What is an ankle sprain?

Whether on shoes, wheels or blades, chances are at some time all of us will sprain an ankle. How we take care of that injury will determine how strong the ankle becomes and how prone it is to reinjury. To understand the sprained ankle we need to know the anatomy of a joint.

A joint is the place where bones meet. Ligaments hold bones together. Think of a ligament as a rope in the shape of a belt with all of the fibers running in the same direction. The most common type of ankle injury is lateral sprain. The lateral is the little toe side of the ankle. A lateral ankle sprain occurs when a person turns the foot under the body and the foot rolls onto the little toe (lateral) side.

A sprain stretches the fibers of the ligament. A mild sprain (called Grade I) slightly stretches the fibers. We can bear weight immediately but with mild discomfort. There is no significant loss of function. You should be able to care for this yourself. In a moderate sprain (Grade II) some of the fibers are torn. Weight bearing is difficult, pain is strong, swelling and discoloration is seen. The person usually limps to protect the injured part. You may need medical help. When a severe sprain (Grade III) occurs, the ligament is completely torn. Weight bearing is almost impossible, the ankle is immediately severely swollen, pain is severe and the joint is unstable. You will need medical help with a grade III sprain. Don't wish a Grade III sprain on anyone.

 

Principles of Treating a Sprained Ankle

In an ankle or other ligamentous injury the supporting structures around the joint may be stretched or torn but they are definitely weak. If they are not brought back to full strength then you are set up for re-injury and chronic instability. There is a well-accepted approach to almost any injury. The plan is known as RICER: Rest, Ice, Compression, Elevation, and the r that is too often neglected, Rehabilitation. Rest the ankle if the injury is severe. Use ice immediately if possible and for at least the first 24 hours. Keep the area very cold. Elevate the leg above the level of the hip if swelling seems severe.

Compression must be applied to reduce swelling. Don't remove shoes or boots when the injury is fresh unless a compression dressing is available. Don't trust a rolled elastic bandage to support a weak or unstable ankle. Elastics only work to control swelling. They do miserable job of joint support. Also don't go for the folklore that says: "I can walk on it. It's not broken". That's not reliable. Get a good examination and, if needed, an x-ray. See a podiatrist, orthopedist or any other physician familiar with bone and joint injuries. An undiagnosed fracture, like a poorly treated sprain, can be big trouble in the future. Don't settle for the "adios treatment". What's the "adios treatment"? "Here's an elastic bandage. Adios." A full dose of ricer is needed with special attention to the Rehabilitation.

A note on ice use: Don't cause frostbite, but do get the ankle very cold. Apply ice 3 to 4 times a day for 20 minutes each time. Do this for the first 24 to 48 hours, or until the swelling stops increasing. Ice massage (rubbing the ice on the part) is better that just leaving the ice in place. Filling a foam coffee cup with water and freezing it can make a great ice massager. When needed it can be used as an ice massage stick.

 

Coming Back From A Sprain

Rehabilitation is the key to avoiding future ankle weakness. A weak unstable ankle is very likely to sprain again and become even unstable. You will know that an ankle is ready for rehabilitation when you can walk pain free without a limp. Before the formal rehab program begins start moving the ankle in the air. One trick is to write your name in the air with your big toe. Once the ankle is stable and pain free push the little toe against resistance to strengthen the muscles and ligaments around the ankle. Next try running figure 8 patterns around cones. Finally stand on a board supported by a dowel or ball and try to keep your balance. Slide boards, like dry land skate training boards, are good things to use as well. Consider making ankle-strengthening part of your regular workout.

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Dear Dr. Scarlet: I am 47 years old; a fitness skater for about five years now (presently skating on Miller X-trainers). Recently my left hip became too painful to skate (6-week layoff now). X-ray showed slight bursitis. Could my pain be caused by slight difference in leg length? When gliding with left foot in front of right, it doesn\rquote t feel as \ldblquote weighted\rdblquote as right foot forward. Also, I moved my frames in more at the toe than previously. Could this be a factor? Could bad mechanics be a cause? I try to practice good technique. I usually skate 10-15 miles 3 or 4 times a week. Any and all info would be greatly appreciated. Thank you for your time. Sincerely, J Saggio

Dear J Saggio: The question is whether a leg length difference could cause hip bursitis. The answer is that leg length inequalities can always lead to biomechanical imbalances which could show up as inflammations in any weight bearing joint. A simple test is to try a 1/8 inch heel lift under the shorter side. That's not easy to do in a rigid, molded boot. If the problem clears up, you're in luck. If the problem gets worse, that might be helpful as well; you may actually be onto the problem. Since you have changed the mechanics and caused a change (even a bad one) you could actually be changing the limb length too much and have to lengthen the other side. Hip joints are really not my area of expertist and you should see an orthopedist if the problem persists.

Editor: Dr Scarlet did not address moving the frames in more at the toe. If he did this move just prior to the commencement of the pain, this might be related.