US Basketball fans let out a sigh of relief when it was reported that Lebron James' ankle sprain was minor and that he would be back practicing in a matter of days. Unfortunately, for many weekend warriors and other part-time athletes, ankle sprains can be much more serious.
Ankle sprains are notoriously under-treated by primary care doctors and emergency rooms, and most importantly by the patients who suffer them, says Dr. Holly Johnson, a foot and ankle orthopedic surgeon from Prosports Orthopedics in Cambridge, MA. Thousands of young men and women, from weekend warriors to professional althletes, suffer ankle sprains daily. They often end up spending more time with lingering pain and swelling than is necessary, and would have been back to sports earlier if only they had rested and then rehabilitated the ankle more aggressively from the start.
This is the typical scenario: a limber, healthy young woman is running and unexpectedly steps into a pothole, twists her ankle and falls awkwardly with all of her body weight onto the side of the ankle. She has immediate pain, and unable to finish the run, limps home. She then notices her ankle is a ripe shade of blue with robust swelling, especially on the outside of the ankle, and the foot becomes more uncomfortable as she tries to put weight on it over the next few hours. She goes to a local walk-in clinic. She gets x-rays, which are invariably negative, and is given crutches, and instructed to ice the ankle and take Ibuprofen. "It's only a sprain," she's told, and in a few days she should be better.
4-6 weeks later, or even a few months later, when the bruising is long gone but the swelling and pain have lingered, the patient is frustrated. She still hurts and can't walk the half mile to work comfortably, let alone get back out running. The runner often then seeks out an orthopedic surgeon.
When x-rays are "negative," no obvious fracture, or broken bone, is identified. However, soft tissue injury to the ankle can often take more time to heal and have more longstanding effects on the ankle than a broken bone might have had. The ligamentous injury - whether the ligament tears completely or partially - often takes weeks to months to heal, and can leave the ankle in a weaker state and more prone to further ankle injuries. In about 5 % of ankle sprains, a small area within the joint is damaged, creating a "pothole" in the otherwise smooth ankle cartilage that can often cause pain in the ankle and require surgery to fix. The "high ankle sprain," as Sidney Crosby and Terrell Owens had, is when the ligaments just above the ankle are injured as well. According to Johnson, "This injury, occurring in about 1% of ankle sprains, takes at least 6-10 weeks to heal."
Johnson suggests that when you have an ankle sprain that you can't shake off in a few days, you should see an orthopedic surgeon. Initial treatment should start with bracing. An ankle support, typically a lace-up type with side panels, or even a walking boot should be used for a few weeks. Bracing allows the ankle ligaments and tendons to rest and recuperate, providing pain relief and protection from further injury. After adequate rest, physical therapy should be started in most cases, especially if the ankle has been immobilized. Physical therapy is crucial to strengthen the ankle, regain any lost ankle motion, and most importantly, to retrain the ankle's tendons and ligaments to respond appropriately to any new twisting injury.
Most people recover fully after proper treatment, and can get back into their typical activities and sports. When the injured ankle is painless, back to at least 80% of the strength of the other ankle, and has full range of motion, the patient can safely return to sports and running. About 10% of the time patients will go on to have ankle instability or lingering pain that requires not only further work-up, usually an MRI scan, but sometimes surgery. Hopefully by giving these injuries the treatment they deserve when they happen, one can avoid being in that 10%.
For more information about sports medicine, visit the Joe DiMaggio Sports Medicine Center.
Mission statement: Manhattan's Joe DiMaggio Sports Medicine Center is devoted to rendering the very best non-surgical foot and ankle care, specializing in effective, non-intrusive methods as a primary objective. At the same time, the Center is affiliated with the world renowned Hospital for Special Surgery (HSS), affording traditional surgical and other options. The HSS, located in New York, has been recently rated the Number One hospital in the country for orthopedics by the US News and World Report. The Center also offers the expertise of orthopedic surgical and non-surgical clinicians in all areas of care.
The Center is named after American sports icon Joe DiMaggio, whose heel spur disability remains one of the most well-known sports injuries in history.