Ankle Sprain Advice

Hi, Dr. Blake -

It's been almost a year since I last was in contact with you.  I sprained my ankle today, and wanted to check in with you.  Last year it was the right ankle, today it was the left.  I looked at your blog, but I wanted to clarify a few things with you directly.

I am elevating and icing and took some ibuprofen.  I still have a few compression socks and horseshoe padding from last time.  Should I start that right away?  Should I not use the padding while icing?

I remember how to do the contrast baths, but I seem to recall that I'm supposed to wait a day or two before starting those.

I have attached a couple pictures of my ankle.  It swelled up right away.  It also feels somewhat different than last year's injury.  With that one, I was able to walk without limping.  This one causes me to limp.  I was not in motion when my ankle rolled, but I was standing on an elevated surface, and rolled down from that (if that makes sense :)

Please let me know if I should come in to see you.  I'm pretty sure it's just a sprain.

Thanks, 

Roberta

Roberta, 

     Thanks for the email and I am so sorry about the sprain. Until the swelling is gone for 2 straight weeks, you should use compression 24/7. Those compression socks will help you, along with the horseshoe padding. I am going to use your email for my blog tomorrow, but will remove your identity (probably call you Roberta). Ice for 96 hours, then begin the contrasts at 1 min hot, 1 min cold for 20 minutes. When you ice you can remove the compression. Schedule with me for Wednesday on, but cancel if it is getting better and better. I will try to be even more thorough in my blog. Rich

     When you sprain your ankle, you need to immediately control the swelling. The more PRICE you do over the first 4 days, the assault and battery days, and the less swelling you have by the end of those 4 days, the faster your ankle will recover. Now, Roberta's (identity removed) ankle looks more like a high ankle sprain (the ligaments above the ankle called the tib-fib ligaments), and it could be a distal fibular bone fracture. So the next few days will tell us if we should xrays. Ankle sprains get better and better, ankle fractures go much slower. So, if Roberta is not feeling a significant improvement with the ability to weight bear on the 5th day post injury, we should definitely be xraying her. I always recommend weight bearing xrays on the foot and ankle since sometimes how the bones line up to the ground and each other can make a difference in diagnosis and/or treatment. To summarize PRICE for you, it is:

Protection: crutches, bracing, removable boots,etc

Rest: Restricting motion of the ankle just enough to not stimulate the pain response

Ice: All the wonderful Anti-Inflammatory measures we have available including avoiding certain foods.

Compression: Remember Compression should be tighter below the injury and looser above the injury

Elevation: Even 1 inch off the floor makes a difference, but get it up as much as you can for the first 4 to 14 days.Control that swelling.

I will leave a Rx for ankle xrays on my asst Kathy's desk. If you feel you should get an xray, call her, schedule an appt, and go to xray 1 hour before. Rich