As the weather warms, people are participating more in outdoor activities. During this time, we often see an upswing in patients presenting to Elite Care Emergency Room with acute ankle injuries. There are many specific types of ankle injuries that can occur because of the multiple bones and ligaments in that joint and surrounding area. So depending on the severity of your injury, you may need to visit an emergency room to be properly evaluated, treated, and referred to the most appropriate form of continued orthopedic care.
Sprain vs Fracture
The vast majority of ankle injuries are sprains. Sprains occur when the ligaments that support the ankle stretch and tear but the bones themselves remain intact. The majority of ankle sprains are minor injuries that heal with home treatment and time. Severe sprains, however, can result in an unstable joint or even a dislocation of the bones that make up the joint. These types of sprains require the ER doctor to either realign the bones of the ankle, or stabilize the joint and coordinate urgent surgery with an orthopedist.
Ankle fractures occur when any of the bones in the ankle are broken. These often occur in addition to ankle sprains depending on the mechanism of injury. Since both sprains and fractures are associated with pain, bruising, and deformity, a visit to a doctor may be needed to determine if your ankle is sprained or broken. In addition to a detailed physical exam, a doctor may need to perform X-ray’s or other advanced imaging tests.
ANY ankle injury that compromises the circulation and nerve function of the foot is a surgical emergency that requires immediate treatment. If your foot is numb, weak, pale or purple, you need to go straight to the nearest emergency room since delay in management can cause lifelong disability that is often preventable with the proper management.
Sprains
Ankle sprains are often caused by sports that require a lot of stopping and cutting. Sometimes, however, even walking on an uneven surface can cause a twisting force that can stretch or tear the ligaments that make up the ankle joint. Symptoms of a sprained ankle include: pain, swelling, bruising, and difficulty walking.
Fractures
Ankle fractures are often more serious and can result from several different mechanisms. The signs of a fracture include those of a sprain, but may also include a bony deformity. Because the symptoms are often similar, a detailed physical exam and x-rays are typically needed to differentiate the two. The reason it is so important to know which injury has occurred is because we want you to heal properly the first time. Whether that requires surgery or taking all of the weight off of your fracture while you heal, it is better to initiate the correct treatment plan as soon as possible.
Treatment (R.I.C.E Therapy)
Most ankle sprains do not require surgery. Typically, they are treated conservatively with R.I.C.E therapy, which is an acronym for:
Rest
Limited movement of the ankle initially by either not walking on it or using an assistive device. This is especially important in the first 24 – 48 hours when the joint is inflamed and swollen. Splints or walking boots can be beneficial to provide immobilization during this early period. If your pain is so severe that walking is unbearable, crutches may also be needed to help you walk during this time of resting your injured ankle.
Ice
Cool compresses (commercial ice packs or ice in a plastic bag that is wrapped in a towel) should be applied to the injury immediately and then four times daily for 20 minutes, especially for the first 2-3 days.
Compression
Helps minimize swelling (which can cause long term complications) and is usually provided by using an ACE wrap bandage that will also help immobilize and support the injured joint.
Elevation
While resting your ankle, try to keep it elevated (on a pillow while in bed or a chair that is next to you) above the level of your hip to help minimize and relieve swelling.
Physical Therapy
The final step in treating ankle injuries is physical therapy. Physical therapy comes in many forms and intensities. For minor sprains you can perform simple exercises at home as soon as you are at a comfortable level of pain. For severe injuries, your doctor might recommended visiting a physical therapist who can assist you on your road to full recovery. Physical therapy can be important in helping to avoid long term problems like arthritis and instability, as well as strengthening the ankle joint to help prevent re-injury in the future.
Depending on the type of and severity of the injury, physical therapy is best when started early after an injury. It consists of exercises to restore range-of-motion and prevent stiffness, strengthen the joint, and maintain endurance, proprioception, and balance.
Outcomes
Most ankle sprains resolve without any long term complications. But improper care and rehabilitation can lead to repeated ankle sprains which are a sign of ankle instability which can lead to chronic ankle pain and arthritis, and may need surgery to correct. Improperly managed fractures can prevent the broken bones from healing, resulting in a problem called non-union. This can result in chronic symptoms as well that require surgical correction.
Prevention
Wearing proper footwear and being mindful of your environment are the best ways to prevent ankle injuries. It is also recommended to warm up the ankle joints and wear a brace if your ankles are at risk of injury because of prior sprains or fractures or you are participating in high risk sports.
