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Saturday, March 17, 2018

Ankle Sprain: Email Advice

Hi Dr. Blake,

      I was googling Contrast Bathing for ankle sprains when I came across your website.  Thanks for the info!  I sprained my ankle on Jan 6 this year.  I knew it was really bad when it happened.  I've sprained this ankle now 4 times that I can remember and thought I could rehab with just home therapy after taking 2 days off work. 

     It's been up and down, aggravated by my overstretching and probably doing too much too soon.  Xray 5 weeks post-sprain was negative for anything acute and only showed an old avulsion injury.  Just had an MRI almost 10 weeks post-sprain which showed findings consistent with full-thickness ATFL tear.  I'm wondering if it's possible the complete tear can still heal this long post-injury.
Dr. Blake's comment: I have been around long enough to see the cycle go from surgery on these grade 3 sprains, to just rehabilitation, to some surgery. Truthfully, a lot of the success of rehabilitation has to do the expertise of the healthcare provider, or team, and the desire of the patient. I know too many patients who have had surgery, but probably could have rehabbed successfully, and I have rehabbed patients only having them need surgery down the line. It takes me a year of rehab on these sprains to decide on the few that need surgery, but of course, that is my bias from the start. 

  I've been off the foot as much as possible a good week now while waiting for the MRI auth and results during which the most stubborn area of the swelling has improved some.  But now that a peroneal tendon tear and OCD have been ruled out, I'm doing some weight-bearing and limited activity again. Any thoughts or advice you have would be greatly appreciated!
Dr. Blake's comment: A bad ankle sprain has on average 3.5 months of swelling which causes instability. You are right to do your contrast bathing daily, and twice on weekends. If you have functional instability, a feeling that you may sprain your ankle, you should wear an ankle brace during these stressful activities. Physical therapy is wonderful to progress you in terms of strengthening, especially the fast twitch muscles and proprioceptive nerve endings, and then return to activity. If you keep the 0-2 pain level healing environment as you decide what you can do now, each month for the next 3 months, you should be able to do more and more. One the best things if it is at all swollen is to wear a compressive wrap or sleeve when you sleep. Definitely start Single Leg Balancing now and progress each month making it harder and harder. If you have more specific questions, I will try to answer. 

Thank you so much,

PS: Here are some other videos that may help.

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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.