What is a Sprained Ankle?
A sprain is a injury to a ligament. The most likely ligament injured in the ankle is the Anterior Talofibular Ligament.
A high ankle sprain is a rare, isolated sprain of the ligament in between the two lower leg bones.
Quick Care or ER?
Ankle sprains should be seen in the Quick care clinic.
Indications that will send you to the ER include:
- Severe pain (indicating compartment syndrome)
- Gross deformity (indicating a dislocation)
- Skin Pallor (indicating vascular compromise)
- Open wound (indicating an infection risk)
Many times it is difficult to determine if the ankle pain is a sprain of the ligaments or a fracture of the bones. An X-ray can make that distinction.
What will your doctor ask?
Your doctor will want to know your symptoms. Remember, a symptom is your description of your condition to your doctor. It is your story.
What happened? Did you twist it? Was it a crush injury?
What makes the pain better? Ice? Medication?
What makes the pain worse?
Is the ankle wound open? That is, is it bleeding?
Can you walk on it?
Do you have associated numbness?
What will your doctor look for?
Your doctor will look for signs. Remember, a sign is an objective finding that a doctor discovers upon examination
Your typical ankle sprain will demonstrate an ankle swollen on the outside. The skin is typically red but may turn purple after a few hours.
Your doctor will want to see that blood is flowing to the foot and ankle. So he/she will feel the pulse on the top of the foot (dorsalis pedis) and at the back of the ankle (posterior tibialis).
Your doctor will want to see if there is an open wound-bleeding at the site. An open wound has a greater chance for infection.
Also, your doctor will look for gross deformity which indicates a dislocation of the bones.
What is your doctor thinking?
Your doctor will consider a broken bone.
Common areas for a broken bone are the end of the fibula.
Another fracture location is the 5th metatarsal bone. Depending upon the exact location, this is called either a Jones or Dancers Fracture
An isolated high ankle sprain is rare. Usually they are associated with a broken fibula. This is called a Maisonneuve fracture.
Another consideration is stress fracture of one of the many foot bones.
There are Ottawa Ankle Rules which have helped in eliminating the need for unnecessary ankle X-rays. I have found that patients do not appreciate such rules. They want an X-ray. I have spoken until I am blue in the face to convince persons that X-rays are not always needed. It’s useless. Patients want X-rays.
Furthermore, a good examination should include the bottom of the foot. Patients may have plantar fasciitis as a cause for the pain. If ecchymosis (purple bruising) is present, a strong consideration is a Lisfranc fracture.
What is the treatment of an ankle sprain?
How to treat a sprained ankle has not changed much in recent years.
Practitioners follow a simple formula called RICE which stands for Rest Ice and Elevation.
It may be difficult for athletes to comply with the treatment of a sprained ankle since it includes immobilization.
One old remedy that still works is Epson salt. In a pan of luke warm water with a cup of Epson salt, I have my patients soak their ankle. Via osmosis, the swelling tends to go down. An ankle dislocation is best reduced on scene if in a remote location and especially if the pulses are diminished.
How long will you have a Sprained Ankle?
Sprained ankle recovery time is one to two weeks. That is, when the ankle has some support such as an Aircast or ace wrap.
Also, weight bearing needs to be limited.
To limit weight bearing, it may mean the use of crutches. I order crutches when my patients can barely take two steps without falling.
Should the ankle not heal in a timely manner, I will order physical therapy.
Let me tell you a story…….
When I walked into the room, Sylvia was sitting down on the stool with her foot up on the gurney. The ice bag that she had wrapped around her ankle was pointing to her reason for visit.
All she wanted was to get back on her feet so that she can get back to what she loved doing- salsa dancing.
When I unwrapped the ice bag from her ankle, it appeared to be a typical sprain. Swollen, tender but no gross deformity or open wounds.
As I treated her injury, she elaborated on her personal life.
Sylvia, like so many other Mexican immigrants here in California, paid a “coyote” (smuggler) to cross the Mexican border. The fee was paid with $5,000 cash and a few sexual favors. Although the sacrifice seemed steep to her pocket book and morals, the dream of getting paid enough to send money home to her impoverished mother was too much t0 pass.
Only 32 years old. No children. No husband. Free as a bird. However, instead of using that freedom to study, she decided to go out every Friday and Saturday. No responsibilities bound her with a curfew.
When I saw her as a patient, she came in a single-color polyester uniform worn by the employees of the local burger joint. At her job, she must say, ‘May I take your order?’ at least one hundred times a shift. It’s a job. Deep in her heart, she wanted something more. This is not what she had dreamed of as she made way to El Norte. Secretly, her hope was to find a young employed prince with union benefits who could sweep her off her feet. No more burger flipping. No more French Fry frying.
Once in a while, reality hits home. She is reminded that she is not where she should be. “When I am standing there taking their order, parents yell at their kids and point to me saying, ‘ If you don’t study, you will end up like her!’ ……… Don’t they know that I can hear them?” Ouch. That hurt.
I responded, “There are a lot of persons who would love to help you. But they will never find you as long as you are making cheese burgers. Go to school. Speak to a counselor. Be around like-minded achieving people. Dancing will always be there but this is your time to grow.”
I asked. “When you go out dancing and meet young guys, do you tell them that you make burgers for a living?”
“No, ” she said.
” What do you think the young guys would think if you told them that your work was flipping burgers?, ” I asked.
She paused and said,”They would think that I am a loser.” I started laughing and, after a brief pause, she laughed too.
She was not a loser. She just lost her way. Her focus turned toward salsa dancing as the central reason for her sacrificial journey.
We continued with her treatment. Once I knew her X-rays were negative, I helped her place on the Air Cast. I prescribed Naproxen and suggested Epson salt soaks.
I hope this helps