This blog comes about due to the recent slippery conditions, resulting ankle sprains. Ankle sprains are one of the most common joint injuries, most people have experienced at least one during their life. Some people have had repeated ankle sprains whether due to sport or as some people will tell me they have “ weak ankles”, more on that comment later.
The ankle joint is formed by the two lower leg bones, the tibia (shin bone) and the fibula (the smaller bone on the outside of your leg) and the bones beneath that are part of the ankle and the heel.
So you’ve just twisted or rolled your ankle, what now? Ankle sprains or any injury to the ligaments ( tough connective tissues that connect bone to other bones) are graded from 1-3.
Grade 1 being the least severe, only some stretching of the ligaments, there may be some swelling and obvious at the end range of movements but no real damage to the ligament. You will be able to stand on your toes and may have a limp for a couple of days. Recovery takes 1-2 weeks.
Grade 2, is more common and involves some partial tearing of the ligaments, here there will be obvious swelling plus some bruising will also appear around the ankle and then into the bottom of one side of the foot. You will limp for up to 2 weeks, you will be unable to hop, run or stand on your toes, there will be pain with most movements. Recovery takes 1-2 months.
Grade 3 is more severe, complete tearing of the ligament, there will be bruising on both sides of the foot, weight bearing is impossible and nearly all movements will be painful and severely reduced. This may require surgery and months of treatment/rehab.
Ok, so when do I need an x-ray, should I go to the hospital? To determine need for an x-ray we follow the Ottawa Ankle Rules. These rules developed by the Ottawa Hospital Research Institute are designed to reduce unnecessary x-rays and reduce unnecessary hospital trips. In short the rules recommend x-ray if there is pain on touching the bones of the ankles and foot or there is an inability to bear weight and take 4 steps ( 2 with each foot) both right after the injury and at presentation to the health care provider’s office.
So what now, Grades 1-2 will respond well to conservative care including chiropractic care. Grade 3 will require a specialist consult, but if no surgery is necessary a conservative route can be taken but will require more time.
Initial home care will be for inflammation control (icing 10minutes/hour), rest ( including crutches), protection /compression of the joint ( some form of tensor bandage or brace) and elevation. Regaining mobility early is important, so moving the foot as much as possible in a non-weight bearing position, i.e. spelling the alphabet with your toes.
In the office we can use electrotherapy, ultrasound and hands on mobilizations to improve range of motion and decrease swelling.
As mobility improves and swelling decreases we will begin with strengthening exercises, initially non-weight bearing and then weight bearing.
Lastly, if you recall at the beginning of the blog, some people will say they have weak ankles or sprain them frequently. The reason for this is they have not retrained the ankle’s proprioceptive ability, or simply the ankle and the brain are not communicating properly and your balance is affected. To train for balance we need to stress the affected ankle alone, with one legged standing, hopping and balancing on an unstable surface.
I hope that this gives you a better understanding of ankle sprains and what to do about them. As always if you have any questions give me a call, send me an email, tweet or find me on Facebook.
www.drkevinfinn.ca info@drkevinfinnca @drkevinfinn 905-831-3939