Foot problems·Supports

“Sprains are not trivial injuries”

Using MalleoTrain supports after supination trauma

From Bauerfeind Life Magazin on 21.03.2024

In short Swiss Sports Physician and Olympic Team Physician Dr. Hanspeter Betschart has to deal with sprain injuries and their consequences a lot. During follow-up treatment, he successfully uses MalleoTrain supports. He introduces two cases from performance sports. He warns of the risk of chronic ankle instability that can result in osteoarthritis as a long-term consequence. Experts should be consulted very soon after supination trauma to prevent inadequate treatment.

One awkward movement is enough: you twist your ankle and suffer from supination trauma. This common injury poses risks and needs to be treated appropriately. The Swiss Sports Physician Dr. Hanspeter Betschart warns of chronic instability of the ankle as a consequence, and regards compression supports as a means for a successful return to activity.

Football and floorball (or unihockey, which is very popular in Switzerland) do not have much in common, but there is one common denominator: the susceptibility to sprain the upper ankle. Team sports with quick movements are predestined for supination trauma. The injury mechanism is a combination of plantar flexion, adduction and an inversion of the foot.

Jan Wörnhard and Ladina Sgier paid the painful price to find this out first-hand. He is a defender at SC Brühl in the Promotion League, the third highest Swiss football league. She plays unihockey in National League B for UHC Waldkirch-St. Gallen. While Jan Wörnhard was able to return to playing quickly, the floorball player was forced to wait for complete return-to-sports and return-to-competition. She did return but had to battle problems.

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Dr. med. Hanspeter Betschart is a Specialist in General Internal Medicine FMH and a Sports Physician (SEMS). He is also the Chief Physician at Berit SportClinic.

POLICE principle for acute treatment

Her injury caused Ladina Sgier chronic instability in the upper ankle, a common complication in cases of sprains. “Chronic ankle instability will develop in 10 to 40 percent of cases after severe supination trauma – often as a consequence of inadequate treatment,” Dr. Betschart reports. He is the Chief Physician at Berit SportClinic in Speicher, Eastern Switzerland, and is providing the footballer and the floorballer with follow-up care. According to Dr. Betschart, appropriate acute treatment should always follow the POLICE principle – Protection, Optimal Loading, Ice, Compression, Elevation – “as quickly as possible,” the sports physician emphasizes. This rule of thumb for acute treatment, ensuring controlled loading as soon as possible, applies to all levels of severity, from mild overstretching of the ligaments to a complete rupture. Lateral ligament structures are affected much more often than medial ligaments. The most common injury is damage to the anterior talofibular ligament. A strain with minor hematoma and no swelling to moderate swelling is classified as a grade I injury. A partial rupture, including hematoma and moderate swelling is referred to as grade II. A full rupture with significant hematoma and swelling is considered as grade III.

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Ladina Sgier, Swiss unihockey player in National League B, during recovery training with her MalleoTrain Plus support for stabilization.

Orthotics ensure safe mobilization

In Dr. Betschart’s experience, a brace for lateral stabilization can generally be replaced by a compression support or tape after as little as two weeks in the case of grade I injuries. With grade II or grade III injuries of the upper ankle – like those suffered by our two athletes – braces are used in treatment for four to six weeks. As part of follow-up treatment, Ladina Sgier was prescribed the MalleoTrain Plus support, which provides additional stabilization, thanks to its strap system. Pads on both sides also accelerate the reduction of swelling around the ankle. Jan Wörnhard was given the MalleoTrain S support, which does not feature pads but an adjustable strap system to ensure a high level of stabilization. For at least three months, the ankle supports or tape will help with further mobilization and the return-to-sports process.

Successful return to activity

“Compression supports are perfect for a return to activity because they help strengthen the stabilizing muscles,” Dr. Betschart explains. “In cases of mild swelling, the MalleoTrain Plus exerts a local micro massage on the malleoli with its pads. I will choose the MalleoTrain S if patients want to get into tight sneakers easily. When it comes to movement, I like both supports equally. They help relieve the ligaments whilst providing maximum freedom of movement. That’s important for functional therapy.” The sports physician, who will accompany the Swiss Olympic delegation at the 2024 Games in Paris and in 2026 in Milan/Cortina d’Ampezzo as the Chief Physician, also likes the compression supports for their positive impact on proprioception. That is why he advocates their use during physiotherapy – be it on the balance board like Jan Wörnhard during his recovery training using the MalleoTrain S, or on the mat like Ladina Sgier with her MalleoTrain Plus.

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Jan Wörnhard, footballer in the Promotion League, during proprioceptive exercises supported by the MalleoTrain S, after spraining his upper ankle.

Chronification of symptoms is a real risk

Despite all measures, the risk of chronic ankle instability, which may be the result of underlying foot deformities, is always present. It is the most common cause of developing osteoarthritis of the upper ankle1. He hopes that this will not be the case for Ladina Sgier. Following her sprain in March 2022, she often suffered from pain, weakness and swelling. “By this point, it makes sense to use MRI imaging to exclude cartilage damage for example,” Dr. Betschart clarifies. In February 2023, Ladina Sgier underwent ligament tightening. Now she is able to take part in competitive sports again, as is Jan Wörnhard, who was lucky not to have complications during his follow-up treatment. However, the risk of upper ankle problems becoming chronic is very real. Any twisted ankle should initially be checked by a physician. Dr. Betschart’s further recommends: “Unfortunately, we meet a lot of patients who were not treated appropriately. They come to see us after two or three months because their problems haven’t gone away. The decision to refer a patient to a specialist may be based on the family practitioner’s own experience and their diagnostic options, but it’s definitely necessary when the symptoms persist for four to six weeks. This applies particularly if full weight-bearing cannot be achieved during the first two weeks. For competitive athletes, we recommend an early referral because the treatment plan must be adapted,” the expert elaborates. “Sprains are not trivial injuries.”

Images: Bauerfeind

  1. Valderrabano V, et al. Ligamentous Posttraumatic Ankle Osteoarthritis. Am J Sports Med. 1. April 2006;34(4):612–20. ↩︎

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