Phoenix Podiatrist Talks Ankle Sprains: Ankle Sprains are legit. TAKE THEM SERIOUSLY AND COME SEE US!
Last night Trae Young of the Atlanta Hawks sprained his left ankle. He went up for a floater and it looked like he landed on the back of Norvel Pelle’s foot. An x-ray confirmed he had no broken bones and he is tee’d up for an MRI today. Ankle sprains make up 25% of all injuries ever sustained! Over two million ankle sprains are treated in the emergency departments alone in the United States and United Kingdom. Half of all ankle sprains occur during an athletic activity. Ankle sprains are the most frequent injury sustained in sports. (Melanson, Shuman Jan 2021)
I see a lot of ankle sprains in my practice. Oftentimes by the time a patient comes in to see me they have sustained chronic ankle sprains for the 4th or 5th time...and they only show up when it’s keeping them off the court or field!! An Ankle Sprain is a serious injury no matter how bad you might think it is, it’s a good idea to get it checked out. People who have one ankle sprain are susceptible to another, especially if it’s not rehabbed--and then you create chronic instability for the ankle. I think the word “sprain” gives the mechanism of injury the illusion that it’s not that big of a deal. Well friends, this couldn’t be further from the truth.
What is an Ankle Sprain?
Let’s start with the word “sprain.” A sprain refers to the violent twist of ligaments (the supportive rubber bands that hold our ankle, wrist, or other joints stable) to cause pain, swelling, or injury. There are four main ligaments that hold the ankle together. The inside of the ankle is held together by the Deltoid ligament. This ligament is super strong, thick, and infrequently injured alone. The outside of the ankle is most often affected, with the ATFL (Anterior Talofibular Ligament) being the weakest and most often injured. There are 2 other ligaments that support the lateral (outer) ankle, the PTFL and CFL (Posterior Talofibular Ligament and Calcaneofibular Ligament). The names of the ligaments aren’t all that important, just know that our bodies bring a LOT of protection mechanisms to help keep us stable...and still we tend to get injured!
Ankle sprains have different levels of severity:
Mild (Grade I)- the ligaments are stretched, not torn. This normally is something you can “shake off” after a few days of icing and resting with very little residual pain, especially with an ACE or other compressive bandage.
If it’s been more than a few days, you’re probably in a Grade II or Grade III category--so you should definitely see your physician.
Moderate (Grade II)- this type of sprain refers to a TEAR of the ligaments of the ankle. One or more ligaments can be affected. This tear is not complete though, and results in pain that is tender to the touch, swelling, and oftentimes a huge pattern of bruising that looks intense. Recovery can look like 4-6 weeks of rest. An X-ray is important here because a bruise pattern and the intensity of the sprain could have led to a broken ankle. I think this is the most dangerous of the 3 because patients can still walk and run, and often push it too far to worsen their injury.
Severe (Grade III)- Yikes! This is your complete tear of ankle ligament(s) that causes an unstable ankle that is difficult to walk on. This causes severe bruising and swelling.
How are ankle sprains treated?
Treatment of an ankle sprain is progressive based on the severity. The first step is always REST, ICE, COMPRESS, ELEVATE, PROTECT. A boot or brace can be helpful protection mechanisms. REHABILITATION EXERCISES ARE IMPORTANT to treat and prevent ankle injuries. I can’t stress this enough, balance exercises and proprioception training are paramount for anyone-athlete or not-in order to prevent recurrence of ankle sprains. Also sport appropriate shoes, stable inserts, and strengthening exercises make a huge difference. In rare cases or in the incidence of repeated chronic ankle sprains where the ligaments are stretched out, surgery may be needed to tighten them up.
Why do high level athletes like basketball players get ankle sprains?
Whether it was Kerri Strug in the 1996 Olympics, Lebron James last month, Trae Young and Kevin De Bruyne yesterday--ankle sprains are super common in gymnastics, basketball, soccer, and tennis. But why?
After watching Last Dance (the Michael Jordan documentary) and seeing how hard those guys train, I’m fairly confident in my assumption that a high level professional athlete that has dedicated their every second to training for their sport has done their time on a Bosu ball with balance and built up their strength/ankle proprioception in the process. Last month our #kidfromAkron King James, LeBron, was deemed out indefinitely with a high ankle sprain. I think we can all agree he’s a beast. Why has he been out over 16 times in his career with ankle sprains?
There are a few factors that contribute to this, overtraining during off season is what some people say. With Trae Young, he had been out with a left calf injury too. And this is the 25th documented ankle sprain LeBron has sustained during a game. While fatigue and other injuries are contributors, most often in athletics an ankle sprain is caused by something awkward that happens! Seriously. It’s someone who gets in the way when they're coming down off a tipped ball or shot. Then the athlete falls down with force on their ankle, it naturally tends to invert underneath them, ripping the ankle ligaments due to the violent force put on them. Trae Young seemed like he landed on the back of Norvel Pelle’s foot coming down off a floater for example.
Why do normal people like us get ankle sprains?
For simplicity sake, same answer--something awkward happens. You come off a curb funny for example. Or you're fatigued on a long hike and lose your footing. Sometimes people's foot type pre-dispose them to instability, which is why good shoes and inserts are important. Most people that sustain one ankle sprain, even if it’s a Grade I (mild) injury do NOTHING about it. They don’t retrain their ankle to be supported on different terrains, they neglect balance exercises, often wear unsupportive Old Navy slides on flip flops and run around--those are things that definitely make us normal people more susceptible to ankle injuries.
There’s a saying in podiatry that ankle sprains are worse than ankle fractures (breaking the bones of the ankle). This is because one ankle sprain leads to another and without a proper medical exam and treatment plan, you could be setting yourself up for inefficiencies on the court, field, and walking path.
At Arya Foot & Ankle, we are equipped with both digital x-ray and ultrasound to diagnose ankle fractures and soft tissue injuries--including determining the exact ankle ligaments affected and to what degree...so there’s no wasting time in creating a recovery plan. As a yoga instructor myself, I enjoy creating rehab plans for all of my athletes that include strength, stretching, and balance to keep people active and doing what they love to do. Thanks for reading. While we don’t wish you to sprain an ankle, if you or a loved one happens to, come see us. We will get you back on your feet ASAP.
To book an appointment call us at 602-309-8788. You can conveniently book online at www.aryafootandankle.com. We offer same day, lunch-time, and Saturday appointments. We are here for any and all of your foot and ankle needs!
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