Huber Heights Office
With the 2012 season of the NFL opening this week, expect to see an increase in the number of sports-related injuries in the news. Already on opening day, the quarterback for the Arizona Cardinals, John Skelton, had to be carried off the field due to an ankle injury. Reports indicate that the injury is an ankle sprain, one of the most common ankle injuries. An ankle sprain is damage to the ligaments of the ankle, the soft tissue structures that keep the joint together. It is important to have an ankle injury evaluated so that the best course of treatment can be determined.
With the Summer Olympics fast approaching I remember one of the greatest and most memorable Olympic moments in history. For the 1996 US women’s gymnastics team to have a chance at gold, little Kerri Strug would have to nail her vault. The unthinkable happened as Kerri completed her first of two vaults; she fell while landing, ripping ligaments in her ankle. She then ignored her injury and stuck the landing of her second vault. Who can forget her collapsing to the floor in pain after securing the American team its first ever Olympics gymnastics gold?!? Kerri Strug went on to become one of the most recognizable faces of the 1996 games. What a great ending, right? Well, if this really was the end of the story, it would be. But it wasn’t.
In 1997 Sports Illustrated wrote about Strug, “A year after her Olympic vault to fame, Kerri Strug now carries herself stiffly and walks with a trace of a limp. Physical therapy took a backseat to making appearances.” A lot of people are like Kerri Strug and see a sprain as a minor injury that they can struggle through without treatment. They don’t take time out of their busy lives to treat the injury, and they end up paying for it later. This time of year is the height of the ankle injury season at Advanced Foot and Ankle Care, and we have all of the experience, diagnostic and treatment tools to get you back on your feet and enjoying the rest of your summer.
To understand how to adequately treat an ankle sprain first we should start at the beginning and understand the injury itself.
Anatomy of an Ankle Sprain:
The ankle bones are held in position by ligaments. The ligaments protect the ankle against abnormal movements like twisting, turning, and rolling of the foot. Ligaments are elastic within their limits, but when they are forced beyond their normal range, a sprain occurs. Sometimes the ligaments even tear, and you may hear a popping sound. Pain and swelling soon follow. Sprains are given grades 1, 2, and 3, increasing in pain and swelling along with ligament injury from stretching to complete rupture.
Diagnosing the Sprain:
The first step in treating an ankle sprain is properly diagnosing it. At Advanced Foot and Ankle Care we have several techniques to properly diagnose ankle injuries. The most important technique we employ is the history and physical examination. By listening to our patients’ mechanism of injury and examining their injured foot and ankle we usually have a good idea of what we’re dealing with. We also take x-rays to rule out a break in the bones. The diagnostic ultrasound machine is often used to evaluate tendons and ligaments for ruptures and tears. It’s also possible that an MRI might be ordered to confirm our diagnosis if we suspect injury to the joint surface, a small bone chip, or a very severe injury to the ligaments and tendons.
Treating the Sprain:
We treat ankle sprains based on their severity or grade.
Grade 1 sprains should be treated with rest using a special boot called a CAM boot, icing, a compressive wrap, and elevation. After a patient has healed enough that a CAM boot is no longer necessary they may find a non-custom brace helpful as they transition back into normal physical activity.
Grade 2 sprains are again treated with rest using a CAM boot (possibly with the addition of an assistive device such as crutches), icing, compressive wraps, elevation, non-custom bracing, and physical therapy. Physical therapy is an invaluable part of treatment to regain strength and range of motion after ankle injury. Adequately rehabilitating an ankle sprain goes a long way toward preventing reinjury to the ankle.
Grade 3 sprains may be treated the same as Grade 2 sprains but could possibly require surgical repair. Physical therapy is of even more importance in these high grade injuries, and a custom brace may be helpful for walking on uneven surfaces or performing sporting activities that require sharp, sudden turns (cutting activities) like tennis, basketball, or football.
Healing an ankle sprain can take as long as healing a broken ankle bone. Lower grade sprains usually take 4-6 weeks to heal, and higher grade sprains can take months to feel back to normal. It may even be several months before you are able to return to sporting activities. 40% of those with acute ankle sprains will develop chronic symptoms of ankle dysfunction such as pain, swelling, recurrent injury, and weakness. The healing process can be slow, but it’s so important to be patient and seek the proper treatment to avoid these problems.
Hillarie Amburgey, DPM
“I Sprained My Ankle”
Sprains of the ankle do not discriminate, as they affect the layperson as well as celebrities (former Olympic gymnast Kerri Strug, ‘American Idol’ winner Kelly Clarkson, ‘Dancing with the Stars’ winner J.R. Martinez, and the NBA’s Dwyane Wade to name just a few). Here, at Advanced Foot and Ankle Care, ankle sprains are a far too common condition that many of our patients have been diagnosed with and/or have suffered through. For the sake of brevity, there are 3 common types:
1. Lateral ankle sprain (most common; outside the ankle)
2. Medial ankle sprain (inner side of ankle)
3. High ankle sprain (i.e. above the ankle…rare. Quarterback Ben Roethlisberger of
the Pittsburgh Steelers suffered this injury during the 2011 NFL season)
A “sprain” occurs when there is either an abnormal stretching or actual tearing of a ligament, a fibrous tissue that connects’ bone to bone’. Blood vessels around a sprain can subsequently burst, leaking blood and fluid into the surrounding tissues causing bruising and swelling. The nerves around the area will feel this abnormal pressure and become more sensitive, resulting in pain.
Treatment is geared first at “RICE” (Rest, Ice, Compression, and Elevation) therapy and immobilizing or splinting the injury. Depending on the extent of the injury, what usually follows (during the subsequent weeks) is bracing or physical therapy to get you back on your feet as quickly (and safely) as possible. In those unfortunate cases where perhaps chronic pain or instability (ligaments have torn too much and leave the ankle loose and unstable) persists, surgical intervention may be warranted where ligaments can be repaired and/or a minimally invasive “clean out” of a painful ankle joint (i.e. arthroscopy) may be performed. (New England Patriots tight end Rob Gronkowski had arthroscopic surgery on his injured ankle after Super Bowl XLVI)
Oftentimes, sprains that occurred years ago are still painful due to either an inaccurate diagnosis or an incomplete rehabilitation in the first place. Some sprains are severe enough to “strain” or tear the tendons around the ankle. Along with a physical exam, diagnostic modalities such as musculoskeletal ultrasound (available at Advanced Foot and Ankle Care) or even an MRI may be warranted to fully understand the extent of your “sprain” and help guide your rehab. Sometimes, a “sprain” turns out to be more involved, including an actual fracture (i.e. broken bone).
The bottom line is this…pain in and around your foot or ankle is not normal. But, first and foremost, it is imperative that you see an appropriate physician for an accurate diagnosis. Our team at Advanced Foot and Ankle Care are trained and fully equipped to accurately assess and treat these types of injuries. If you’ve had the misfortune of suffering a recent ankle sprain or are still experiencing symptoms from an older injury, contact any of our Advanced Foot and Ankle Care Center locations including our Troy office for an evaluation.