The most common type of ankle injury is a sprain. A sprain is stretching and tearing of ligaments (fibrous bands connecting adjacent bones in a joint.) There are many ligaments around the ankle, and these can become damaged when the ankle is forced into a position not normally encountered.

The most frequently seen sprain occurs when weight is applied to a foot - which is on an uneven surface, and the foot "rolls in" (inversion). Because the sole of the foot is pointing inward as force is applied, the ligaments stabilizing the lateral - or outside part of the ankle are stressed. Many patients report hearing a "snap" or "pop" at the time of the injury. This is usually followed by pain and swelling on the lateral aspect of the ankle.

THE MOST IMPORTANT INITIAL MANAGEMENT OF A SPRAIN IS: RICE (Rest, Ice, Compression, Elevation)

Many of the problems resulting from sprains are due to blood and edema in and around the ankle. Minimizing swelling helps the ankle heal faster. The RICE regimen facilitates this.

• Rest - no weight bearing for the first 24 hours after the injury (Possibly longer, depending upon severity)
• Ice - apply ice packs using a towel over a plastic bag to the area that is painful. Be careful to avoid frostbite. Ice should be intermittently applied for the first 24 hours.
• Compression - an ACE bandage or other soft elastic material should be applied to the ankle to help prevent the accumulation of edema. · Elevation - elevating the ankle helps in removing edema. By having the foot higher than the hip (or heart), gravity is used to pull edema out of the ankle.
• Elevation - elevating the ankle helps in removing edema. By having the foot higher than the hip (or heart), gravity is used to pull edema out of the ankle.

In the initial 24 hours, it is very important to avoid things which might increase swelling.
Avoid:

1. hot showers
2. heat rubs (methylsalicylate counterirritants such as "Ben Gay", etc.
3. hot packs
4. drinking alcohol
5. aspirin - prolongs the clotting time of blood and may cause more bleeding into the ankle. (Tylenol or Ibuprofen may be taken to help with pain, but will not speed up the healing process)

WHEN TO SEEK MEDICAL ATTENTION

An athlete who sprains his or her ankle on a Friday night can usually follow the RICE regimen, and see a physician on Monday or Tuesday.

Because it is not possible to predict or discuss every possible situation that might arise, it is recommended that the athlete use common sense in dealing with their injury.

TREATMENT

After the initial 24 hours, the patient can begin partial weight bearing using crutches - gradually progressing to full weight bearing over several days as tolerated. The patient should try to use a normal heel-toe gait. An ankle brace may be necessary to protect the joint from re-injury. As soon as pain allows, rehabilitation exercises should be done.

THE REHABILITATION EXERCISES ARE THE MOST IMPORTANT ASPECT OF RECOVERING FULL FUNCTION OF THE ANKLE.

A full list of exercises is available from your doctor or therapist. One simple exercise that can be begun early in the course of treatment is the "alphabet" exercise. This is non-weight bearing and involves trying to draw the letters of the alphabet with your toes.

Most sprains heal completely within a few weeks. The more severe the injury, the longer the healing time. Often it is necessary to continue rehab exercises for several months following an injury. Most injuries, even severe injuries are usually managed conservatively - rehabilitation exercises, etc. - but a small percentage may require surgery.

Should you have any additional questions, please do not hesitate to contact our office. We will be more than happy to answer any questions you may have.

Phone: (503) 885-8008