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May 24, 2012 at 11:57 AMComments: 2 Faves: 1

Dr. VanWingen's Complete Guide to Ankle Sprain Care

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As spring turns to summer here in Michigan, people are dusting off their baseball mitts and frisbees. Snow skis are being traded in for the old water skis in the closet and, as this change occurs, so do the patterns of injuries I see in my office.

Regardless of the season or the sport, however, no injury is as prevalent as the ankle sprain.

3 Types of Ankle Injuries

Second Degree Ankle Sprain: 

These ankle injuries are more than a simple tug that gets walked off (a first degree sprain). The tendon(s) of the ankle are stretched significantly, but they remain intact. Blood vessels may be broken, causing bruising and swelling.  A limp may be observed, but, in general, there is no weakness.

Third Degree Ankle Sprain: 

This next stage in the injury spectrum occurs when one of the ligaments ruptures. This significant injury is thankfully much less common than first and second degree injuries.  In addition to pain and swelling, weakness or instability occurs due to the loss of the ligament’s connectivity between the bones.

Ankle Fracture:

For simplicity, only the most common fracture, the fibula fracture, will be covered.  This accessory bone attaches just below the outside knee and extends down the leg to make up the outside knob (malleolus) of the ankle.  Excessive inversion of the ankle can cause a fracture in the bone.

When should you go to the ER for an ankle injury?

The most common questions people have after injuring an ankle are, “Should I go to the ER?” and “Do I need an X-ray?” Fortunately these questions are more easily answered thanks to an exquisite study that was done in Ottawa, Canada giving us the Ottawa Ankle Rules. 

Prior to these guidelines, everyone with ankle pain got an X-ray in the emergency room, but concerned about cost and unnecessary radiation exposure, the Canadian medical system performed a huge study toward teasing out what symptoms correlated with fracture.  Surprisingly, a few easily assessed symptoms predicted accurately whether there was a significant fracture risk. Now, a quick analysis can be done to determine whether an X-ray is needed. In fact, if you know these rules, it can save you a trip to the ER or justify your need to go.

If any of the following are present after an ankle injury, an X-ray should be performed:

  1. Significant pain over the posterior (back) portion of the middle or outside ankle bone
  2. Inability to walk four weight-bearing steps after the injury

Home Care for and Ankle Injury

If you injure your ankle, think RICE.

  1. Rest: Get off the ankle.  You can make the injury worse by continuing to use it.
  2. Ice: the ankle down.  If you don’t have something formal, a bag of frozen vegetables works great.
  3. Compress: the ankle with a wrap.  This controls swelling.
  4. Elevate:  the ankle to help control swelling.

Second Degree Ankle Sprain Care:

  • Heal Time: In general, a second degree ankle sprain heals about 90% after about 7-10 days. 
  • Home Treatment Options:
    • Ace Wrap: Using some compression with an ace wrap can help add stability.
    • AirCast: If significant discomfort or instability is present, a device called an aircast may be used. Essentially this is two pieces of molded plastic velcro strapped to the sides of the ankle to allow walking while preserving stability.
    • Physical Therapy: Range of motion is important during the recovery time. This involves taking the ankle maximally through all of its motions. To accomplish this, I encourage patients to write the ABC’s with their big toe as if it were a pencil. From there, standing on the injured foot, working on balance is helpful in the final phase of recovery. 
  • When to Seek a Doctor: If there is still significant pain after 10 days, consult your doctor.

Third Degree Ankle Sprain Care:

  • Treatment: If a third degree ankle sprain is present, an aircast will be required as well as physical therapy. 
  • When to Seek a Doctor: If healing does not occur sufficiently, surgery may be required.

Ankle Fracture Care:

  • Heal Time: Healing happens over 6 weeks.
  • Treatment: Fibula fractures do not require people to be off their feet since the fibula is not a weight bearing bone. A person can bear weight as they are able with the help of an aircast. Range of motion with the ankle is important through this healing process. 
  • When to Seek a Doctor: After anticipated healing, an X-ray should be performed to confirm that the bones are coming together.

Ankle Injury Prevention

In general, ankle injuries are difficult to prevent. With sports, make sure the playing field is flat, without holes or defects. Runners do better with well-lit predictable surfaces as opposed to sidewalks or the edges of roads. For repeat sprainers, the use of braces or wraps for prevention of ankle injuries in sports is controversial. If anything, a brace leaves a person mindful that they are susceptible to injury. 

Ankle injuries are common.  While most will heal with Rest, Ice, Compression and Elevation (RICE), some “red flag” symptoms should prompt a doctor visit with an X-ray as outlined in the Ottawa Ankle Rules.

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2 Comments

  • Weird, useful studies and guidelines coming out of a nationalized medicine system...must be evil.

  • Wow, thanks Dr. VanWingen! I am definitely what you would call a repeat sprainer. I have rolled my ankle playing basketball more times than I like to recall. (And according to this, some of those I probably should have gone to the hospital! But, as usual, no medical insurance for me, at least none that I could afford the copay.) I will keep these tips in mind if it ever happens again.

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