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Agile Ankles—the importance of avoiding sprains Print E-mail

By Raymond Villaverde, Physician’s Assistant

 

Sprained ankles are the most common musculoskeletal injury seen in the U.S., in both sports and every day activities. Most athletes will mention they've at least "rolled" an ankle at one point, and research shows women athletes are 25 percent more likely to sprain their ankles.

There are three "grades" of sprains, which range from ligament stretch and microscopic swelling, to a complete ligament tear with severe swelling and instability.

If you return to activities before your ankle is fully healed, you will have increased risk for more strains, and in the worst case, you can develop Chronic Ankle Instability or CAI, which of course heightens the chance of more severe injuries such as ankle tendonitis and fractures.

As you age, those repeated ankle injuries will also increase your chance of arthritis.

You can promote ankle health by wearing shoes that provide good stability, arch support and higher sides to support the ankle.

In addition, exercises to encourage range of motion in your ankle joint, as well as conditioning exercises to strengthen the muscles groups surrounding the ankles will help you avoid those injuries and hopefully, more serious consequences down the road.

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Ankle circles through a full range of motion are easy to do and will help keep your joint mobile and flexible. Stretching the calf and heel daily is helpful, especially after any activity.  “Drawing” the alphabet with your toes improves mobility and promotes “proprioception,” or more simply, balance. As the ankle is trained to recognize the body’s orientation in space, it will help you maintain your balance and avoid positions that will stretch and injure the joint.

Eversion exercises, where the bottom of the foot is turned outward against resistance, will also help increase your balance and strength, offsetting a less stable ankle from stretched or torn ligaments. The most simple eversion exercises are with an exercise band, where you slowly move your foot and ankle outwards against the resistance band as far as possible.  If you’re a member of a gym, there are a variety of machines for eversion, which your trainer can demonstrate.

One research study showed that students who performed these simple exercises for 15 minutes per day for two weeks leading up to a soccer season were able to reduce their incidence of ankle injury by 50 percent during the season.

For patients who do sprain their ankles, early rehabilitation and bracing can help to avoid surgery.  When patients have persistent pain or instability despite physical therapy and bracing, surgery is available to fix torn ligaments and tendons and damaged cartilage in the ankle.

The ankle ligaments and tendons can be tightened in order to prevent recurrent ankle sprains.  I’ve pioneered techniques that utilize tendon transplants in order to stabilize loose and painful ankles.  Ankle arthroscopy is often performed at the same time as the reconstructive surgery in order to remove harmful spurs and address ankle cartilage problems that come along with ankle sprains.

Ankle ligament surgery can be performed under general anesthesia or in combination with a regional anesthetic as an outpatient.  Patients are asked to elevate their legs for 6-10 days after surgery.  They can resume weight bearing at 10-14 days after surgery and often start physical therapy at that point.

Most athletes can start closed chain, low-impact exercise at 6 weeks post-op and more physically demanding sports at 12 weeks after surgery.  Total recovery time can range from 6-12 months after surgery, depending upon the severity of the ankle damage, patient age and accompanying medical conditions.  Please consult with your orthopaedic surgeon to determine if ankle ligament reconstruction or arthroscopy is appropriate for your specific condition.

 

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