如果你扭伤了脚踝怎么办

面试官: 如果你扭伤了脚踝怎么办? Dr. 克里斯啊 是初级保健 运动医学 犹他健康大学的急诊医师, and he's diagnosed and treated ankle sprains for professional athletes and people just like you and me.

所以你认为你扭伤了脚踝, 或者你很确定你已经扭伤了脚踝, 这是什么意思？? 有什么迹象和症状，你能做些什么?

诊断踝关节扭伤：体征和症状

Dr. 让大发娱乐先从症状和体征开始. 脚踝扭伤的典型体征和症状是什么?

Dr. 哎呀: 所以基本上脚踝扭伤是什么, is that you have stretched or torn some of the ligaments that connect the bones together in the ankle. 由于拉伸和撕裂, 肿得厉害, 有很多淤青, 通常也会带来一些痛苦.

面试官: 好吧. And if somebody sprains their ankle, how good are patients generally at self-diagnosing that? 我的意思是, do they have a pretty good sense that that's what it is as opposed to maybe something else that they've done?

Dr. 哎呀: 老实说，我觉得他们很不错. 大多数人都明白它是什么. The ones that aren't quite as good are the ones that have a higher level of trauma and they've actually fractured something in addition. But I think most people are pretty good at understanding and recognizing when they've got a sprain.

面试官: So if I said I sprained my ankle, you would trust that for the most part if a patient told you that?

Dr. 哎呀: 是的,完全. There are some simple or relatively simple physical exam things that you can do to try to rule out a fracture or a tendon injury with an ankle sprain as well.

面试官: 这是普通人能做的事吗, 还是只有你这样的人才会这么做?

Dr. 哎呀: 显然，把它交给经验丰富的人会更好, 但你也可以自己做.

举个例子, 踝关节中经常骨折的部位之一是侧骨, 就是那种长在脚踝外面的骨头. 韧带实际上连接到骨头的底部. 所以如果你只是在底部或者它下面的柔软区域感到疼痛, 可能只是扭伤了.

如果这种疼痛是在骨头上延伸几厘米, 然后你开始担心那里可能会骨折. 这并不意味着你肯定有. 它的意思是嘿, 你可能需要拍x光片，这是大发娱乐在诊所一直使用的东西.

分级踝关节扭伤严重程度

面试官: 所以说到脚踝受伤, I understand that there are different classifications that are used to determine how severe they are. 你能给我解释一下吗? Because that will impact how somebody might need to treat it or if they want to actually see a professional.

Dr. 哎呀: 完全. 最简单的评分系统是三级递进制.

一级踝关节扭伤

第一级就是你刚刚拉伸了韧带. 所以如果你把自己切开，看看它, 你会看到那个小带子或者小韧带仍然附着在骨头上, 它只是被拉伸了. 你会感到疼痛，但总的来说，你还能做一些活动. 你还能在上面行走. 它可能会肿胀一点，但这些都是保守治疗，他们做得很好.

二级踝关节扭伤

二级是你已经部分撕裂了. And so if you were to look at those fibers, you'd see some were torn, almost like a frayed rope. 没有完全撕裂, 所以应该会好起来的, 但这可能会更痛苦一些, 有点肿, 而且有时很难绕开.

三级踝关节扭伤

三年级的时候，你完全把它撕掉了. 现在, 信不信由你, 伤口还是可以愈合的, 你不需要去修那些, 但这可能会导致未来的不稳定. 所以通常会有更多的肿胀, 更多的瘀伤, 大多数情况下，人们有时一两个星期都走不了路. And sometimes those need to be followed up to make sure that they don't have ongoing instability in the ankle that's going to cause problems down the road.

区分踝关节扭伤等级

面试官: And as a 运动医学 physician, how do you tell the difference between Grades 1, 2, and 3? 这只是单纯的成像还是你做了其他事情来确定等级?

Dr. 哎呀: 是的，所以你可以用成像来做. 超声波或核磁共振肯定能告诉你. 历史和物理可能是大发娱乐使用的主要方法.

在一次体检中, 他们可能会抓住你的脚踝，用力拉它, 基本上就是往前拉, 把它推回去, 把它倾斜到一边. 如果韧带还完好的话, 它会给出一个很好的终点, 意思是当你想拉它的时候, 它就停止了. 它不会放手. 如果它完全撕裂了，它会尽可能地张开.

然后是介于两者之间的，二年级的，他们有点难. 有时你会有一点虚弱，或者有一点松弛.

但是，是的，那些15年级和3年级的学生很容易在体检中确定.

渥太华脚踝规则

面试官: 好吧. So a provider like you might not even recommend imaging then because the physical exam is so good? 还是你总是建议做影像学检查?

Dr. 哎呀: 是的, so there is something called the Ottawa Ankle Rules that a lot of providers will use. 他们做了一项研究他们找来一群人，他们说, “嘿, 所有人都做了脚踝x光检查. 哪些确实有骨折?“他们寻找那些表明他们需要x光检查的发现.

其中之一就是我说过的, 腓骨末端的压痛, 大约6毫米高. 有一些温柔. 如果你的其他部位有疼痛, 比如在跖骨底部或者舟骨上, 那么这些东西可能需要做个x光检查.

除此之外，还有大发娱乐提供者的水平和舒适度. If they decide this patient has ongoing instability despite trying to do therapy and bracing, 也许他们需要核磁共振成像来确定伤口是否会愈合, 他们有多条韧带撕裂, 或者也可能有肌腱或软骨损伤.

面试官: 你提到了渥太华踝关节规则以及它们如何适用于是否骨折, 但这也能检测肌腱是否撕裂吗?

Dr. 哎呀: 不一定. 是的，那只是针对骨折的. 所以没有一个好的规则体系.

然而，大多数脚踝扭伤会愈合，他们会做得很好. 最大的风险是你可能会有一点不稳定. So a lot of times what we'll try to do is have the patient go through some physical therapy, building up the muscle and the tendon and trying to get that stable so that then you can get back to activity. 有时候，如果你一直不稳定或者是一个高水平的运动员, 这些可能会被修复，他们可能会有韧带固定和收紧.

踝关节扭伤的治疗策略

面试官: 大发娱乐来谈谈治疗. Talk us through the treatment plans of the different classifications and how the different classifications might also play into other factors. 那么让大发娱乐从1年级开始，最糟糕的.

Dr. 哎呀: 完全. 对于1年级, 实际上和他们所有人, 你要做的最重要的事情就是把脚踝里的积液取出来.

处理踝关节扭伤积液：抬高、压缩和冰敷

我看到的其中一个问题是有人扭伤了脚踝，然后他们就把它抱起来了, 或者他们把它放在括号里，不使用它, 它一直放在地板上, 现在又肿又痛.

如果可以的话，把脚抬高，让脚高于心脏. You can use some compression like an ACE bandage or a sleeve on that ankle just to keep it from swelling too much, 把冰敷在脚踝上10到15分钟, 每天3到4次. 然后还要用布洛芬.

所有 those things with any ankle sprain are going to significantly decrease the amount of swelling and bruising that you have. 这就是很多痛苦的来源.

The more nuanced stuff is whether or not you need to be in a brace and you need to be off of it. 肯定, 如果你担心它坏了, 你可能需要用拐杖，远离它. 如果骨头上有明显的压痛, 那你最好在做x光检查之前别碰它.

但对大多数人来说, 几天或一个星期后，当你感觉稍微舒服一些的时候, 你可以开始做一些运动练习，让脚踝活动一下. 这也会大发娱乐液体从脚踝排出，这样会感觉好一点.

面试官: 那是什么液体?

Dr. 哎呀: 这就回到, 当这些韧带撕裂或拉伸时, 它们会撕裂血管和组织. 实际上，这些血液会进入组织，进入这些区域.

所以很多时候当你脚踝扭伤的时候, 你会注意到瘀伤不仅发生在脚踝周围, 但会延伸到脚趾和脚后跟, 这就是所有的血液在重力的作用下通过你的皮肤向下流动.

面试官: 这是如何使治疗过程复杂化的? 在我看来，提升它, 布洛芬的, 这些都是为了排出液体.

Dr. 哎呀: 完全. 这会让事情变得复杂，因为组织不喜欢所有的液体. 这真的让他们很恼火. 所以会更痛苦. It's harder to move because it is so swollen, and it just doesn't come back quite as quickly.

何时寻求专业的踝关节扭伤大发娱乐

面试官: So it sounds like that possibly a patient could do these types of treatment on their own without the help of a professional, but at what point would you want to perhaps go see somebody more educated in ankle sprains?

Dr. 哎呀: 所以，首先，你试着做所有这些事情来减少液体. 如果一个星期后你仍然很难移动它, 还是很痛, 或者只是疼痛没有好转, 在这一点上, 你绝对应该被看到.

另一件要看的事情是，如果你觉得脚踝脱臼了, 这意味着它是伸出来的, 整个脚踝都出来了，又回来了. 这种情况并不常见，但一旦发生，几乎总是伴随着骨折. And so those ones probably need to be seen right away and probably should not be putting any weight on them.

面试官: So what is the advantage of seeing a professional such as yourself if somebody thinks that they do have a sprained ankle?

Dr. 哎呀: So one of the things that I think can really help you if you're able to see somebody early is that they can rule out any kind of a fracture or significant tendon or bony injury to the ankle. 这很重要，因为你可以更快地开始做更多的康复训练.

反正你也要做冰敷，抬高和布洛芬, 但如果我能排除骨折的可能性, 然后大发娱乐可以说, “嘿, 你真的可以开始锻炼了, 移动它. 你可以把重量放在上面.“所有这些事情实际上都能大发娱乐你更快地感觉好起来, and that can help your rehabilitation kind of speed up instead of having to wait a few weeks to see which direction it goes.

So one of the things that's really important with the ankle and that I try to stress with all of my patients is that when you stretch the ligaments, 你还拉伸了那里的小神经.

大发娱乐的身体里有一种叫做本体感觉的东西, 这意味着大发娱乐不用看脚就知道它在什么位置. 然而，当这些神经被拉伸时，位置感就会有点混乱.

所以即使肿胀消退，脚踝感觉好了，你也可以在上面行走, 这种位置感不像以前那么好了. 所以如果你走在不平坦的地面上, it's a little more likely for you to twist the ankle again if you step on a little rock or something like that. 这就是物理治疗真正有用的地方.

他们所做的就是重新训练你的平衡能力. They work on single-step kind of balance exercises to retrain the quickness of the tendons' and muscles' response to perturbations in your balance and in your position. 它们能够加强支撑脚踝的肌肉.

所以即使你的韧带严重撕裂, those muscles are going to help to support that ankle and a lot of times you can get away without having to do surgery if you're able to go through some good physical therapy.

踝关节扭伤的外科治疗

面试官: 你提到了手术. 扭伤的脚踝可能需要做手术? 我从没想过脚踝扭伤会那么严重.

Dr. 哎呀: 正确的. 大多数时候，他们不会. 可能只有百分之几的人需要它, and it's really when you've torn all the ligaments on one side or the other in the ankle and it just continues to be unstable.

所以尽管做了很好的治疗，人们还是会一次又一次地扭伤脚踝, 尽管使用了支撑, 诸如此类的事情, 有时他们需要把它固定好，这样它就不会随着时间的推移而损伤关节.

High-level athletes will sometimes do it because in theory they can get a little more stability and get back maybe a little bit faster than having to go through multiple sprains. 这是其中的一些想法.

面试官: 在这一切结束的时候, 如果有人在听这个并且他们扭伤了脚踝, 你给他们的最后一条建议是什么? 他们应该如何进行呢？?

Dr. 哎呀: 是的, 首先, 我肯定会做大发娱乐说过的所有事情：糖霜, 保持高水平, 保护它, 开始做一些动作.

如果你有任何顾虑, 看起来更痛苦, 这有点不正常可能是因为你之前扭伤过脚踝, 一定要去看医生. We can help you kind of determine if there's anything more wrong and we can help you get back a little bit faster and definitely get you into therapy where that can be key to not only getting back quicker but also getting back 100% so that you don't have any ongoing problems with it.