Protect your ankles against sprains this

THE SPECIALIST: DR. STEVEN WEINFELD ON ANKLE SPRAINS

Weinfeld, who serves as chief of the foot and ankle service at Mount Sinai, is an orthopedic surgeon who treats injuries ranging from broken ankles to dislocations of the foot. Sprained ankles are the most common injury he treats.

WHO'S AT RISK

Every day, 25,000 Americans sprain an ankle. “Ankle sprain is one of the most common injuries out there,” says Weinfeld. “Pretty much everyone has one in their lifetime.” While the majority of these sprains will heal on their own in time, about 15% will cause recurrent problems.

The ankle is a complex hinge joint where the foot and leg meet. “It’s made up of the talus bone, better known as the ankle bone, as well as parts of the tibia and fibula,” says Weinfeld. “As the joint that allows us to propel weight forward, the ankle is only supposed to do up and down motions.”

Ankle sprains occur when the foot twists or rolls beyond its normal range of motion, causing the ligaments of the ankle to be stretched beyond their capacity.

Everyone who walks is at risk of an ankle sprain, but some groups of people are at higher risk. “ ‘Cutting’ sports like basketball or volleyball, where you’re moving from side to side, put extra stress on the ankle,” says Weinfeld. “So do change-of-direction sports like tennis and squash — a lot of that torque takes place in the foot.” Ankle injuries are also common in people who do in-line skating.

Doctors used to consider ankle sprains a problem of young people, but that has changed. “We’re seeing the older population staying active, so we’re seeing these injuries more in older patients than we did,” says Weinfeld. Being overweight and having high-arched feet or loose joints can also predispose you to sprains.

SIGNS AND SYMPTOMS

Sprains are defined as tears in a ligament, and ligaments are made up of multiple fibers. “The more ligament fibers that are torn, the more severe the sprain,” says Weinfeld. Ankle sprains are most often an inversion injury. “The bottom of the foot turns in toward the center of the body, stretching the ligaments on the outside of the ankle,” says Weinfeld.

Patients often describe a sudden feeling that the ankle has given way, followed by swelling, pain and, in severe cases, the inability to bear weight on that leg. “Swelling or pain that doesn’t resolve within a day or two should be checked,” says Weinfeld.

Ankle sprains tend to follow a certain progression.

“Within one day, you see the classic black-and-blue bruising,” says Weinfeld. “Swelling will usually be centered over the outer aspect of the ankle.”

TRADITIONAL TREATMENT

For garden-variety ankle sprains, time is the best healer when accompanied by the classic measures: rest, ice, compression and elevation. For these everyday sprains, Weinfeld recommends using a compression wrap bandage, applying ice and taking an anti-inflammatory medication like ibuprofen or Aleve if you need it.

More serious sprains may require the ankle to be immobilized with a brace or a cast. “If it’s a severe case, I’ll put them in a brace but let them walk if it’s not too painful,” says Weinfeld.

Most patients keep their braces or casts for three to four weeks. “If they still have symptoms, we’ll send them into physical therapy to strengthen the muscles and teach the ankle to sense when they’re about to twist,” he adds.

The return to athletic activity depends on the activity and the severity of the injury. “They can get on a stationary bike or elliptical trainer in a few weeks, but it can be six weeks or more for cutting sports like basketball,” notes Weinfeld.

About 15% of the people who suffer an ankle sprain have chronic ankle problems as a result. “They feel like their ankle is going to twist, or it does keep twisting, or they have persistent pain,” says Weinfeld. Surgery can be an option for these patients.

“The surgery entails placing stitches in the ligaments to reinforce them and transferring a band of tissue in the area to reinforce it,” says Weinfeld.

The recovery period is usually about six weeks, with a return to weight-bearing in two weeks and return to the sport in three to four months.

RESEARCH BREAKTHROUGHS

The surgeries used to repair chronic ankle instability have improved dramatically. “Within the last couple of years, we’ve started using cadaver tissue to reconstruct the ligaments in a minimally invasive way,” says Weinfeld. That cuts down the healing time, as does another advance — platelet-rich plasma therapy that promotes healing of ligaments.

QUESTIONS FOR YOUR DOCTOR

A good place to start is, “What are my treatment options?” or “What can I do to get better as quickly as possible?”

For many weekend warriors, the burning question is, “How long do I have to stay out of my sport?” The length of time out depends on the severity of the injury and the nature of the sport. Many patients are shocked by how long the ankle takes to heal completely. “Acute pain usually lasts for a few days, but the swelling can last three to four months or longer,” says Weinfeld.

WHAT YOU CAN DO

Be careful with your footwear. “High heels are a setup for these sprains,” says Dr. Weinfeld, “as are shoes that have worn out unevenly.” Runners should make sure to replace their shoes fairly often.

Take extra precautions. Taping your ankles or wearing high-top shoes for sports can provide your ankles with extra support.

Run smart. Running on a track or other even surface is a good idea, because running on uneven surfaces increases your risk of injury.