This is something that happens from time to time at podiatry clinics around the country, including ours:
A patient walks in complaining about a sprained ankle.
“Doctor, this sprain just won’t go away! I’ve had it for weeks, months, years and it’s not getting any better! It still hurts, and there is still swelling!”
At this point, without having even started the evaluation, there’s already either one big problem or two big problems.
The first big problem is that, even if it’s “just” a sprain, you should never suffer through weeks to years of pain before making an appointment! Sprains are serious injuries and they need prompt evaluation and treatment from a professional. (We’ll have more on why that’s true in just a minute.)
The second big problem? Sometimes a “sprain” isn’t just a sprain.
More often than you might think, the sprain is hiding or masking another foot injury that is causing pain but has so far gone unnoticed. In fact, it’s possible ligaments have been partialy torn—even torn completly! Fact is even a completely or partially torn ligament will heal as good as it would following surgery if it is not walked on after the injury and immediately immobilized. Where a fracture the doctor knows to immobilize the area a tear can be undiagnosed and treated like a sprained ligament and the patient will likely go on to be a chronic ankle sprainer.
Now it’s time to go through the diagnostic process. Talk about symptoms, when, and how the injury occurred. Perform a physical examination. Run the X-ray.
Sure enough. Broken ankle. Tenderness in the area of a ligament, not so sure is this a strain, sprain, partial or complete tear of that ligament.
Ankle Injuries—Including “Just” Sprains—Are Serious Business
Ankle sprains are, without a doubt, the most common of the acute injuries. They are frequent in just about all sports, and even relatively common among non-athletes. Take an awkward tumble off a curb, and you’ll know what we mean.
Unfortunately, because they’re so common, many people have a tendency to underestimate their destructive potential. No ankle sprain should ever be “walked off” or treated exclusively at home. If you have swelling, discoloration and you are unable to apply weight on the area after the injury due to the excessive pain.
There are two major reasons for this:
- Sprains that don’t get the treatment they need and aren’t rehabilitated properly can develop persistent and chronic pain, weakness, and instability. This makes it much more likely that you’ll continue to suffer future sprains with minor activities and uneven surfaces.. It is extremely unwise to attempt to do this on your own without a physician’s evaluation and advice.
- Like we said, it might not be “just” a sprain. On their own, sprains are serious enough. But if there’s a partial or complete tear of the ligament or related joint structure, your problem is even more urgent.
So the first step is the same whether you have an obvious break or “just” a sprain. Book an appointment with a foot and ankle specialist as soon as possible, to get an accurate diagnosis before it is too late for conservative care to be successful..
For first aid, practice RICE therapy (rest, ice, compression, elevation). In short, do not put weight on the injured foot and try not to move it if there is severe pain, swelling or discoloration. Use ice packs and/or compression bandages to control swelling and pain. Try to prop the ankle up above chest level.
Sprains vs. Tears: Telling Them Apart
“Under the hood,” the difference between a sprain and a partial or complete tear is clear. A strain or sprain is where the ligament is intact. A partial tear or rupture of the ligament is as bad as a fracture of the bone in that the treatment plan is changed and immobilization and non-weight bearing may be necessary for healing that allows for full function and being able to resume all activities without return of injury.
But it’s not always obvious, based on pain or a physical inspection alone, whether your ankle happens to be sprained or broken. Either way, the most obvious signs are pretty similar:
- Sudden pain
- Difficulty bearing weight
- Increased temperature
If these are the big issues you can see and feel, the truth is there’s no way for you to rule out a fracture or a tear on your own, without a professional evaluation. However, if you notice any of the following symptoms, it’s more likely that a tear or fracture has taken place.
- The above symptoms are particularly severe. For example, the average fracture or ligament tear will result in a lot more bruising, swelling, and pain than the average sprain—although severe sprains can have significant symptoms too.
- On the other hand, if you feel no pain at all in the area around the bone—just severe pain on the bone—you’re probably looking at a break.
- Moving the ankle is extremely difficult or impossible. This is a pretty strong signal that a break, or tear is likely, however the lack of severe pain with movement or when walking does not ensure you that you do not have a tear or break in the bone.
- The ankle joint appears twisted, crooked, or deformed. Enough said there.
- You recall a distinct cracking sound at the time of injury. (Sprains or fractures might sound more like a “pop,” if you can hear or even feel them.)
Treatment and Rehabilitation for Your Ankle Injury
Treatment and rehab protocols for sprains and breaks can vary depending on things like the seriousness of the injury, your age, your short- and long-term activity goals, etc.
Generally speaking, treatment for broken bones is more serious than sprains, which is only minor damage to the ligaments less than a partial or complete tear. However, this is not a hard and fast rule. Some severe sprains may require surgical repair, especially if you have a history of previous sprains, as the intact ligament may have healed so stretched out it may no longer provide the stability that is did prior to the injury. On the other hand, some stable fractures will not require surgery—only immobilization.
Conservative treatment options may be effective and appropriate for most sprains and some fractures. We often recommend:
- Continuing the RICE therapy you began as first aid. This will help limit the pain and swelling during the early stages of recovery.
- Immobilizing the injured ankle, for example using a brace, walking boot, or cast. Crutches may be provided to help you get around without putting weight on the ankle especialy if there is still pain with weight bearing using an immobilizing device.
- As soon as possible, we’ll get you started on physical therapy and rehab exercises designed to improve range of motion, strength, flexibility, and stability. This is a delicate balance. You don’t want to do too, much too soon, as this can interfere with healing. But waiting too long can delay recovery and prevent the ankle from rebounding as strong as it can. We will help guide you with an appropriate rehab plan.
For severe sprains and unstable breaks, surgery is often necessary. This may include procedures to repair, reconstruct, or reinforce torn or chronically weakened ligaments, as well as realign and stabilize broken bones.
We’ve said it many times already, but we’ll say it again—whether it’s a sprain or break, you don’t want to gamble with your long-term health. Make sure you make an appointment right away for an accurate diagnosis and evaluation (using X-ray and/or MRI when necessary), as well as effective treatment options.
You can find all these things at the Upland office of Dr. Jan David Tepper and his associates, Dr. Cristina Elena Marchis-Crisan and Dr. Edward S. Azar. To schedule an appointment, please call (909) 920-0884 today.