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Wednesday, August 10, 2016

Ankle Sprain Advice

Good afternoon Doctor Blake,

I came across your blog the other day and wanted to reach out to you with a question. I greatly appreciate your time and dedication to helping people.

5 weeks ago I had twisted my right ankle / foot somehow while walking on an unstable slippery surface.  I felt a slight pain along the outer ankle surface along with an audible pop or (knuckle popping) sound. 
Dr Blake's comment: Golden Rule of Foot---pop without pain, probably no big deal, pop with pain, definitely a big deal. 

 I was able to get back to my feet and walk without much pain.  I walked on the foot without much pain that evening, however, in the morning, it began to hurt only with motion of the ankle joint when I pointed my toes downward or turned my foot (rolled) it inward. It also hurt when I touched or pushed around the ankle bone. 
Dr Blake's comment: For Grade I or 2 sprains, the pain may not come until you stop moving it and the swelling has time to set in. Grade 3 sprains (complete tears of the ligament) always hurt and swell within minutes to several hours. 

 Walking was fine with a little bit of discomfort.  The ankle also felt slightly unstable.  
Dr Blake's comment: The instability can be from ligament tearing or just fluid which collects in the joint and makes the joint surfaces float on each other (wobble effect).

There was no bruising but the ankle was slightly swollen (not bad like some pictures I have seen).  I iced the ankle, elevated it and compression wrapped it for the next few days.  A week later I visited the doctor who examined the ankle, took x-rays (nothing appeared to be broken) and said it was a sprain and told me to wear a brace and let it rest.  Needless to say, I did rest from my daily heavy activities (I am very active, run every day, etc.) but I did walk allot on it and did not really keep off of it.  I have found the brace to make it hurt more so I never used it much. 
Dr Blake's comment: The difference in Grade I vs 2 sprains is that Grade 2 will eventually have some bruising due to the partial tearing of the ligament. So, we can assume that this is a Grade 1 sprain. 

 3 weeks later and the ankle range of motion has increased before I feel pain / tightness.  I am now going on 4 weeks and the ankle still bothers me.  The sensation I feel, especially when I am wearing short socks or gym shoes is like a rubber band around my ankle, very tight and along the top of my foot near where the foot meets the shin. When I point my toes downward it feels very tight and when I add a slight roll to the downward toe point I feel some pain.
Dr Blake's comment: Everyone has a different pattern towards healing. Some swelling more leading to the tightness feeling you have. Some scar more leading to the tightness you have. Some ankle weaken more leading to tightness as the weak tendons try to work. So, there are many reasons for this. The swelling theory should be addressed easily with you doing contrast bathing twice daily for the next 10 days.

The scar tissue and weakness may have to be addresses with a physical therapist, but you can try and see how single leg balancing and ankle active range of motion exercises go each evening for the next month. It is typical to ice the ankle for 15 minutes after strengthening. 

  I am scared to go any further with the range of motion as I don’t want to re-injure it.  There is no pain to the touch or from pressure around the bone now, but I still can’t run or do any agility exercises.  Should I be concerned?  There has been little progress over the last week as opposed to the first few.  I figured it would be healed up by now and I could do some PT to strengthen it and flexibility and be all set. 
Dr Blake's comment: Plateaus are common in rehabilitation. And, you are smart not push through pain. I try to keep my patients in the 0-2 pain range at all times in the rehab process. 5% of ankle sprains are slow because of more significant cartilage damage interiorly. This may or may not be picked up by x ray, but definitely by MRI. If you can start a walk run program and let us know how you do, that would be the best test right now, other than imaging studies. Good luck. Keep in the 0-2 range and you probably will not hurt anything, even if you are not aware of all that is happening interiorly. 

Thanks and I look forward to your comments.

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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.