The Sprained Ankle
“I sprained my ankle… or did I break it?”
Last week I saw a patient who had a chip fracture of his ankle, at the inner or medial malleolus bone. I had to put him in an ankle walker (boot) device. He needed his crutches adjusted, as well.
But ankle fractures are far less common than sprained ankles, which are a common injury in sports and other physical activities.
How do you know if it’s a fracture versus a sprain? One guideline that doctors use is the ability to walk a few steps immediately after the injury/accident. If you can walk those steps, it’s probably not broken. The second is the ability to walk a few steps when examined in the office. The final is the presence of tenderness on the bone, especially the tip of the ankle bones (inner or outer). With any of these abnormal findings, an x-ray is a good idea. Urgent care or your doctor’s office should be able to determine this and perform an x-ray or order one if needed.
Most of you have heard of RICE when it comes to ankle sprains. Rest, ice, compression, elevation. That is a good start for sprains, in general, and especially of the ankle. A cane (in the opposite hand of the foot you hurt) or a crutch or crutches (properly fitted) can also be helpful in the acute phase. An air-stirrup ankle support is great in the first days after your injury. In more severe cases, an ankle walker (boot or ski boot looking device) can be considered.
But sprains also benefit from gentle range of motion, as tolerated, to pump the fluid out. Elevation also helps with this. Sometimes therapeutic, gentle massage or physical therapy can also help with swelling and pain. Anti-inflammatory medication like advil (ibuprofen) or aleve (naproxyn) can also help with pain and inflammation/swelling. Standing all day on a newly sprained ankle—not a good idea. Walking and dancing— not yet!
As you being to recover, spelling the alphabet (capital letters works) with your injured foot is a good range of motion exercise and test. Massage that works on the calf and foot and gently at the ankle may help you recover faster and be in less discomfort.
How long? Sprained ankles can take from a week or two to as many as six to eight weeks to recover to the point where you can return to usual activities and sports. Start slowly as a reinjury will typically take a lot longer to heal than the original sprain.
Prevention—good shoes, good proprioception (position sense in space)—this can be improved with certain exercises (check online), and flexibility may reduce your risk of spraining your ankle or doing so again after you recover from the injury.
Dr. Schechter practices in Culver City and is a Sports Medicine/Family Medicine physician.