Alexander Zverev’s injury at the French Open spotlighted the all too common scourge of ankle injuries

A silent tear rolled down my cheek when the lanky German Alexander Zverev wildly clutched his ankle and writhed in pain as he fell on the clay court during the French Open men’s singles semifinal match. As tweets surfaced on social media about this “eye grabbing moment that one would not wish for anyone”, I went into flashback mode, thinking of the mind-numbing pain I had felt six months ago when my ankle had rolled.

During a hurried walk and an unfortunate stumble, my overstretched ankle ligaments had snapped. The pain was searing and it took me every ounce of strength to even sit on the pavement. The feeling of helplessness that came over me had never been so acute as I reached for my cellphone to call for assistance. Perhaps, athletes are used to experiencing varying degrees of pain, but agonising moments like Zverev’s etch a permanent memory that’s extremely difficult to erase.

Acute ankle sprain is the most common lower limb injury in athletes, accounting for 16-40 per cent of all sports-related injuries, according to a report in the World Journal of Orthopedics (December 2020). The authors have noted that approximately 40 per cent of all traumatic ankle injuries and nearly half of all ankle sprains occur during athletic activity, with basketball, American football and soccer having the highest incidence. It is more prevalent in women, children and athletes taking part in indoor and court sports.

Sprains are usually graded on the basis of severity, says Dr Nilesh Kamat, a sports surgeon and former executive member of the Indian Arthroscopy Society. The incidence increases when pivoting activity occurs; when the foot turns depending on the direction of play. When this activity is sudden, as happens in sports like football or basketball, such injuries can occur. These injuries are reported in contact sports as well.

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Also susceptible are the “weekend warriors”, people who find no time for sports during their working week but embark on strenuous Saturday-Sunday activity, often without proper training, adequate warm-up and appropriate footwear, says Dr Kamat. Soft tissue injuries are common here as are ankle sprains and their recurrence. At least 20 per cent of patients with ankle sprains develop chronic ankle instability, says the surgeon.

Now, ligaments are like static ropes which tie the bones together to provide stability to a joint. Ligaments work along with dynamic muscles that control the ankle by contracting and relaxing. Dr Anand Gangwal, sports and musculoskeletal physiotherapist, says ligaments usually get stretched or torn when an ankle sprain occurs. A damaged ligament can reduce one’s proprioception ability (the perception or awareness of the position and movement of the body). For example, a torn ligament can limit one’s ability to walk or kick without looking at one’s feet.

A report, `Recent advances and future trends in foot and ankle arthroscopy’, in the Journal of Arthroscopy Surgery and Sports Medicine, has said technological advances in instrumentation, imaging and biological reconstructive materials have most likely pushed the boundaries of what is doable with this treatment modality. However, ankle sprains are a spectrum of injuries, graded according to recovery time. When indicated, a surgical option that allows full recovery is often desirable, especially for complete tears.

Surgery may not always be the answer for ankle ligament tears. Ankle ligaments outside the joint tend to heal far better than knee ligaments. Experts like Kamat insist that rehabilitation is extensive; it cannot be a quick fix. The injury must heal and muscles around the ligament must be strengthened. Ankle rehabilitation can take between 12 and 16 weeks and failure to comply leads to increased chances of injury recurrence.

Other structures in the ankle can get damaged due to recurrent falls and even knee and hip injuries cannot be ruled out. Developing chronic ankle instability is a risk that has to be explained in detail so that a patient learns sports-specific drills and progressive loading before returning to competition is one maxim that Dr Gangwal follows.

There’s hesitation among sportspersons at the top level to go under the knife to remedy injuries and experience a long rehabilitation period as this has a bearing on their earnings. Getting sidelined and hoping to make the grade in the next sporting season is an uncertainty in one’s career that can be traumatic.

Before my third ankle twist episode, I had looked forward to bettering my 10 km run time from 70 minutes to under an hour. A carefree waltz and rock-and-roll session on the dance floor at Christmas was also on my mind. The road to those goals may appear long now. But hope burns eternal and igniting the spark is the sight of Rafael Nadal, a player living with a foot injury by his own admission, tearing the competition to shreds on clay for his 14th French Open title.

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