College students seem to have more than their fair share of ankle sprains, likely courtesy of ridiculously competitive intramural sports, spike heels on uneven parking lots, rainy/icy days coupled with oversleeping-induced-rushing to class, and oh yes, alcohol-induced wobbling. And don’t get me started about electric scooters…At any rate, the vast majority (~85%) of injured ankles are sprains, and one sprained ankle often leads to a cycle of other injuries, from repeat sprains and “weak ankles” to knee or hip issues. Let’s talk about what to expect and and what you can do to avoid this pathway.
First things first- do you need an XRAY?
MOST ankle injuries do NOT need XRAYs for proper diagnosis and treatment. The evidence-based Ottawa Rules help clinicians decide who is and who is not likely to have a broken bone, thus decreasing the cost, time and radiation exposure for their patients.
Who SHOULD get an XRAY? If you cannot bear weight enough to walk three steps immediately after your injury, OR if you cannot take those same three steps when you are in the doctor’s office, it’s time for an X-ray. Likewise, when your doctor examines you, if you have increased pain when she presses on a few high-risk-for-fracture spots on your ankle and foot, it’s time for an X-ray. And that’s pretty much it. Remember that X-rays show bones, not ligaments, so we are looking for cracked, broken or displaced bones-not torn ligaments.
The vast majority of ankle sprains happen on the lateral (outside) ankle, torn because they are overstretched from the foot buckling under, with your sole facing your other foot. Swelling and bruising are common and expected. Immediate treatment includes “RICE” (Relative Rest, Ice, Compression, Elevation) and pain relief medicine (ibuprofen or acetaminophen)- no surprises here.Your doctor will add in a splint or brace, usually a “stirrup” style hard plastic support or a softer, lace-up and velcro style one. Please note: only accept a splint that you will actually WEAR, because this should be your constant companion for the next 6-8 weeks. If your fashion sense is opposed to the larger stirrup brace, have that conversation with your clinician, because there are plenty of braces to choose from! However, the most important part of treatment comes next.
REHAB! Ankle sprains result in a loss of strength, flexibility and balance. If all you do to treat a sprain is splint long enough to allow the torn ligament to heal, but do not fix the other problems, you are setting yourself up for more injuries. So, once your ankle pain is down to a manageable ache, then every single day for the next six weeks, do these three exercises:
Foot flexion exercise: Seated with bare feet, use your big toe to write the alphabet in both lower and upper case, not moving your leg (so only moving your toe, foot and ankle)
Foot strengthening exercise: Still seated with bare feet, place a towel on the ground in front of you. Using only your toes, scrunch the towel, pulling it towards you one scrunch at a time till the whole towel has passed under your foot. Now place the towel sideways, and repeat using your toe scrunch in a side to side motion to pull the towel left to right, using your toes, foot and ankle but not moving your leg.
Balance exercise: Stand on one leg, hands on your hips, for timed one minute. Repeat on other leg. When you can easily do this, repeat the exercise with your eyes CLOSED.
The full set of these three exercises take less than ten minutes, and if you do the balance exercise while brushing your teeth, you’ll knock it down to five minutes, so lack of time is no excuse!
Bottom Line: Consistency with rehab exercises is your KEY to stronger, flexible, fully rehabilitated ankles. And don’t forget-after your first two months of constant use, KEEP using your ankle brace for the next year whenever you are going to be active (exercise, sport, or whatever event).
Shout out to the awesome sports medicine doctor (and Airforce Colonel) Anthony Beutler, MD, for his wonderful lectures on this topic, as well as to my sports med colleagues at the University of Texas, who help us help our students!