The Center for Podiatric Care and Sports Medicine

Ankle Sprains: The Danger of Inadequate Care

Posted by on Monday, March 30th, 2015

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Every day, 25,000 Americans are treated for ankle sprains. Yet, the American College of Sports Medicine adds that 40 percent of ankle sprains are misdiagnosed or poorly treated.  “Ankle sprains are notoriously under-treated by primary care doctors and emergency rooms, and most importantly by the patients who suffer them,” Massachusetts foot and ankle specialist Dr. Holly Johnson told The Huffington Post

Taking a flippant attitude toward an ankle sprain today can lead to crippling pain, limited range of motion, chronic instability, re-injury, and arthritis later on. Ankle sprains are one of our chief concerns here at The Center for Podiatric Care and Sports Medicine in NYC, so come on in and meet our friendly staff if a recent ankle injury has caused pain and swelling.

ankle sprains
Ankle sprains are a common tennis injury. Image Source: Wikimedia.org

What Exactly Is An Ankle Sprain?

There is a pervasive tendency for patients to think that a “sprain” is not too bad, compared to a fracture. However, ankle sprains can hurt just as much and cause all the same symptoms as a bone break, not to mention lead to the same type of structural instability that can cause long-lasting problems if not treated seriously.

Ankle sprains involve damage to the ligaments–the short bands of fibrous connective tissue that join bones together. A Grade I sprain is the most common type, with pain and swelling related to overstretching of the ligament. With a Grade II sprain, often seen in athletic injuries, the pain and swelling are more moderate due to partial tearing of the ligaments. Grade III sprains present significant swelling and pain when the ligament is completely torn.

How Does A Sports Medicine Doctor Treat Ankle Sprains?

Initial treatment begins with an accurate diagnosis, which will include a physical exam, discussion of medical history, and diagnostic imaging. The Center For Podiatric Care and Sports Medicine’s doctors of podiatric medicine will select an appropriate immobilization device for you–be it athletic taping, a lace-up brace with side panels, a walking boot, or (in rare cases) a cast.

We’ll counsel you on steps you can take to rest and recover at home, including ice, compression, and elevation routines, as well as the proper use of anti-inflammatory medication and mental coping mechanisms.

After your initial appointment, you’ll work with an experienced physical therapist who will help you stretch and strengthen the ankle and calf muscles. We’ll advise you on activities like walking, swimming, or cycling that can reduce weight on the ankle, while maintaining cardiovascular fitness and body strength as you recover. Proprioception–re-training the muscle sensation and balance–is also a crucial part of our rehabilitation work with patients. Using wobble boards improves stability and reduces the risk of re-injury up to 50%.

When treated appropriately, 90% of patients will be fully recuperated from their ankle sprain. The remaining percentage may need additional physical therapy, advanced treatments like platelet rich plasma injections to aid in healing, or arthroscopic surgery to repair ligament damage.

Why Do Some Ankle Sprains Fail To Heal?

An article published in the Journal of the American Academy of Orthopaedic Surgeons in May 2009 found that 40 percent of ankle sprain sufferers went on to experience chronic ankle pain and instability. There could be one of several reasons behind this:

1. Poor diagnosing

Standard X-rays may not detect all types of trauma resulting from ankle sprain injuries; magnetic resonance imaging (MRI) evaluation is often necessary to determine the full extent of injury. In addition to the ankle sprain itself, many patients have bone bruising, chondral injury (damage to cartilage), tendon tears, nerve impingement, persistent inflammation in a condition called Sinus Tarsi Syndrome, or a subtle occult fracture.

The Arizona researchers who wrote the 2009 article warned that “Peroneal tendon injuries are underdiagnosed and should be considered in every patient who presents with chronic lateral ankle pain.” To achieve a favorable outcome in treatment, “understanding the anatomy of the peroneal tendons and knowledge of current treatment approaches for peroneal tendon tears, subluxation and dislocation of the tendons, and peroneal tenosynovitis are of great importance,” they add. For these reasons, it is best to seek medical attention from a doctor of podiatric sports medicine who specializes in foot and ankle anatomy, rather than seeing a general physician or emergency room for this type of injury.

2. Rush to recovery

Soft tissue injuries to the ankle often take months to heal completely. High ankle sprains, in particular, require a full 6-10 weeks for recovery, and three months is often the timetable for return to high-intensity activity. The patient may begin feeling better in a matter of weeks, and resume normal weight-bearing activities prematurely. Ankles in a weaker state are prone to re-injury–which, in turn, puts patients at risk of developing scar tissue and arthritis due to prolonged healing.

3. Failure to perform rehabilitation exercises

“A comprehensive rehabilitation program is a critical part in the treatment of ankle sprains,” says the American College of Sports Medicine. Patients who go to general physicians or emergency rooms are typically discharged without further care. By comparison, an orthopedic doctor, sports medicine doctor, or podiatrist takes you through a physical therapy program during the weeks following your accident.

4. Natural healing mechanisms

The foot and ankle, by nature, is an area that is relatively slow to heal because the extremities do not see as much circulation as other areas in the body. Inflammation and scar tissue are natural healing mechanisms that are essential to tissue repair, but also impede fast recovery. It simply takes time for the body to regenerate. You’ve got to work on a gradual course of range-of-motion exercises, flexibility training, and strengthening for these newly-formed tissues to see favorable results.

A pesky ankle sprain can turn into more if ignored or under-treated, but with the proper care, it can be no more than a temporary bump in the road. Roll an ankle in New York City? Contact The Center for Podiatric Care and Sports Medicine to start your recovery right away!

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.