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Fallin' For Autumn

Posted on Tuesday, September 30, 2014, by Ashley Snyder

By Dr. Kathryne Buege

What makes fall so spectacular?  The kids are back in school (woo-hoo!), football season has started, the leaves are changing colors, stylish-boot-and-sweater weather has arrived, Halloween festivities are beginning - all adding up to make this my favorite time of the year.

Although there is plenty of clean-up and preparation for winter that will keep us occupied, here are just a few helpful hints to keep in mind before you jump into that pile of leaves.  With school sports in full gear, the inevitable slip and fall may be headed your way.

The most common injuries seen by primary care physicians, urgent care centers and emergency rooms are ankle injuries.

What Is An Ankle Sprain?

An ankle is sprained when an injury occurs that causes tears the ligaments of the ankle.  This type of injury is very common, but can vary in type, location and severity.

  • Lateral Ankle Sprain - The most common type of sprain occurs when the foot rolls inward, or is inverted, pushing the ankle outward and causing damage to the lateral ligament complex on the outside of the ankle.
  • Medial Ankle Sprain - The medial deltoid ligament complex is the strongest of the ankle ligaments and is seldom injured.  Most forced eversion injuries, where the foot rolls out and forces the ankle inward, result in chip, or avulsion, fractures of the medial malleolus (ankle bone) because of the strength of the deltoid ligament complex.
  • High Ankle Sprain - Dorsioflexion, where the foot is pointed upward, with eversion may cause a high ankle sprain.  This type of sprain can lead to chronic ankle instability, which may lead to recurrent ankle sprains down the road.

When examining a sprained ankle, medical practitioners grade the sprain on a scale of I to III, based on certain clinical signs and functional loss.

  • Grade I: mild stretching with microscopic tears.  No joint instability occurs and most patients are able to bear weight and are, therefore, not typically seen in a doctor's office.
  • Grade II: a partial tear of the ligament.  This is a more severe sprain where patients experience moderate pain, swelling and bruising and weight bearing is painful.
  • Grade III: a complete tear of the ligament.  Patients have severe pain, swelling and bruising, and are unable to bear weight or ambulate.

When Should You Seek Medical Care?

  • If the patient is unable to walk or bear weight
  • If there is an obvious deformity, swelling or bruising
  • Some patients complain of immediate nausea and may hear a "crack" at the time of the injury, which can indicate a fracture.
  • ANYTIME THERE IS A CONCERN!  A clinical evaluation and history will direct treatment care and determine the necessity of an x-ray or any further imaging.

Most medical practitioners utilize the Ottawa Ankle Rules when determining the need for x-ray imaging.  These guidelines require the provider to:

  • Assess for bony pain/tenderness at the ankle and foot
  • Onserve the patient's ability to bear weight
  • Note any special circumstances.  This can include patients with diminished sensation, such as diabetics with neuropathy and anyone who may have had a little too much fun at Oktoberfest!

How Are Ankle Sprains Treated?

Injuries can be treated immediately using the RICE method: Rest, Ice, Compression, Elevation.

  • Rest - limit weight-bearing and use crutches if you are unable to walk
  • Ice - or as we call it, cryotherapy.  Ice or cold water immersion is recommended for 15-20 minutes, every 2-3 hours for the first 48 hours until swelling subsides.
  • Compression - use an elastic bandage, such as ACE, to minimize swelling.  This type of bandage is preferred over tape, which can cause skin irritation.  During functional rehabilitation, patients with instability should use lace-up or semi-rigid ankle supports.
  • Elevation - elevate the leg to heart-level to further alleviate the swelling

In addition to this method, NSAID pain relievers like Aleve (Naprosyn), Motrin or Advil (Ibuprofen) can be used to help alleviate pain.  Once acute pain and swelling subside, exercises should be performed as early as possible to fast-track the healing process and maintain the ankle's range of motion.

And remember: if there are any concerns or questions about an ankle or foot injury, seek medical help with your primary physician, MASH Urgent Care or the local ER.  Enjoy the fall weather while it lasts, and GO BILLS!