What Should I Do If I Sprain My Ankle?

San Francisco Podiatrist Explains How To Stop The Ankle Pain and Swelling When You Twist Your Ankle

Ankle sprains are the most common sports-related musculoskeletal injury. Unfortunately many patients who roll their ankles head to the Emergency Room to treat the pain, swelling and bruising. The reality is, you can often get ankle pain relief much faster if you don't go to the ER. When deciding which doctor is best for your ankle sprain, you should see a specialist: an ankle expert called a podiatrist (not a Jack-of-all-Trades in the ER).

The best ankle sprain treatment right after the sprain is P.R.I.C.E.

P=Protection
You have to prevent any further injury to the sprained ligaments. An ankle brace or fracture walking boot can let most ankle injuries heal without having to worry about hobbling around on crutches.

R=rest
If you get sick and rest, you get well faster. If you tear your ankle ligaments and rest, they heal faster. Try to get some rest and take it easy for the first 48 hours after a bad ankle sprain.

I=ice
Ice is one of the cheapest and most effective home remedies for an acute ankle sprain. Apply ice to your injured ankle for 10 minutes out of every hour during the first 24 hours after you roll your ankle.

C=compression
Use the elastic bandage given to you by Dr. Segler a your House Call visit. By keeping your ankle wrapped the way he showed you, the swelling will stop and go down as fast as possibly. Your ankle ligaments won't start to heal until the swelling goes away.

E=elevation
Use gravity to your advantage! Prop the injured ankle way up on a pile of pillows. It has to be above your heart to really work well. Keep it elevated for the first 24 hours and the throbbing ankle pain will start to go away. Remember, your ankle ligaments won't start to heal until the swelling goes away.

By following the PRICE method, you can help stop all of the inflammation that causes ankle pain and leads to prolonged healing of the ankle sprain.

You can also view the Ankle Sprain First Aid Video here.

Dr. Christopher Segler is a podiatrist and a true ankle expert. He published the largest research study every conducted on subtle ankle fractures that are often misdiagnosed as ankle sprains. The fact is, ankle injuries often don't get the best treatment in the Emergency Room. Dr. Segler won an award from the American College of Foot and Ankle Surgeons for his ankle injury research which showed that lateral process fractures are 10 times more common than previously thought. These ankle fractures often don't heal properly because they are incorrectly diagnosed by busy ER physicians. Dr. Segler now has a podiatry practice in San Francisco that offers same-day house calls for people in the San Francisco Bay Area who have ankle sprains or other sports medicine -related foot and ankle injuries.

If you rolled your ankle and have a question, you can actually call him directly at 415-308-0833. And yes, you will actually get to speak with an award-winning ankle surgeon. No nurses, students or residents... direct access to a true ankle expert.

Learn More about ankle injuries at the best podiatry site in San Francisco: AnkleCenter.com

How to Prevent and Heal an Ankle Sprain

An early morning run out on the trails. The smell of fall is in the air, the sound of crisp fallen leaves crunching under your feet. It seems that it is finally cooling off after a long scorching summer.  You look forward to enjoying more brisk morning runs as your end of season race approaches.  Suddenly your foot rolls out from under you. You catch your balance, but nearly fall. You look back on the trail and there is a stick emerging from under the color of rusting leaves, barely visible.  You turn and run off hardly paying attention to the aching in you ankle.  It doesn’t hurt, except every time you land on a root, a pinecone or even an acorn.  The next day the ankle is sore and swollen with a mild throbbing pain with the first few steps. You don’t think much about it. After all of the ankle sprains you had before, how would this be any different. A little ice, dig out that ace wrap and you think you’ll be good as new.

Ankle sprains are the single most common injury in sports. They can lead to considerable disability, premature arthritis and long-term pain. Worse (if you are a runner) they can keep you from running. Thankfully for runners, in most cases they are avoidable. 

So what exactly is a sprain? A “sprain” is an over-stretching of a ligament that results in tears. An ankle sprain is classified by the location of the injured ligament as well as severity. 85% of all ankle sprains involve the lateral ligaments (those at the outside of the ankle).  There are three lateral ankle ligaments.  Of the three ligaments the anterior talofibular ligament (ATFL) is far more frequently injured than the others. 

A Grade I ankle sprain is a minor injury typically involving only partial tears of the ATFL.  There is usually little loss of function with this type of injury, such as described in the opening paragraph. A Grade II sprain involves a complete tear of the ATFL and may include stretching or partial tearing of the other ligaments.  This will involve more pain, difficulty walking and a risk of long-term problems with ankle instability if not correctly treated and rehabilitated.  A Grade III sprain is a severe ankle sprain.  Most people with a Grade III sprain cannot walk. They usually also have significant bruising and swelling. These injuries require intensive treatment to get back to activity. 

Fortunately, the minor sprains are the most common variety. Most people who have had an ankle sprain, have actually suffered several ankle sprains. Many of these folks actually have sprains so frequently that they don’t even think of them as injuries. The reason for this is that when the ATFL (the primary stabilizing ankle ligament) becomes weak or completely torn after an initial sprain, the ankle becomes unstable. Then merely stepping on an uneven surface, a rock, or a tree root can cause the ankle to roll.  Those that have been through this become accustomed to this instability.  In many cases, they have rolled the ankles so many times that the nerve fibers in the area have been damaged and it hardly even hurts.  So if it doesn’t always hurt, why does it matter?

It matters because even minor sprains have the potential to cause far more serious damage. Every time the ankle rolls (whether you fall down or not) there is a risk of a number of small fractures of the talus (the bone at the top of the foot that moves up and down in the ankle). These fractures can lead to pain, locking of the ankle, or pre-mature arthritis with damage to the cartilage that cushions and absorbs shock. It is also possible to tear other ligaments that stabilize the tendons at the ankle and control the motion of the foot. 

The good news is that distance runners, particularly those who run on roads, are at low risk of an ankle sprain while training.  But there are times when the risk goes way up. Trail running and cross-country running significantly increase the risk due to uneven terrain. Often these surface irregularities are not even visible due to grass, leaves and other forms of ground cover.

Interestingly, during organized road races (on very flat paved roads) there are lots of ankle sprains.  The reason for this is that runners trust the road to be flat, but they cannot see very far ahead.  Think about a marathon start.  You and several thousand other excited highly trained runners finally getting to head away from the start and out on the course. You could reach your arm out in any direction and touch a different person.  During the first few miles, most of your focus is on the people around you, just trying not to bump into them while attempting to maintain your desired pace.

All it takes is a dropped water bottle, a centerline reflector, or a small pothole.  Step on one of these while you are staring at the back of the runner in front of you and your ankle can roll right out from under you.  So that brings up the obvious…keep your eyes on the road. If possible, try to keep a little distance so you see a water bottle just before you step on it. If you run on the crown of the road, avoid the paint and that will keep you off the reflectors.  If it is raining, stay way off the paint…it is extremely slippery when wet and can easily send you to the ground. Wearing worn out shoes have also been shown to contribute to ankle sprains, but you should know better by now. 

If you know that you have unstable ankles, get checked out. There are many ways to reduce your risk of further injury and recurring sprains. Strengthening exercises can re-train the muscles surrounding the ankle to work in sync and take over some of the lost function from the injured ligaments. There are also ways to tape or brace and restore enough stability to allow for running without any difficulty. If you do suffer an ankle sprain, the standard initial treatment is P.R.I.C.E (protection, rest, ice, compression, elevation). However, the key is rehabilitation, not just decreasing pain. Most people underestimate the significance of an ankle sprain and the importance of restoring the function of the ankle through a proper ankle rehab program. When properly treated, ankle sprains recover well, and most of the time without any surgery.

With fall training weather comes renewed delight with running as the trees start to change.  Keep your eyes on the road or the trail (as the case may be).  Just don’t let the roots trip you up and watch out for the errant pinecone or acorn. 

Christopher Segler, DPM, AACFAS

MyRunningDoc.com 

Stay Fit. Go Long. Run Fast. Be Strong.

Doc On The Run: San Francisco Podiatry House Calls

Achilles Tendonitis in a Runner: How to Prevent It.

According to Greek mythology, when Achilles was born his mother tried to make him immortal by dipping him in the river Styx. However, when she dipped him in, she forgot the spot on the heel she held him by, which left one small area unprotected. In the end, Achilles was struck by an arrow in his vulnerable heel and was killed. Achilles shares his vulnerability with the rest of us entirely mortal runners, and that is why the tendon which connects the calf muscles to the heel bone bears his name today. The Achilles tendon is the largest tendon in the entire human body and is very strong, but it is also the tendon we rupture the most often. Anyone who is active can suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

If you are out running hills and feel a sharp pain or dull ache in the back of the leg down near the heel, this could be Achilles tendonitis.  That said, not all pain in the back of the leg or heel is Achilles tendonitis. If you have a tender swollen knot at the back of the heel where the tendon attaches it might not be Achilles tendonitis.

There is a condition called Haglund’s disease (commonly known as “pump bumps”) which is really bursitis and inflammation of the soft tissues near the attachment of your Achilles tendon. In some cases there may be an underlying bony enlargement as well. In most cases the tender bump is red, painful and more irritated by a stiff heel counter (the back of the shoe).  If you have no pain doing toe raises and most of the pain is related to shoes rubbing on the area, it is more likely just bursitis.  Bursitis is inflammation of the fluid filled sac that eases friction between tendons and bones. This will usually calm down with icing and shoes that don’t press on the area.

If you feel along the course of the tendon (where it is mobile just above your heel bone) and you have tenderness, this is most likely Achilles tendonitis. Don’t ignore this. Ice the area and decrease your activity level. Avoid hills or speedwork until it subsides.  If it doesn’t quickly get better, see your podiatrist. Otherwise you might end up sidelined for four to six weeks. 

The best way to prevent Achilles tendonitis is to stretch and warm up before intense workouts.  As mentioned earlier in this injury prevention series, a little self-restraint, the right pair of running shoes, and a good training program (such as the ones on the Chickamauga Battlefield Marathon training website) can help you stay injury free. Always stretch before speed workouts, hill repeats and long runs. Stretching helps to keep the tendon pliable, preventing micro-tears. In addition, stretching can improve blood flow, enabling a speedy recovery if you do become injured. Stretching is most effective after a short warm-up; never stretch aggressively when you muscles are cold. This can increase your risk of problems.  Include these stretches in your workout routine s follows: 

Stand upright about one large pace away from the wall with your feet parallel and about hip width apart. Keep your feet in line as shown.  Place your hands against the wall, at shoulder height. Move your right leg half a pace forward. Lunge forward on your right leg so that the knee is brought directly above the ankle. Stretch your left leg back as far as is comfortable with the foot and heel remaining flat on the floor. Slowly lean forward to stretch the left leg calf muscles and tendon. Hold the stretch for 10 seconds, relax, and repeat on the other leg. This is for prevent…do not stretch as illustrated if you have pain. You can also view demonstration videos of these stretches at MyRunningDoc.com.

Symptoms of Achilles tendonitis can include mild pain after exercise or running that gradually worsens, a noticeable sense of sluggishness in your leg, and episodes of diffuse or localized pain, sometimes severe, along the tendon during or within a few hours after running. Other symptoms can be swelling, morning tenderness in the Achilles tendon, or stiffness at the back of the leg that generally diminishes as the tendon warms up with use.

Treatment depends on the degree of injury to the tendon, but normally includes rest. It may even mean a total withdrawal from running or exercise for a week, or simply cross-training with another exercise, such as swimming, that does not stress the Achilles tendon. Treatment can also include non-steroidal anti-inflammatory medication or orthoses, which are devices designed to help support the muscle and relieve stress on the tendon, such as a heel pad or shoe insert.

Other treatments are bandages specifically designed to restrict motion of the tendon, stretching, physical therapy, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upward foot flexors that work against the Achilles tendon. If the tendonitis is mild, simple modifications of activities may help. Decreasing mileage, running on flats instead of hills, and backing off the activity level until there is no pain with exercise can allow the tendon to heal. In general ice is much better than heat for tendonitis.

Some medications can increase the risk of Achilles tendon ruptures (complete tear).  If you are taking steroids (prednisone) or flouroquinalone antibiotics (Cipro, Levaquin, etc.) you should not exercise unless you have discussed this with your treating doctor.  You may have seen in the news where the FDA recently posted a strong “Black Box” warning about these antibiotics and the associated risk of tendon ruptures.

A torn Achilles tendon is serious. Interestingly, it is not always painful.  However, there is usually significant weakness and difficulty standing up on the toes if this has occurred. Any suspected torn tendon can be serious and should be evaluated by a podiatrist. In rare cases surgery may be needed to repair the tendon. 

If you happen to be a marathon or half marathon runner in training for battle in Chickamauga; warm up, stretch, and stick to your training program.  Do not run through the pain if you think you have Achilles tendonitis.  If you are a Trojan War hero in battle, and you see any arrows coming your way, stay low and keep moving!

Christopher Segler, DPM, AACFAS

Award Winning Foot & Ankle Surgeon

MyRunningDoc.com

Doc On The Run Podiatry House Calls in San Francisco