Comments on: The Trainer’s Room: Sprained Ankle Treatment, Rehab, and Recovery Time

By: Lisa

Lisa — Sun, 25 Oct 2009 19:55:40 +0000

Three weeks ago I rolled my ankle when I stepped down off the stairs, and I believed I dislocated it. I felt what I think was the bone dislocating out of the joint, and it felt almost as if the leg bone hit the floor because I got a jarring sensation further up my leg. The whole incident was the most excrutiating pain I've ever felt. My foot looked as though it was twisted to the side, and it hurt immensely to try to straighten it. I went to the ER immediately and they said there was no fracture and it just a sprain. They didn't tell me much more than that, just gave me an air splint and crutches and told me to follow up with my doctor in 10 days. When I went to the doctor (at 11 days post injury) I was still experiencing significant pain and swelling. He mentioned a concern of the smaller fractures you mentioned and told me to return in a week or two if I was still experiencing pain. It's now been three weeks since I injured it, and I have more mobility and am able to stand and (sort of) walk on it, but it's still swollen and still painful at times. I cannot flex it towards me without significant pain. Is this part of the normal healing process or should I return to the doctor for further checkup?

By: Ray

Ray — Sat, 24 Oct 2009 19:06:52 +0000

About 4 months ago I was running down the stairs and jumped off of the 3 to last step and landed on the side of my foot spraining my ankle. I put ice on it for awhile and used ibuprofen. even after 3 months there was mild pain to turn my foot to the left and right. About a month ago I was running on the sidewalk with my son and I stepped off onto the grass and turned my ankle again. This time it hurt so bad I became nauseous. I used ice and heat as well as ibuprofen. It doesn't hurt to turn it right or left anymore, however it hurts when I move it up and down. I haven't gone to the doctor simply because it was a sprain. What can I do to strengthen it up. I am a very physically active person and this has kept me from many of the exercises I usually do at the gym. Thank you.

By: Mark Korda

Mark Korda — Thu, 08 Oct 2009 20:00:23 +0000

Hi Ross,I am a rugby fan,but only played football.I saw a lot of my buddies get injured.I walked home from my favorite pub 3 weeks ago and stepped in a pot hole.I went down like I got shot with an elephant gun.I'm 52 but until the ankle injury worked out every day.Some freinds gave me an air cast and almost every brase you could think of.I paint interiors for a living and was working for a female doctor who really did not take a close look.I'm hobbling around without crutches,and the right side of my right foot seems like where the injury presides.I don't have worring color yet,and I have no insurance,and I don't think I'm getting any improvement.The doctor I was working for said she did the same thing and it took 4 months to get better.I think I needed some one to vent to,and your injury sounded like mine.I'm going crazy…..lost my cable tv and am doomed to listen to AM talk radio.If you got the time,I got the time to listen…..thanks..Mark Korda Portland Maine.

By: Scott

Scott — Fri, 25 Sep 2009 13:16:10 +0000

@Ross, you should absolutely have it x-rayed.

By: Scott

Scott — Fri, 25 Sep 2009 04:11:13 +0000

Here is a tricky one:

Water ski accident. Binding did not release feet in high speed fall resulting in axial loading of talus. Examination suspects neck of talus fracture and damaged deltoid ligmanets, however no fracture appears on xray, even after 4 weeks. First two weeks were on crutches with no weight bearing. Second 2 weeks were walking with boot. Ankle is still swolen and painful when twisted or loaded at any angle. Planning to visit doctor again in 1 week.
Thoughts????? Going on week 6 and the ankle is still swolen.

By: Jackie

Jackie — Thu, 24 Sep 2009 22:34:47 +0000

Hi,
About 6 weeks ago I sprained my ankle on an obstacle course training with my Reserve unit. The obstacle required me to jump off of a platform that was 12 feet high onto some soft rubber. Unfortunately when I landed I rolled my ankle and immediately heard and felt a pop in my ankle and absolutely could not put any weight on it from that exact moment. I had to be carried into the car and rushed to the ER. They took X-rays then, and the doctor said it was not broken, but just a bad sprain. He gave me crutches and an aircast which I used for about three weeks. When I got home I made an appointment with a sports orthopedic and he thoroughly examined my ankle and took more X-rays. He diagnosed me with a grade 2 sprain, gave me a compression ankle brace and advised me to do therapy. Also advised me to come back in 3-4 weeks, if not better, to do an MRI.

It has now been six weeks. I’ve been putting it in the cold pool for at least 15 min a day, putting a hot pack at night before I go to sleep and doing the rehab. My ankle still feels like something is terribly wrong with it. I know these things take time to heal but I’m afraid that its just not healing quick enough. I am a personal trainer and have to be on my feet all day. I know this has a lot to do with the healing process, but what other option do I have? I am an avid runner and have not been able to do anything for 6 weeks and counting. And I still cannot run! Should I make another appointment with my doctor and get the MRI?

Thanks,
Jackie

By: Carlos

Carlos — Sun, 13 Sep 2009 01:33:17 +0000

Thanks for your reply Dr. McNelly. It turns out I didn’t have a fracture, but actually quite a sprain. The MRI report (done 3.5 days after the injury) states the following impression: 1 – complete tear of anterior talofibular ligament with high grade tear of calcaneofibular ligament; 2 – low grade sprains of inferior band of posterior tibiofibular and talofibular ligaments; 3- focal split tear of peroneus brevis tendon in fibular and subfibular location; 4 – small marrow contusion of inferolateral aspect of talar head associated with small talonavicular joint effusion; 5 – moderate tibiotalar joint effusion with fluid communicating with flexor hallucis longus tendon sheath. It makes note of other ligaments, tendons, and bone cartilage that appear normal. The doctor’s note (6 days after injury) makes mentions of a “negative squeeze test as well as talar tilt test”, “moderate pain with plantarflexion”, “notable pain against resistance with inversion and abduction”. “2+ dorsalis pedis pulse and cap refill in less than 2 seconds”. At therapy we have worked on exercises with elastic bands to prevent too much weakness of the ankle, but after a couple of sessions had to stop the balancing exercises (moving the good leg in back/forth and sideways motion while standing on injured leg) because the ankle way getting swollen and there was noticeable pain along the ATFL area as well as on the posterior/medial aspect of the ankle.

With that said. I am wondering what might be your approach to something like this. Particularly regarding protection and rest. How long should I use the aircast boot and crutches? What would you recommend in terms of exercise plan? They are trying to push me to walk again but it just doesn’t feel like I can do it without crutches without getting into a cycle of pain and swelling. I am also not using the boot since therapy started 2 weeks after injury. I saw there is a reference to a recent Lancet article on the immobilization of severe ankle sprains ( Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW (February 2009). “Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial”),which I can’t read but seems to advocate for the use of boot or similar below the knee immobilization leading to faster recovery at 3 months. Lastly, I would be interested in specific nutritional advice for a good recovery (i.e. how much collage supplements should be taken, diet etc).

I know this is a lot to ask, but any help you can provide is immensely appreciated as I haven’t been able to get much in terms of information about all these concepts.

Thanks very much!

By: me

me — Mon, 07 Sep 2009 03:13:42 +0000

@Anthony, PUSSY!!!!!!

By: Adam Ross

Adam Ross — Sat, 29 Aug 2009 08:09:14 +0000

22 years old, grade 2/3 sprain.

Hi,

4 weeks ago at rugby ground I rolled my ankle on an uneven surface sidestepping at full pace.

I knew straight away that it was a bad sprain, I did not think that a break occured.

I did the right thing and got it xrayed – their was however two breaks. One on either side of the ankle (the one on the inside of the ankle was probably an old injury!).

After three weeks in a cast I went back to the hospital for further prognosis and (without another xray) the doctor feels that it is just ligament damage now and stuck me in another fiberglass cast this one weight bareing.

I am roughly four weeks into my recovery, how long do you feel I will be out for and are there any tips and comments you could offer to help speed up this recovery?

Thanks in advance

Adam

By: Dr.Erhuy, D.C.

Dr.Erhuy, D.C. — Fri, 21 Aug 2009 15:34:57 +0000

@Ross, It sounds like youâ€™re going through a lot of pain and I am sorry to hear that. But as the article says grade 3 takes 4-28 weeks to recover. A grade 4 on the other hand will take even longer because of the damage done to the ligaments. Try some of the advice in the article such as Hi-volt to push the swelling out of the area. As for the discoloration this is a normal step of the healing process, it doesn’t look every nice but itâ€™s normal. Please feel free to keep us up dated on your ankle.

Thanks,
Dr. Erhuy, DC

By: Dr. McNally, D.C.

Dr. McNally, D.C. — Fri, 21 Aug 2009 00:22:40 +0000

@Carlos,
I am assuming when you say the “ball” you are referring the lateral mallelous of the tibia, which is the outside bump of the ankle joint. This is the most common area for a lateral ankle sprain, and the ligaments pass around this point. The swelling is normal and it is common to get swelling around the entire ankle even on the inside. However without knowing the severity of the sprain or actually seeing you I cannot say for sure. If the ankle is still swollen and starts bruise and walking becomes difficult it may be a good idea to get an x-ray. Sometimes it is possible to fracture that part of the tibia we where referring to.
Dr. McNally

By: Dr. McNally, D.C.

Dr. McNally, D.C. — Fri, 21 Aug 2009 00:15:34 +0000

@jered wood,
How is the ankle now? The more you practice on it, while it is sore the longer it will take to recover. While you are out of practice try some of the things above to start to rehab the area. I in no way intend to offend your trainer however they are not really trained with the knowledge of how to actually treat these types of injuries to the extent you could get at a doctors or a therapists office. They do however tape better than anyone, and see a ton of ankle injuries so keep a close eye on the ankle. If it is not improving see someone else. If you feel the tape is helping, then follow your trainers instructions.
Dr. McNally

By: Dr. McNally, D.C.

Dr. McNally, D.C. — Fri, 21 Aug 2009 00:09:01 +0000

@mark,
If anything causes pain to do then it is not the right move at all. Start with small ankle movements and see how far you can go before the pain starts. That is where you know you can do your exercises and can try to go further each week and that will help strengthen the area. Also wobble boards are a good way to increase stability, but be careful if your balance is not good try holding on to something first, if you fall you will hurt yourself worse.
Dr. McNally

By: Dr. McNally, D.C.

Dr. McNally, D.C. — Fri, 21 Aug 2009 00:05:37 +0000

@Sherry,
Did you get a cast for the broken fibula? If you do not get some form of treatment the ankle will remain unstable and could be at risk of further injury. I would recommend either seeing a chiropractor or physical therapist, there treatment is usually significantly cheaper and they are more familiar with soft tissue treatment, such as a sprained ankle, however you will need an ortho for the broken bone. For example if you have an x-ray of a bone at an ortho’s office or hospital you could pay up to $500, at my office we charge 40 for an x-ray of the ankle. There are places you can be treated without insurance, you just need to find the right place.
Dr. McNally

By: Ross

Ross — Wed, 19 Aug 2009 12:27:03 +0000

I was playing rugby and whilst i was chasing someone it felt as if i trapped my right foot in a hole or simply went over on it , im still quite unsure. Immediately my ankle started to swell up and the pain was excruciating. I went straight to the hospital where i was given x-rays , it showed nothing was broken and i had suffered a 4th degree/grade ankle sprain and i was simply told to rest and ice it. The next few days were agony , my leg , foot , ankle and toes were unbelievably swollen and covered in dark bruising.
Should I be concerned ?
I have continued to rest it and it has now been 6 weeks since the injury. I have had more x rays and reassured there was no evident breaks. Yet i still cannot walk , it is still swollen and my foot is a worrying colour.