Your Injured Ankle, Part 1: Diagnosis and Care

 
​As many of my clients, friends, colleagues, strangers, and anyone who will listen to me complain already know, I twisted my ankle really badly last week. I was taking part in the extreme activity known as “walking,” and I just rolled it over. This is nothing new for me. My right ankle is a constant issue, and is often tender from whatever stress I've put it under most recently. This time, however, my left side is the one that went down. I've had enough. I decided to learn more about what the heck is going on with my ankles, and now I'm sharing that with you. In Part 1 I'll be looking at some stats, types of ankle injuries, and how to care for your ankle when you hurt it.

Some Statistics

A study looking at the Canadian Community Health Survey examined the data of Canadians who suffered injuries from 2009-2010. You can check out the Stats-Can article explaining the findings here, but in the meantime, here are some key points:

• 15% of Canadians over 12 suffered an injury severe enough to limit their usual activities
• 35% of injuries occurred during participation in some type of sports or exercise
• Sprains and Strains accounted for 51% of all injuries
• The ankle/foot was the most commonly injured body part, making up 21.1% of injuries to people19-64 years old

So if you've never experienced an ankle injury, you likely know someone who has. More importantly, as someone who engages in regular physical/athletic activity, you are more likely to experience this type of injury than your sedentary friends. The article also says that after falls, overexertion was the biggest cause of injury, which points to the importance of prevention (something we'll look at in part 2).

Types Ankle Injuries

You've likely heard the terms “Sprain,” “Strain,” “Twist,” and of course “Broken” to refer to ankle injuries, but they are not all the same, and the treatment of each is different. The diagnosis is extremely important in determining whether you need a cast, rest/ice, or even surgery; as always, a visit to the doctor is the best way properly diagnose your injury (unless, of course, you do your own x-rays at home).

Twist – This is often thrown around as a diagnosis, but it more accurately refers to the method by which the injury occurred. I don't have a twisted ankle, I have a sprained ankle because I twisted it.

Broken/Fractured – This is when one or more of the bones that make up the ankle joint is, well, broken or fractured. A fracture that occurs as the result of a twist or impact may be accompanied by damage to the soft tissue in the surrounding area, which can make self-diagnosis difficult. To determine if you require an x-ray, you can check yourself against the Ottawa Ankle Rules. In short, if you have pain in specific areas of the ankle/foot, or if you can't walk more than 4 steps immediately following the injury and in the emergency room, you need an x-ray.

Strain – A strain is when there is damage to the muscles and/or tendons. While acute ankle strains can occur from twists or impacts, it is more common for a strain to be the result of chronic overuse such as running long distances or repeated hard impacts from jumping. If your ankle is strained you may also be experiencing tendonitis, and injuries from overuse may mean that you need to reevaluate your training program, your technique, your footwear, etc.

Sprain – This is the most common type of ankle injury, and it occurs when the ligaments in the ankle joint are stretched or torn. This can be due to the foot rolling past the normal range of motion, making a sudden rapid motion with the feet planted, or just walking on uneven ground, like me. You'll feel pain right away, followed by swelling, redness, and possibly bruising. In a more severe sprain you might even hear a pop or a snap, and if it's bad enough you may not be able to walk or bear any weight on the ankle (which may mean it's time for an x-ray, as mentioned above).

Treatment

Depending on the severity of your injury, your ankle could take anywhere from a couple of days to a few weeks or more to heal, and taking the right steps immediately following the incident will allow the healing process to start right away. The RICE process is pretty universally accepted has been described many times, but here it is anyway!

Rest – This may not take much convincing, but avoid walking or standing, and move the ankle as little as possible as it heals.

Ice – To reduce pain and swelling, apply icepacks to the area for 20-30 minutes at a time, 3-4 times throughout the day. Putting ice directly against the skin can cause tissue damage, so wrap your icepack in a cloth and avoid more frequent icing schedules.

Compression – Use an elastic bandage to reduce swelling and provide support to the joint. Immobilizing the area will prevent further damage, but be sure not to wrap so tightly that circulation is cut off.

Elevation – Keep the ankle elevated above the level of your heart for the first 48 hours following the injury, which will help with swelling and discomfort. Plus, you get an excuse to put your feet up for a couple of days! Silver linings, my friend.

In Part 2 I'll take a look at rehabilitating your ankle once the initial healing is done, as well as some preventative measures we can take to avoid future injury.

​Further Reading
http://www.webmd.com/a-to-z-guides/tc/ankle-sprain-overview#1
https://www.sports-health.com/sports-injuries/ankle-and-foot-injuries/all-about-ankle-sprains-and-strains