Talk about your pain-in-the-ankle! One of the more common complaints I see in my sports medicine practice is the ankle sprain

sprained ankle

Just what is a sprained ankle? It is when one or more of the ankle ligaments is partially or fully torn. It usually is accompanied by a great deal of ankle pain and swelling.

Most of the time an ankle sprain is caused by inversion: the ankle rolls inward, so the sole of the foot faces the mid-line.  This injury is common during simple walking, more so when hiking over uneven ground, and also to a varying degree with sports. 

Once sprained, the outer side of the ankle becomes tender, often puffy, and sometimes bruised. 

Especially in cases where weight-bearing is difficult, prompt medical attention is helpful:

1.       Clinical exam: I always compress both the shin bones towards each other starting midway between knee and ankle.  As one moves the heels of the hands down the leg, one can determine if the bones are intact all the way to the ankle.  Then palpation, including with the foot partially inverted, will often highlight which tendons and ligaments are involved.

ankle anatomy

2.       Images: An X-ray will show bone damage (fractures, spurs), an ultra-sound will show soft tissue damage

Where indicated, bone scans or MRI’s may also be needed to identify finer detail.

x-ray ankle

Once the images are reviewed, the plan for recovery can be firmed up.  In cases of frankly broken bones, or completely torn ligaments, operation or immobilization in cast or walking boot may be needed.  In most cases of simple strain, immobilization is NOT helpful, except for a few short walks.   Rather than get a full Velcro walking boot, many will opt for a couple of days of crutches, or simply hop the few paces needed at a time.  As soon as weight bearing is pain-free, we encourage it.

 In almost all cases, the best recovery comes from movement, as long as one can do this without pain. 

If you don’t have access to resistance bands, you can resist each movement of the foot with the opposite muscles.  Instead of flopping the foot like a dead fish, try to resist raising it, or pointing it, and in the movements of describing circles.  Visualize putting a pen between your toes, and writing the alphabet in slow motion, trying to resist every movement to add tension to the opposing muscles.

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To best protect yourself from ankle sprains, consider:

  1. Activity selection: Some activities are ankle friendly, such as an elliptical or bike in the gym.  Others have ankle-friendly boots, like skating and downhill skiing. 
  2. Equipment selection: Sports that involve lateral movements, like tennis, need a shoe with a heel shaped like a pyramid when viewed from behind.  Normal running shoes tend to have heels that are straight on each side, like a man’s dress shoe, as they are anticipating no sudden side-twists.  Do NOT play tennis in regular running shoes.  For much the same reason, hiking boots are designed with high-tops and firm laces, to support the ankle.  Wear these when you hike, not regular running shoes or flip-flops.
  3. Watch out for static ergonomics.  As we discussed in our How To Keep Your Spine Straight post, there is much damage done sitting at the desk, especially with the legs flexed and feet folded up for hours.  Remember to set a timer for every fifteen minute interval, and straighten your leg to do a few more resistance exercises with the ankle.
  4. Ice after activity, along with elevation above the heart will help reduce swelling.  Remember that sitting with your foot on a stool is not elevation, as the heart needs to be six inches below the foot to let the fluid run downhill.
  5. Walk like a duck.  A little known anatomical trick will help prevent the ankle from rolling inwards, especially on uneven or slippery ground.  If you evert your feet (like a duck) it is very difficult to roll your foot inwards, due to the support of the ankle bones.  If the feet point straight ahead, or, worse yet, if they are pointed slightly towards each other, then an inward roll/sprain is much easier to occur.  Try your duck walk the next time you are walking over uncertain ground on your way to the car, or over a patch of ice or wet leaves.  It may feel a little silly, but it will help keep the sprains away!
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