Spring is in the air in most of the country. 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 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 puts 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. 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 ROM and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athlete’s or in those patient’s 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.