Spring is in the air in North Texas. The brief snows are
gone and recreational sports are starting their schedules.
The soccer, baseball and lacrosse leagues are having their
first games; the high-school track team is gearing up for
competition, and The Leukemia Society's Team-in-Training
groups are just starting to increase their mileage aiming
for an early summer marathon finish. Spring is in the air,
and our old friend the ankle sprain is starting to show up
more frequently in the office. Basketball and volleyball
seasons are always the main producer of this injury; but
you would probably be surprised how many ankle sprains
occur in outdoor sports like soccer, baseball, lacrosse and
of course track and field. Ankle sprains have been reported
to be approximately 20% of all sports injuries with more
than 25,000 occurring every day in the United States.
Uneven, wet fields coupled with early season fatigue and
competitive full-contact intensity equal injuries. The
ankle is the joint that compensates for uneven surfaces.
85% of ankle injuries are sprains, which are caused by a
failure to compensate for this uneven footing. Jumping,
cutting, and pivoting put the ankle at risk. Many athletes
put themselves at further risk by not rehabilitating these
injuries properly, returning to sport too early, and giving
themselves an inadequate adaptive ability to uneven
surfaces or sudden twisting. The use of narrow cleats with
minimal arch support or the use of running shoes for a
court sport can also place an athlete at risk for ankle
sprains.
Ankle sprains occur in runners mainly because they are
chatting away as they are on a long run and are simply not
paying attention. How many runners have you seen fall off
the curb or in a pothole while running? Lots...Pay
attention to where you are going and you can prevent this
type of injury. If you know you are a klutz, run on an even
surface, like a track, when you are tired or distracted.
If you have an ankle sprain, you should be evaluated by a
sports medicine podiatric foot and ankle surgeon if you
have localized pain, swelling and bruising, as well as
inability to walk more than 5-7 steps comfortably. Many a
foot fracture has been missed in the emergency room when
x-rays were taken only of the ankle and not the foot. The
fifth metatarsal is often broken with the same mechanism of
injury of an ankle sprain, so the foot should be evaluated
as well. If severe ligament injury is suspected, an MRI can
evaluate the grade of injury. This is really what decides
whether surgery is needed for full recovery.
Treatment for ankle sprains really depends on the degree of
severity, which can only be determined by your doctor.
Initial treatment always includes "R-I-C-E" therapy - Rest,
Ice, Compression, and Elevation. Pain and edema is usually
controlled with NSAID's (non-steroidal anti-inflammatories)
like ibuprofen. Bracing or casting coupled with
non-weightbearing on crutches may be needed in more severe
injuries to rest and stabilize the ankle while it heals.
Return to pain-free range of motion (ROM) and stability is
the goal. Surgery is only recommended in Grade 3 severe
injuries in athletes or in those patients who have had
multiple ankle sprains and suffer from chronic ankle
instability. Long-term ankle instability can often be
avoided with an aggressive physical therapy program.
Bracing should only be used in the short-term during
rehabilitation because long-term bracing actually causes
atrophy and decreased ROM.
Physical therapy is needed for all ankle sprains. The goals
of physical therapy should be to regain full ROM, strength
and proprioception (where your brain thinks your ankle is
in space). Regaining strength in the peroneal tendons as
well as overall balance training are the keys to successful
rehabilitation of an ankle sprain. A maintenance program of
ankle strengthening, stretching, and proprioception
exercises helps to decrease the risk of future ankle
sprains, particularly in individuals with a history of
multiple ankle sprains or of chronic instability.
Bottom line: if you happen to fall down and go "Boom", have
your ankle sprain evaluated by a podiatric foot and ankle
surgeon. Delaying treatment and rehabilitation can lead to
life-long instability.
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For more information on ankle sprains and chronic
instability, visit my website http://www.myrundoc.com or
http://www.faant.com and click on Patient Information.
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