improve your quality of life.

Treating Arthritis with Medications

  • For osteoarthritis, drug treatment revolves around providing pain relief.
  • For rheumatoid arthritis, drugs can be used to relieve pain and reduce inflammation but may also be used to slow down the progression of the disease itself.

Treating Arthritis with Injection

  • For osteoarthritis, Synvisc injection can be explored.
  • For rheumatoid arthritis, anti-inflammatory injection is recommended.

Treating Arthritis with Surgery

Although most people with arthritis will never need surgery, it can be used as a last resort if all other treatment options failed to work or if the joint is very badly damaged.

Joint Replacement

This procedure involves the total replacement of the affected joint (usually the hips or knee). During the operation, the surgeon will remove the damaged joint and replace it with an artificial one (made from plastic, ceramics or metal). Joint replacements usually last between 10 and 20 years.

Hip Resurfacing

Resurfacing the damaged joint is a less drastic alternative to replacing the joint completely, and is most usually performed in younger people with arthritis. Typically, the surface of the joint (usually the hip joint) is replaced by a metal hemisphere and the joint socket is lined with a metal shell.

Call +65 6471 2674 (24 Hour) if you wish to see our doctor and seek treatment regarding arthritis.

 

Arthritis in Simple Science

Learning how your joints function and what happens when your arthritis symptoms flare up can help you to understand your condition and make it easier to live with.

We have already seen how arthritis is a disease that causes pain and inflammation in the joints. It doesn’t matter which type of arthritis you have been diagnosed with, if it is not managed properly you will usually end up in a certain amount of pain and may have problems getting around and doing certain things. That said, the two major types of arthritis, osteoarthritis and rheumatoid arthritis, are actually quite different in terms of:

  • their symptosm
  • the rate at which they develop
  • the people they affect
  • the way in which they are treated

These differences arise because what’s actually going on in the joints is very different. Although both conditions involve the breakdown of cartilage in the joint, osteoarthritis is due to age related changes in which the cartilage becomes thinner in some joints, and the joint becomes less cushioned, whereas rheumatoid arthritis is related to a problem with the body’s own immune system.

Osteoarthritis occurs when the cartilage starts to disappear and the lubricating (synovial) fluid loses its protective cushioning properties.

Osteoarthritis

Osteoarthritis is also known as degenerative arthritis, because the cartilage that protects the bone gradually gets worn away (or degenerates). If the cartilage wears away completely then the ends of the bones can end up rubbing together, which can be extremely painful.

At one stage, scientists believed that osteoarthritis was a natural (and inevitable) consequence of getting older, but we now know this to be untrue. The real story is probably much more complicated. Although it is true that the older you get, the more worn out your joints become, not everyone of a certain age automatically develops arthritis. It is more likely that osteoarthritis can be put down to changes taking place in the miscroscopic structure of the joints. These changes may start with the cells that make cartilage. The changes that go on in your joint(s) if you have osteoarthritis usually happen in a certain order.

  • The cartilage in the joint roughens and becomes worn down (and may disappear altogether).
  • Tiny cracks may start to appear in the cartilage.
  • Extra bone is laid down to replace the damaged or lost cartilage. The bone underneath the cartilage thickens and grows outwards.
  • The amount of bone laid down far exceeds the quantity that is actually needed to replace the damage cartilage.
  • Bony outgrowths (called osteophytes) start to form along the damaged joint.
  • Fragments of bone may break off into the joint, which cause the joint to become inflamed and swollen (and painful_.
  • The synovium starts to produce more synovial fluid than usual, which adds to the swelling in the joint.
  • The loss of cartilage, the wearing of bone and the bony outgrowths can all start to change the shape of the joint. This forces the bones out of their normal position and causes deformities.

Rheumatoid Arthritis

A case of mistaken identity

Rheumatoid arthritis can be traced back to a malfunction in the immune system. The body produces antibodies that attach the cells of the joint lining (the synovium) because it mistakes it for a foreign invader, making it painful, unstable and deformed.

At the moment, no-one knows exactly what causes them but the more we understand autoimmune diseases, the easier they will be to treat and even prevent. At the moment, however, there are some gaps in what we know.

The immune response

So what are antibodies and what do they do? Antibodies are made by white blood cells called B-lymphocytes. They can be thought as Y-shaped structures, with a special region at the tip that recognises and attaches to specific foreign substances, called antigens. Once it has bound to  the antibody, the antigen is neutralised so that it is no longer harmful. This process is known as immune response.

Of course, if the immune response is triggered inappropriately, perfectly healthy and harmless cells may become damaged. This is what happens in the joints when autoantibodies are made in people with rheumatoid arthritis.

Our blood is made up of three types of cell: white blood cells, red blood cells (which help to form blood clots). White blood cells are a key part of the body’s defence mechanism against infection.

How does autoimmunity cause inflammation and pain?

Rheumatoid arthritis usually progresses in three distinct stages:

  1. The synovium swells up and becomes inflamed as so-called inflammatory cells in the blood (specialised cells that are responsible for controlling inflammation) flock to the place where they are needed (i.e. the joint). This causes pain, warmth, redness and stiffness.
  2. The inflammatory cells in the synovium grow very rapidly, which causes the synovium to thicken and swell together.
  3. The inflamed cells then start to break down the bone and cartilage of the joint, often causing the joint to lose its shape and become unstable to move as it once did.

Call +65 6471 2674 (24 Hour) to make an appointment with our doctor to treat arthritis today.

Why do I Have Arthritis?

If you have arthritis, or are caring for someone with the condition, you are certainly not alone. Arthritis is the single biggest cause of physical disability in Singapore.

How Common is Arthritis?

The answer is ‘very common indeed’. Of the two major types of arthritis (osteo- and rheumatoid arthritis), osteoarthritis is by far the most common.

  • Osteoarthritis is more common in people over the age of 60 and as the population of the UK gets older, the number of people who suffer from osteoarthritis will also increase.
  • In contrast, rheumatoid arthritis can affect people of any age, and is usually first picked between your 30s and 50s. About one in every hundred people is affected by rheumatoid arthritis, with women up to three times more likely to suffer than men.

Osteoarthritis is much more common than rheumatoid arthritis and tends to affect older people.

How did I end up with Osteoarthritis?

In the past, osteoarthritis was wrongly considered to be an unavoidable consequence of wear and tear on the joints. We no know that joints don’t just wear out with age, so if you do develop osteoarthritis, it can usually be traced back to at least one (and possibly a few) of the causes listed below.

Arthritis

Growing older

The chances of getting osteoarthritis seem to increase with age.

Being overweight

Carrying extra weight can put joints (especially the knees and hips) under unnecessary stress and can damage them, leading to osteoarthritis.

Injury

Sustaining an injury to a joint (like a fracture) can make you more likely to develop osteoarthritis in the future. Some professional athletes can injure the same joints over and over again.

Your occupation

Performing certain tasks on a regular basis can put your joints under strain. Farmers often develop osteoarthritis in their hips and people who operate machinery like pneumatic drills can develop arthritis in their hands or elbows.

Damage from another joint disease

Suffering from a joint-damaging disease like rheumatoid arthritis can make you more likely to develop osteoarthritis in later years.

Your family history

Some forms of osteoarthritis do run in families, especially those cases that affect the small joints of fingers. But in general, heredity is not a major reason for developing osteoarthritis.

Rheumatoid Arthritis Hand

Your gender

In most joints, especially the knees and hands, osteoarthritis is more common and severe in women.

Your anatomy

Being born with abnormal anatomy (like having one leg slightly longer than the other) can make you more susceptible to developing osteoarthritis. This is called a congenital abnormality, because you are born with it.

How did I end up with Rheumatoid Arthritis?

Unlike osteoarthritis, if you develop rheumatoid arthritis in all probability there would have been very little you could have done to prevent it. In many cases the actual cause of rheumatoid arthritis is unknown. Scientists simply do not know enough about the condition to point the finger at any one particular factor, but some of those listed below may contribute.

Genetic factor

We have seen that rheumatoid arthritis is an autoimmune disease that occurs when the body’s own immune system starts attacking the tissues of the body’s own joints. Our genetic make-up is determined before we are born, and with it, our susceptibility to developing rheumatoid arthritis.

Infection

Some scientists believe that it is possible that being exposed to or infected with a particular bacteria or a virus could trigger the autoimmune response and ultimately lead to rheumatoid arthritis (although nobody has been able to show exactly what this infecting agent is).

Hormones

Rheumatoid arthritis is more common in women that in men, and this may be linked to different levels of different hormones. Furthermore, the disease can go into remission during pregnancy, only to relapse afterwards. There is also some evidence that those women who take the contracetive pill are at less risk of developing rheumatoid arthritis.

Call +65 6471 2674 (24 Hour) to make an appointment to see our doctor regarding arthritis today.