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Thursday, January 3, 2013

Ankle Sprain Advice From Afar: To Xray or not Xray That is the Question??

Hello Dr Blake!

We're enjoying a wonderful honeymoon in Tasmania, but despite the small population we haven't met your second cousin yet!  

Unfortunately I injured my ankle last week and wonder if you will check your email today for some quick advice.  8 days ago, we were hiking and I rolled my right ankle severely outwards.  With my loose joints, this happens all the time and I usually recover in 1 or 2 minutes, but this time it was bad.  I think I felt a "pop".  After hiking about 2 miles back to our friends' vehicle, the ankle was very swollen.  We wrapped it for compression, but were unable to get any ice on it for at least 6 more hours.  For the next 24 hrs, I iced and elevated, limited walking around our camp site to the bathroom and picnic table, etc.  The following 3 days, I didn't have ice available at next site, but took max dose of ibuprofen daily, limited walking.  Only have pain when ankle rotates outward on uneven ground.

On days 5, 6, and 7 we did minimal cycling (10 - 15 miles) on fairly flat, easy roads.  I noticed that I was OK for the first hour, then some pain in different parts of the ankle and foot towards the end of the ride.  We finally rolled into a bigger town and decided to see a doctor at an urgent care clinic.  She barely looked at my foot, but said it was probably a sprain or torn ligament, prescribed a strong anti-inflammatory.  

I also have a referral for an X-ray and ultrasound, and currently deciding what to do next.  I would like to try some minimal, easy cycling for the next 9 days of vacation and see how it goes, though a little voice is worried that this may be unwise.  I have the option to get an x-ray here in this small town today, and/or travel to the bigger town (1 - 2 hrs by bus) for an ultrasound.  Do you think either of these is necessary?  I still have some swelling after 8 days, some level 3 (out of 10) pain while walking.Thank you and happy new year!

Dr Blake's comment:

Hey Stephanie,

      Sorry to hear about your ankle, and hope you run into my relatives soon. Maybe they own an xray machine. 
Definitely I would get the xray to rule out a fracture. I say rule out because that is what we want to do---eliminate it from the discussion. It is the best information you can give me. If you have a negative xray, the injury is probably all soft tissue, and pushing through some of the pain is probably okay. If the xray shows a fracture, more beach time for you girl!!! Keep me in the loop. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.