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US Basketball fans let out a sigh of relief when it was reported that Lebron James’ ankle sprain was minor and that he would be back practicing in a matter of days. Unfortunately, for many weekend warriors and other part-time athletes, ankle sprains can be much more serious.
Ankle sprains are notoriously under-treated by primary care doctors and emergency rooms, and most importantly by the patients who suffer them, says Dr. Holly Johnson, a foot and ankle orthopedic surgeon from Pro sports Orthopedics in Cambridge, MA. Thousands of young men and women, from weekend warriors to professional athletes, suffer ankle sprains daily. They often end up spending more time with lingering pain and swelling than is necessary and would have been back to sports earlier if only they had rested and then rehabilitated the ankle more aggressively from the start.
This is the typical scenario: a limber, healthy young woman is running and unexpectedly steps into a pothole, twists her ankle, and falls awkwardly with all of her body weight onto the side of the ankle. She has immediate pain, and unable to finish the run, limps home. She then notices her ankle is a ripe shade of blue with robust swelling, especially on the outside of the ankle, and the foot becomes more uncomfortable as she tries to put weight on it over the next few hours. She goes to a local walk-in clinic. She gets x-rays, which are invariably negative, and is given crutches, and instructed to ice the ankle and take Ibuprofen. “It’s only a sprain,” she’s told, and in a few days, she should be better.
4-6 weeks later, or even a few months later, when the bruising is long gone but the swelling and pain have lingered, the patient is frustrated. She still hurts and can’t walk the half-mile to work comfortably, let alone get back out running. The runner often then seeks out an orthopedic surgeon.
When x-rays are “negative,” no obvious fracture, or broken bone, is identified. However, soft tissue injury to the ankle can often take more time to heal and have more longstanding effects on the ankle than a broken bone might have had. The ligamentous injury – whether the ligament tears completely or partially – often takes weeks to months to heal, and can leave the ankle in a weaker state and more prone to further ankle injuries. In about 5 % of ankle sprains, a small area within the joint is damaged, creating a “pothole” in the otherwise smooth ankle cartilage that can often cause pain in the ankle and require surgery to fix. The “high ankle sprain,” as Sidney Crosby and Terrell Owens had, is when the ligaments just above the ankle are injured as well. According to Johnson, “This injury, occurring in about 1% of ankle sprains, takes at least 6-10 weeks to heal.”
Most people recover fully after proper treatment and can get back into their typical activities and sports. When the injured ankle is painless, back to at least 80% of the strength of the other ankle, and has a full range of motion, the patient can safely return to sports and running. About 10% of the time patients will go on to have ankle instability or lingering pain that requires not only further work-up, usually an MRI scan, but sometimes surgery. Hopefully, by giving these injuries the treatment they deserve when they happen, one can avoid being in that 10%.