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Sprained Ankle

If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:

  • Chronic pain
  • Chronic ankle joint instability
  • Early-onset arthritis in that joint

During the physical exam, your doctor will check for points of tenderness. He or she will move the joint in a variety of ways to check your range of motion and to see if any particular position or movement causes pain.

If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage:

  • X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for evaluating bones, but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
  • Computerized tomography (CT). CT scans are useful because they can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.

Treatment for a sprained ankle depends on the severity of your injury. Many people simply treat their injury at home.

Medications
In most cases, over-the-counter pain relievers — such as ibuprofen are enough to handle the pain caused by a sprained ankle.

Therapy
A few days after your injury, after the swelling has gone down, you may want to see a physical therapist and start performing exercises to restore your ankle’s range of motion, strength, flexibility and balance.

Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint. These exercises may involve various degrees of balance challenge, such as standing on one leg.

If you sprained your ankle while exercising or participating in a sport, talk to your doctor about when you can begin your activity again. You may need to wear an ankle brace or wrap your ankle to protect it from re-injury.

Surgical and other procedures
If your ankle joint is unstable, your doctor may refer you to a joint specialist for evaluation. You may need a cast or walking boot to immobilize your joint so that it can heal properly. In rare cases of severe ligament tears, or if you are an elite athlete, you may need surgery to repair the damage.

For immediate self-care of an ankle sprain, try the R.I.C.E. approach:

  • Rest. Avoid activities that cause pain, swelling or discomfort. But don’t avoid all physical activity. Instead, give yourself relative rest. With an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest. That way you still exercise three limbs and keep up your cardiovascular conditioning.
  • Ice. Even if you’re seeking medical help, ice the area immediately. Use an ice pack or slush bath for 15 to 20 minutes and repeat every two to three hours while you’re awake, for the first 48 to 72 hours. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could indicate a cold injury. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
  • Compression. To help stop swelling, compress the ankle with an elastic bandage until the swelling stops. Don’t wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, if the area becomes numb or if swelling occurs below the wrapped area.
  • Elevation. To reduce swelling, elevate your ankle above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.

Prevention

Take the following steps to help prevent a sprained ankle:

  • Warm up before you exercise or play sports.
  • Be careful when walking, running or working on an uneven surface.
  • Wear shoes that fit well and are made for your activity.
  • Don’t wear high-heeled shoes.
  • Don’t play sports or participate in activities for which you are not conditioned.
  • Maintain good muscle strength and flexibility.
  • Practice stability training, including balance exercises.

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Patient Guide to Ankle Pain and Tendinitis (Tendonitis)

Ankle pain and tendinitis facts

  • The ankle is a “hinged” joint.
  • Ankle pain can be caused by injury or disease of the ankle joint.
  • The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair).
  • Tendinitis of the ankle can be caused by trauma or inflammatory arthritis.

The Anatomy of Ankle:

The ankle is a “hinged” joint capable of moving the foot in two primary directions: away from the body (plantar flexion) and toward the body (dorsiflexion). It is formed by the meeting of three bones. The end of the shinbone of the leg (tibia) and a small bone in the leg (fibula) meet a large bone in the foot, called the talus, to form the ankle. The end of the shinbone (tibia) forms the inner portion of the ankle, while the end of the fibula forms the outer portion of the ankle. The hard, bony knobs on each side of the ankle are called the malleoli. These provide stability to the ankle joints, which function as weight-bearing joints for the body during standing and walking.

Ligaments on each side of the ankle also provide stability by tightly strapping the outside of the ankle (lateral malleolus) with the lateral collateral ligaments and the inner portion of the ankle (medial malleolus) with the medial collateral ligaments. The ankle joint is surrounded by a fibrous joint capsule. Tendons that attach the large muscles of the leg to the foot wrap around the ankle both from the front and behind. The large tendon (Achilles tendon) of the calf muscle passes behind the ankle and attaches at the back of the heel. A large tendon of the leg muscle (posterior tibial tendon) passes behind the medial malleolus. The peroneal tendon passes behind the lateral malleolus to attach into the foot.

The normal ankle has the ability to move the foot, from the neutral right-angle position to approximately 45 degrees of plantar flexion and to approximately 20 degrees of dorsiflexion. The powerful muscles that move the ankle are located in the front and back portions of the leg. These muscles contract and relax during walking.

Ankle sprains are one of the most common musculoskeletal injuries. Sprains are injuries to the ligaments of the ankle, causing them to partially or completely tear as a result of sudden stretching. They can occur on either or both of the inner and outer portions of the ankle joint. Ankle sprains more commonly happen when there is a preexisting muscle weakness in the ankle area or a history of previous ankle injuries. The typical injury occurs when the ankle is suddenly “twisted” in a sports activity or by stepping off an uneven surface. The pain is initially severe and can be associated with a “popping” sensation. Immediate swelling over the area of injury often occurs as the injured blood vessels leak fluid into the local tissue. Examination of the area may cause severe pain when the ankle is moved. The degree of pain may not necessarily indicate the degree of damage to the ligament(s). Ligament injuries are often graded from I to III, ranging from partial to complete tears. Partial tears retain some ankle stability, whereas complete tears lose stability because the strapping ligaments no longer brace the ankle joint. After an examination, significant ankle sprains are commonly evaluated with an X-ray. X-rays can determine whether there is an accompanying break (fracture) of the bone.

Acute ankle sprains are initially treated with ice, rest, and limiting the amount of walking and weight-bearing on the injured ankle. The leg can be elevated to reduce swelling, and crutches are often recommended to avoid further trauma to the injured ligaments. Anti-inflammatory medications can be given to reduce local inflammation. Ice packs help decrease further swelling of the area and can reduce pain. Patients with severe injuries are placed in immobilization casts. Surgical repair of grade III injuries is considered, especially for those patients contemplating future athletic participation. Physical therapy programs are part of the rehabilitation process, incorporating strengthening exercises of the lower leg muscles. Broken ankles (fractures) can accompany ankle sprains or occur without sprains. Fractures are repaired with casting to immobilize the bone for healing. Depending on the severity, fractures can require orthopedic casting, surgical procedures including pinning, and open repair of the fractured bone.

Tendinitis

Tendinitis (also referred to as tendonitis) is an inflammation of the tendon. Tendinitis of the ankle can involve the Achilles tendon, the posterior tibial tendon, or the peroneal tendon. This condition usually results from trauma, such as from sudden injury in sports or overuse injury as from running but can result from underlying inflammatory diseases or illnesses such as reactive arthritis (formerly called Reiter’s syndrome), rheumatoid arthritis, and ankylosing spondylitis. All forms of tendinitis cause pain, swelling, and tenderness in the tendon area involved. The onset may be rapid, such as with an athletic injury. Immediate treatment of tendinitis involves immobilizing the area, elevation, and limiting weight-bearing, applying ice, and using nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease inflammation. NSAIDs are commonly used for this purpose. More severe inflammation can require orthopedic casting. Athletic participation should be limited when the tendon is still inflamed, as there is a significant risk of rupturing or tearing the tendon, especially in the Achilles area, with continued athletic activity. Achilles tendon more frequently occurs in patients who have had previous Achilles tendon inflammation. When the Achilles tendon ruptures, it usually requires orthopedic surgical repair.

 

Picture of the metatarsal (foot) and calcaneus (heel) bones, the plantar fascia ligament, and the Achilles tendon of the lower leg and foot

What diseases and conditions can cause ankle pain, and how are they treated?

Inflammatory types of arthritis (inflammation of the joint) that can involve the ankle area include rheumatoid arthritis, reactive arthritis, gouty arthritis, ankylosing spondylitis, and psoriatic arthritis, among others. They generally are not induced by trauma injury and often develop gradually. A thorough evaluation by a doctor with blood testing can be necessary for ultimate diagnosis. These types of arthritis are associated with pain, swelling, stiffness, redness, and warmth in the involved area. These diseases each have unique management as described elsewhere.

Other conditions of the ankle which can cause ankle pain include tarsal tunnel syndrome. This is a result of nerve compression at the ankle as the nerve passes under the normal supportive band surrounding the ankle called the flexor retinaculum. Tarsal tunnel syndrome is described elsewhere.

Infections of the ankle joint are rare. They most commonly occur as a result of bacteria being introduced into the ankle joint through puncture wounds or trauma. They also occur with a breakdown of the skin over the ankle as a result of ulcerations or abrasions. Patients with impaired immune systems such as those with AIDS, or other immune diseases, are at an increased risk of infections in the joints, including the ankle. Also, patients with diabetes or those who take cortisone medications have an increased risk for bacterial infections of the joints. Bacterial joint infections are serious and require drainage and antibiotics, usually intravenously.

It is possible to develop viral infections of the ankle joints. In an isolated joint, such as the ankle, this most commonly occurs in children and is referred to as “toxic synovitis.” It results in temporary joint inflammation and can be first noticed as subtle limping in the child. It is benign and resolves on its own with only symptomatic treatment, such as acetaminophen(Tylenol), for relief of pain.

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Don’t Ignore Ankle Sprained

Ankle sprain is a common injury in Singapore athletes as well as the active adult. Most of the time, the ankle heals with a little care (rest, taping, ice). But one rare complication of lateral ankle sprains is a condition called peroneal tendon instability.

A lateral ankle sprain means the side of the ankle away from the other leg is sprained. The two peroneal tendons go down the leg and around the back of the ankle bone. The tendons set down inside a tunnel formed by bone and connective tissue called the retromalleolar groove. A fibrous band (the superior peroneal retinaculum) goes across the tendon to hold them in the groove.

When this fibrous retinaculum is ruptured, the tendons can dislocate or pop out of the groove. The result is persistent pain along the outside aspect of the ankle bones. There may be a painful popping or snapping sensation.

Swelling may mask the symptoms of tendon displacement at first. It’s only weeks to months later when the painful symptoms don’t go away that the additional tendon damage is recognized. Early MRIs may not show peroneal tendon instability, especially if the tendon pops in and out of the groove spontaneously.

A relaxed tendon is more likely to remain in the groove. Any active movement of the ankle will force the tendon out of its protective tunnel. If the ankle is relaxed and the tendon is repositioned correctly at the time of the imaging study, then diagnosis can be delayed. Dynamic ultrasound tests are the best diagnostic tests because they will reveal the movement of the unstable tendon.

Since this problem is rare, not much is known about the best way to treat it. Conservative (nonoperative) care is only possible when the unstable tendons can reposition inside the retromalleolar groove. A cast or boot placed on the lower leg will give the tendon a chance to heal.

If conservative care is unable to achieve a stable gliding tendon or if the tendon displacement is unstable from the start, then surgery is necessary. There are several different surgical options to consider. The fibrous protective sheath (retinaculum) can be reinforced or reconstructed. The groove can be reshaped (deepened) and rebuilt. The surgeon must be careful not to destroy or disrupt the smooth gliding surface of the bone that helps form the retromalleolar groove.

The retinaculum is repaired or reconstructed depending on the severity of the damage. Incision shape, drill holes, suture type and placement, and method for protecting the groove surface are discussed. Photos of each step in the surgical procedure are provided.

In summary, traumatic displacement of the peroneal tendons is a rare but painful complication of some lateral ankle sprains. Pain and swelling may mask the presence of this problem at the time of the injury with a delayed diagnosis. A careful examination with tenderness palpated over the torn retinaculum is the best way to accurately identify the injury. Treatment is usually surgical with the surgeon’s own preferred treatment presented.

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About Ankle Injury

1: Is it possible for the ankle to wear out?

Yes. However, it is not easy for this to happen as the ankle cartilage is extremely resistant. There is usually a cause, like a previous severe fracture, recurrent sprains or an infection of the ankle joint.

2: Can I ignore a sprained ankle and allow it to heal on its own?

No. A typical ankle sprain is usually one where there is an isolated tear of the anterior talofibular ligament (ATFL).

The consequences are loss of strength in turning the ankle outwards and proprioception, or the sense of body position awareness.

Patients will find that their ankles are ‘clumsy’ and weak, even for weeks after the swelling has gone down. They tend to have recurrent sprains.

Strengthening and balance exercises are needed to regain ankle stability and prevent future sprains.

A sprained ankle can also comprise injuries apart from the ATFL tear – some of these can be serious and you will need to see a doctor to exclude these injuries.

3: Is Tui Na, a form of Chinese massage, an effective way of treating sprained ankles?

When we do deep massage over the torn ligament or manipulate the joint – like in Tui Na – we may increase the bleeding in the area and separate the torn edges further, reducing the chances of the ligament regaining its integrity.

In ankle sprains, we need to address the instability by doing active balance and strengthening exercises, since position awareness and strength are not derived from Tui Na.

4: If I have injured my ankle, what activities should I avoid and for how long?

First, it is best to have your ankle injury examined and treated. All sporting activities should be avoided until the injury heals.

Sprains: It depends if the injury is acute or chronic. If acute, it is best to rest, ice, compress and elevate the ankle before undergoing physiotherapy. For chronic sprains, physiotherapy is recommended.

If patients improve with physiotherapy, then they can gradually go back to doing sports.

If there is no improvement, surgical repair of the ligaments is recommended.

Fractures: Surgical treatment is usually recommended, followed by physiotherapy. It may take about six months to a year before you can resume sporting activities.

Ankle arthritis: Activity levels are dictated by the pain experienced by patients. If the pain is mild, they are advised to limit activities to low impact sports, like swimming or cycling.

However, if the pain is severe or bothersome, it is recommended that patients undergo surgery.

5: What if my ankle still hurts a month after I injured it?

Then it is unlikely to be a simple isolated ATFL tear and you need to see your doctor. Most isolated ATFL tears feel much better within two weeks.

6: I have injured my ankle more than once. What are the consequences?

Repeat injuries to the ankle typically leave it in poorer condition and predisposes it to arthritis.

It is therefore recommended that the ankle injury be diagnosed and given the appropriate treatment.

7: I have ankle arthritis. Can I go for ankle replacement surgery?

Ankle replacement is generally suited for ankle arthritis patients who are above 50, do not do heavy manual work and are not overweight. It is not for the active, the young and manual workers who lift heavy loads. The ankle prosthesis is an artificial joint and can wear out with heavy usage.

8: Do I need to take supplements for ankle health?

No. Glucosamines have been recommended for joint health. However, there is no evidence that it helps in the ankle joint.

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Ankle Instability and Ankle Sprains

The ankle works in a systematic way. Movement is only supposed to be in one plane, in other words, up and down. We call this dorsiflexion and plantarflexion. The ankle joint is held in place securely by a group of bones that house the main anklebone (called the talus) inside a box-like effect. On the inside is the medial malleolus and on the outside the fibula.

Front of the ankle.
M= medial malleolus, L=lateral malleolus (fibula). The outside of the heel is pushed inwards to stress the joint. In the normal ankle, no tilting of the ankle should occur at all. Note the tilting of the talus in the ankle.

The inward and outward movements of the back of the foot do not actually occur in the ankle joint but occur in the joint underneath it called the subtalar joint. The muscle that pulls the foot inward (inversion) is slightly stronger than the muscles that pull the foot outward (eversion). When the foot lands in an awkward manner there is a tendency for the heel to roll inwards and create stress on the outside ligaments. If this stress is severe then a sprain of the ankle occurs. A sprain is actually a tear that occurs in the outer supportive ligaments of the ankle. As these ligaments are stretched, a critical point is reached beyond which ligaments do not return to their normal elastic function and a tear of the ligament occurs. Sprains can range from the relatively minor to those where the ligaments are completely torn and the ankle can be quite loose.

The acute sprain of the ankle is commonly associated with marked swelling and bruising on the outer side of the ankle. Rest of the ankle with immobilization of some sort is critical. The classic treatment for a sprain of the ankle is what we refer to as the Rice Program. It involves rest, ice, compression and elevation. This treatment is designed to decrease the inflammation and swelling of the ankle associated with the sprain. The Rice Program by itself will not heal the ligaments. In order for the ligaments to heal the ankle needs to be immobilized with either a cast or a boot. For minor sprains a brace can be applied to the ankle. Walking is permitted during this recovery process, allowing the ankle ligaments to heal.

Following this period of initial immobilization, strengthening exercises are essential to regain the balance of the ankle. It is critical that the tendons and muscles on the outside of the ankle (the peroneal tendons) are strengthened. This should be done initially in a supervised exercise program. If the ligaments have been severely torn, the ability to fine tune the ankle and prevent further sprains from occurring depends on the strength of the peroneal muscles. As the ankle turns repeatedly, the peroneal muscles weaken further. This weakens the ability to prevent recurring sprains. Patients with a high arch or a heel that is naturally turned in slightly are predisposed to sprains.

As a result of continued rolling, turning or instability of the ankle, the ability to fine tune the foot on uneven surfaces becomes limited. The ability to make rapid changes in the position of the foot on the ground surface is called proprioception. If this ability is diminished, the likelihood of a more severe ankle sprain occurring is increased. In recurring ankle sprains we call this chronic recurrent instability of the ankle. The ankle is at risk of developing other problems. These include bruising of the cartilage of the talus and bone spurs that develop around the front and sides of the ankle. These are all precursors of ultimate arthritis of the ankle.

These pictures illustrate a patient with chronic ankle instability. Note how loose the ankle is when it is turned slightly inwards. The ligaments are completely torn in this ankle and the likelihood of recurring sprains is very high.

The diagnosis of chronic recurrent instability is made through a careful examination of the ankle and X-rays that are taken while stress is applied to the ankle.

Here are two X-ray’s of a patient with chronic recurrent instability of the ankle. In both the right and the left ankle, an assistant is pushing on the outside of the foot (in the direction of the white arrow) while the XR is taken. The XR on the left is normal, while the one on the right demonstrates a loose (unstable) ankle.

Once the diagnosis of the extent and severity of the ankle instability is made then a treatment plan can be initiated. A strengthening program is helpful before proceeding with surgery. This is true even with patients who have had recurring sprains and chronic recurrent instability.

Fortunately, surgical repair of the chronically loose ankle ligaments can be performed. There are many different techniques used to stabilize the ankle. Some rely upon repairing the ligaments themselves by tightening them up. Others depend more on using a tendon behind the ankle (the peroneal tendon) or a tendon graft to tighten up the ankle completely. These operations are usually very successful. Individuals are able to return to all forms of athletic activity without risk of recurrent injury to the ankle.

Read more about Ankle Sprain

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Achilles Tendon Rupture

The Achilles tendon is the largest and strongest tendon in the human body.  It is crucial in transmitting forces responsible for walking, running and various other activities.  An injury or tear within the Achilles tendon can cause substantial pain and limitation due to its importance in these daily activities.

Anatomy:

The Achilles tendon is made up of the tendons of the gastrocnemius muscle and soleus muscle, which make up the largest muscles within the calf.  It inserts at the back of the calcaneus (heel bone) and many of the tendon fibers can extend further underneath the heel.  Tears of the Achilles tendon can be partial tears, which only involve a portion of the tendon or complete tears.   Most often a tear occurs in the mid-portion of the tendon, often referred to as the “water shed” area due to its limited blood supply.   It is the limited blood supply that can make Achilles tendon tears challenging and can take an extended length of time to heal.

Etiology:

Tears of the tendon are often a result of indirect trauma.  Overload forces exceed the tensile strength of the tendon which results in tearing of the tendon fibers.  Complete ruptures most often occur in individuals between 30 and 45 years of age with the majority of injuries sustained during sporting activities.  Tendon tears are can also in patients with systemic diseases such as rheumatoid arthritis, lupus, chronic hemodialysis and many others.  Other factors correlated with potential Achilles tendon tears are steroid use, fluoroquinolone antibiotics and previous injury to the tendon.

Symptoms of Torn Achilles Tendon:

  • Pain
  • Swelling
  • Bruising
  • Loss of strength
  • Palpable gap in tendon

Diagnosis:

  • The most crucial step to diagnosis of Achilles tendon tears is a thorough and detailed physical examination.   Patients may not experience complete loss of strength in many instances.  Because of this and the swelling in the area, up to 20% may be missed on initial presentation.  A delay in treatment can have long lasting effects on the overall outcome and thus emphasizes the importance of being evaluated by a foot and ankle physician in a timely manner.
  • Radiographs may be taken to rule out other associated injuries.  To fully evaluate the extent of Achilles tendon injury, an ultrasound, or more often, an MRI will be performed.   This allows the physician to visualize the extent of tendon injury and determine the best treatment plan.

Treatment:

  • Treatment will vary depending on the extent of tendon tear, duration the tear has been present, and the patient.  An acute, complete rupture of the tendon requires surgical intervention.  This is typically done by re-approximating the torn ends of the tendon to allow for appropriate healing.  For the best function results, the repair should occur within one week in order to avoid retraction of the tendon ends.  Unless the patient is relatively sedentary, cast immobilization as the primary treatment of an Achilles tendon rupture should be avoided due to the increased risk of re-rupture, decreased strength and sub-optimal functional results
  •  Achilles tendon tears that are not treated for longer than 4 weeks are considered chronic.  Because of the delay in treatment, the tendon ends are become retracted and cannot be repair like an acute rupture.   Chronic Achilles tendon ruptures are typically repaired surgically and involve more extensive tendon transfers, flaps or grafts.  After surgical intervention, patients are immobilized in a cast for 2-3 weeks, followed by a transition to a walking boot.    It is essential to try to begin strengthening of the tendon as quickly as possible to avoid weakening.  This needs to be done carefully by trained physical therapist who understand the recovery protocol of Achilles ruptures.

Read more about Achilles Tendon Pain

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Sprained Ankle

A sprained ankle occurs when a ligament is injured through stretching or a sharp pull. Ligaments are strong bands of tissue that connect one bone to another and help to hold joints together.

A sprained ankle, or twisted ankle, is the most common type of soft tissue injury. Soft tissue means any tissue in your body that isn’t bone. Around 1.5 million people go to UK accident and emergency departments each year with severe sprained ankles.

A minor sprain is when a ligament is stretched or partially torn. In severe sprains the ligament is completely torn. Sometimes the end of the bone to which a ligament is attached can crack or be pulled off. This is called an avulsion fracture.

Symptoms of Sprained Ankle

When you sprain your ankle there is sometimes a snapping or popping sound and a feeling of ‘giving way’ – this could be a ligament tearing or a bone cracking. A sprain can be very painful with the pain getting worse when you move your ankle. With a severe sprain you may not be able to put weight on your leg.

You may have swelling and bruising. Swelling happens soon after the injury but bruising can take up to 24 hours to fully develop. The swelling around your ankle can make it difficult to move your foot and your ankle may feel unstable.

Causes of a sprained ankle

The most common type of ankle sprain is when the sole of your foot turns inwards, overstretching the ligaments on the outside of your ankle and squeezing those on the inside. This is called an inversion sprain.

Ankle sprains make up about a quarter of all sporting injuries. They are especially common in sports that involve running and jumping, landing from a jump, changing direction quickly, or lots of stop-starts.

Other causes include:

  • walking on irregular surfaces
  • your foot slipping off the edge of a kerb
  • slipping while going up or down stairs
  • losing your balance while wearing high heels

You’re more likely to sprain your ankle if it has happened before.

Treatment of a sprained ankle

The treatment you receive will depend on how severe your injury is.

Self-help

Follow the PRICE procedure as soon as possible after injuring your ankle. PRICE stands for the following.

  • Protection. Protect your ankle from further harm, for example, by using a support or high-top, lace-up shoes.
  • Rest. Try to rest your injury for the first 48 to 72 hours. Use crutches to help you get around if you need to. After this time, gradually re-introduce movement to the affected area.
  • Ice. Apply ice packs or ice wrapped in a damp towel for 15 to 20 minutes every two to three hours. Never apply ice directly to your skin as it can give you an ‘ice burn’ – always place a cloth between the ice and skin. If you have no ice to hand, you could also use a bag of frozen peas or immerse the area in iced water. This will help to reduce any swelling and bruising. You should try to apply ice for the first 48 to 72 hours after your injury but only when you’re awake – never leave ice on while you sleep. Also, don’t use ice if you have skin disorders that make your skin sensitive.
  • Compression. Compress the area by bandaging it to support the injury and help decrease swelling. You can use a simple elastic bandage to do this or an elasticated tubular bandage. It should fit snugly but not be too tight. Make sure you remove the bandage before going to sleep.
  • Elevate. Elevating your ankle above the level of your heart will help to control the swelling. Use a pillow to keep the area raised. Try to keep it elevated as much as possible until the swelling goes down.

It’s important to begin gentle flexibility exercises within 48 to 72 hours of injury as long as it doesn’t cause excessive pain – this will help your injury to heal more quickly. It will also help you regain the full range of motion in your ankle.

You could try the following exercises.

  • Move your foot up and down as though pressing on a car pedal.
  • Make circles with your foot, both clockwise and anti-clockwise.
  • In either a sitting or a standing position, shift your weight from front to back and from the inside to the outside of your foot.
  • Stretch your Achilles tendon (without putting weight on it) – you can do this by using a belt to pull your toes up towards you.

It’s important to see your GP or a physiotherapist if:

  • you can’t walk more than four steps on the affected ankle immediately after you injure it
  • your ankle remains extremely painful or swollen after four days of self-treatment
  • you have a lot of pain, redness or swelling over a bony area of your foot
  • you have lumps and bumps that aren’t usually there
  • your ankle feels numb

If possible, see a physiotherapist who can advise you on exercises to restore the range of movement in your ankle. Your risk of injuring your ankle again is very high if you don’t get the correct treatment.

Medicines

You can take paracetamol to help reduce pain and swelling. However, don’t take tablets that contain a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, or use creams or gels that contain NSAIDs until 48 hours after you injure your ankle. These will reduce inflammation, which is an important part of the healing process.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Surgery

Surgery to treat a sprained ankle is rare and usually only done if your ankle remains unstable. Surgery can repair torn ankle ligaments, but there isn’t enough evidence to say whether this is better than keeping your ankle in a cast, or keeping your ankle moving and wearing a support brace. Your doctor may recommend surgery for torn ankle ligaments that aren’t getting better.

After your treatment

Following a sprain or a strain, the length of time that it takes for you to recover will depend on how severe your injury was. The pain and swelling should begin to subside after a few days. At this point, try to move your ankle more than you have been able to. If you’re using a brace or taping, take this off after two days because it limits movement. Instead use a compression bandage that doesn’t restrict movement as much.

Exercises to strengthen your muscles are important because they will help your recovery. They will also make your ankle more stable, helping to prevent another injury. Try to increase how far you move your ankle each day but take care not to cause more pain.

There is evidence suggesting that a below-knee cast or brace worn for 10 days for a severe sprain may speed up the healing process compared with an elasticated bandage that allows movement.

The time it takes for you to recover fully will depend on the severity of your injury.

Prevention of a sprained ankle

There are measures you can take to help reduce your risk of spraining your ankle again.

  • A brace or taping can support your ankle in the short term if your injury is severe but try to strengthen the muscles around your ankle through exercise to give it more long-lasting support. See a physiotherapist as soon as possible after injuring your ankle to get advice about the sort of exercises that will help.
  • Wear footwear that supports your ankle.
  • Don’t wear shoes that are worn on one side and take care when wearing high heels.
  • Try to keep stairs and hallways clear.
  • Don’t exercise if you’re tired – your muscles will be tired too and offer less support to your joints. Injuries can occur as a result of being tired from playing sport or doing strenuous activity.
  • Do strength and endurance training before the season begins if you’re a competitive sportsperson.
  • A recent study showed that doing balancing exercises can cut your risk of spraining your ankle again. A physiotherapist can advise you on these and how to advance them as your ankle gets stronger.

To schedule an appointment to treat your ankle sprained / for second opinion / to get your ankle checked, please call us at +65 6471 2744 or SMS to +65 9235 7641

Achilles Tendon Pain

Achilles tendon pain occurs when there is an irritation or an inflammation of the Achilles tendon. The Achilles tendon joins the heel of the foot to the calve muscles. It is the largest tendon in the body, and is thick enough to support the entire body weight. Any rupture (small or big), inflammation, or injury to it causes pain while walking or running, as the tendon has to bear nearly eight times an individual’s body weight during a sprint or a run.

Causes of Achilles Tendon Pain
There are numerous reasons why Achilles tendon can inflame. A common cause is the advancing age, where it becomes less flexible, and more susceptible to injury. It can also be caused due to excessive shearing and stretching forces placed on the Achilles tendon, resulting in inflammation and tightening of the calf muscles.

Footwear contributes heavily to tendon irritation. Ill fitting shoes or high heels force the feet to be confined in less space, shortening the Achilles tendon, leading to an increased tension to the Achilles tendon. Shoes that have excessive heel cushioning for greater shock absorption, stretch the tendon, as absorption of shock sinks the shoe more frequently when the heel makes contact with the ground. Mechanical abnormalities and misalignment such as misshapen foot or heel bones, unequal leg length, short or tight Achilles tendons or calf muscles, weak calf muscles, all lead to placing excessive stress on the tendon, making it prone to injuries and pain. Athletes who increase their training duration with more powerful movements during exercises also experience Achilles tendonitis.

Symptoms of Achilles Tendon Pain
The most common symptoms associated with Achilles tendon is the searing heel pain experienced over the back of the heel. This occurs because the tendon gets pushed on the heel bone. It causes tenderness around the tendon and in some extreme cases there is an occurrence of a localized nodule filled with a small sack of fluid on the tendon. For most people suffering with Achilles tendon pain, walking during early mornings, or a long period of inactivity is the most painful time. A sudden sprint, or a jumping activity also results in a lot of pain. A slight swelling around the heels and sometimes around the calf muscles are also an exhibited symptom of Achilles tendon pain.

Prevention and Treatment of Achilles Tendon Pain
Preventing the condition of the Achilles tendon pain is simple. Avoiding any activity that places stress on the tendon is the simplest preventive measure. Treatment includes therapy as well as medications. A therapeutic approach includes rest and immobilization. Together, it will help reduce the swelling and inflammation on the tendon. To reduce swelling and increase the flow of blood around the tendon, one can apply an ice pack several times a day. Avoid giving heat treatment, and wearing thick warm socks (unless medically recommended). Heel relaxing products such as arch supports, heel cups, etc. inserted into the shoes, are used to minimize the stress on the Achilles tendon. Many physical therapists recommend stretching and rehabilitation program to increase the flexibility of the Achilles tendon. Medications mostly include non-steroidal anti-inflammatory medications along with painkillers, or in severe cases cortisone injections are administered.

Achilles tendon pain is a very painful condition, which can hamper the course of a normal life. A constant painful tendon leads to rupture, and in extreme cases an individual is rendered immobile for days. Prevention can help many avert the condition of painful Achilles tendon.

Stop the Pain and get your Ankle checked today!  Call +65 6471 2744 for Appointment or Email to: info@boneclinic.com.sg