Surviving COVID-19 without my Podiatrist
Ankle Sprains
Welcome to the fifth installment of my blog, Surviving COVID-19 without my Podiatrist. Each article provides at home self-help guidance to common foot ailments. The information provided in our blog is not intended as a substitute for a medical diagnosis or care. My intent is to help the reader take care of their feet in these difficult times where access to immediate medical care is limited.
If you have any questions about any of the topics covered, as well as any other subject you would liked addressed, please email me at drreyes@ngfootclinic.com.
Ankle Sprains
This is perhaps the most common lower extremity injury we experience. It can occur during an intense sporting activity or by a taking a misstep.
An ankle sprain is caused when the ligaments that help to keep the ankle bones aligned are either “overstretched” or torn.
The most common type of ankle sprain is an inversion injury, or lateral ankle sprain. The foot rolls inward, damaging the calcaneofibular ligament and the posterior talofibular ligament. The reason the lateral ankle sprain occurs so often is because the fibula (the outside ankle bone) is much thinner than the tibia (the inside ankle bone). It thus gives way when there is any kind of disruption with our footing.
Ankle sprains are usually not considered as serious as ankle fractures. The majority of ankle sprains are usually first treated in urgent care centers. Once it is determined that there is no fracture present, you rarely will see a treatment plan or a referral to a specialist initiated. However, if an ankle sprain is not properly treated it can lead to a problem called ligament laxity. This is where the affected ligament is overstretched and never returns to its normal tight position. The same can occur if there is a partial tear of a ligament is present. Ligament laxity can lead to chronic ankle pain and makes a patient susceptible to having more ankle sprains and even fractures in the future. Therefore ankle sprains have to be taken seriously.
Treating Ankle Sprains at Home
Initial management of an ankle sprain has to begin immediately after the injury.
It must be pointed out that managing this condition at home until proper medical care is available isn’t the ideal protocol. However, given the times we currently live in, it is an acceptable alternative. Yet one must immediately seek urgent medical care if the following instances occur to the affected limb: loss of sensation, a discoloration from a normal hue to a paler hue, a deep open wound, or severe swelling with blistering and purple discoloration of the skin. The last description is usually indicative of an unstable fracture probably requiring surgery. Even though it is still considered elective surgery and may not be allowed during the current pandemic restrictions. It must still be medically managed until it can be treated.
My Home Care Regimen
- Rest your ankle by not walking on it.
- Ice should immediately be applied to the affected area. However, don’t apply ice directly on the skin. Instead apply the ice over a towel. Direct cooling from the ice can cause peripheral nerve pain. Treating the area with ice is normally done for 5 minutes at a time, every 2 hours, for the first 24 hours and as needed for relief of the pain.
- Apply very light compression dressings, bandages or ace-wraps in order to support and immobilize the ankle. Please remember better loose fitting rather than tight here.
- Elevate your ankle above the level of your heart as often as possible during the first 48 hours. This can be achieved either on a recliner or on your bed elevating the injured ankle under two pillows.
- You will need to be completely off weight bearing during this period of time. Ideally crutches are recommended. These can be purchased via Amazon from the comfort of your home. If you can’t use crutches because of stability issues, then a wheelchair with foot elevation device will do. These too can be purchased online. I don’t like patients using CAM walkers initially for ankle sprains because even though they immobilize the ankle, they still cause vertical force to stress the swollen tissue when you bear weight.
- The healing process for an ankle sprain requires inflammation. Therefore don’t take anti-inflammatory medication such as Advil, Motrin, Naprosyn or etc. They will tend to slow down the healing process.
- Another way to help heal torn ligaments is by supporting the metabolism of the proteins the body needs in order to repair the injured ligament. Zinc is essential in achieving this goal. I have patients take 50mg of Zinc daily as a dietary supplement during their rehabilitation.
How long does it take for an ankle sprain to heal properly?
The normal healing process for a lateral ankle sprain is usually 3 weeks, if the patient follows the prescribed treatment regimen. Many patients can be moved into a CAM walker and do some physical therapy in order to strengthen their muscles and improve their equilibrium. This is usually done for two weeks in cases of severe sprains or patients who have re-injured the same ankle. In cases of mild ankle sprains the patient can return to normal shoe-wear and gradually return to normal activities. Usually the body will tell you how much you can handle at first.
Listen to your body!
I have found that most patients, particularly athletes, will start feeling better and abandon their treatment regimen. The ankle will seem like it healed on the surface, however the ligaments have not. Thus giving way to ankle instability, pain and re-injuring of the ankle.
I once had a patient who was a competitive high school soccer player. He had suffered a mild ankle sprain and decided that his ankle was miraculously healed after 10 days. He re-injured it three weeks later. This time leading to an unstable fracture requiring surgery and a long rehabilitation process. The ordeal cost him a college soccer scholarship at his school of choice.
What is the difference between an ankle sprain and a ligament tear?
There are times when the force causing the ankle sprain is so severe that it causes the ligaments to tear rather than just overstretch, although the majority of tears are partial tears.
How do you know if you have a ligament tear?
There is no sure way for you to know this at home without a medical evaluation (I don’t recommend a telemedicine evaluation for this injury) and probably a non contrast MRI, but there are some signs that are suggestive of a torn ligament. The first is the level of pain. Most patients who have suffered a ligament tear, describe a severe “burning sensation” to the area. Other patients also describe the sensation of a “deep open wound.” The second clue is in the actual appearance of the injured ankle. Ligament tears will present themselves with a lot of swelling and a purplish hue on the tip of the fibula area which is just above the heel. This purplish discoloration is called ecchymosis and is the result of internal micro bleeding due to a tear.
As stated previously though, the majority of ligament tears are partial tears which means that the remaining attached ligament tissue can try to repair itself. Therefore, they can be treated with the same immobilization regimen as used for ankle sprains.
However, tears need between 4 to 6 weeks to heal. They will also require a follow up non contrast MRI when available to confirm that they have healed. These patients will be required to use a semi rigid ankle brace for another three weeks after there is evidence of healing in order to help stabilize the ankle. It has been my experience that patients who follow this treatment protocol do very well.
What about complete ligament tears?
They can be treated in the same manner and have the possibility of healing. However, because the healing process of tissues such as ligaments causes a lot of fibotic scar tissue. The healed ligament may prove to be brittle and not provide the stability and pain free range of motion, ROM, the patient desires.
Active patients may find it difficult to resume their normal activities after a full ligament tear. Surgical repair of the torn ligament is a suitable treatment option for these patients and has proven to have excellent results. Patients that are less active and are experiencing pain and discomfort after a full tear can also have a custom molded ankle, foot and leg orthosis made that can restore pain free ROM, as an alternative to surgical correction.
The take home lesson here is that with the exception of the serious complications initially presented, most ankle sprains and even stable ankle fractures can be conservatively managed with this at home regimen until medical evaluation and care is available.
I hope this helps!
If you have any questions I am always available, drop a comment here, email me, or send me a DM through any of my social media pages.