No matter how many times you (or your kids) roll, twist or bend your ankles, you can never seem to remember the difference between a sprain, a strain and a fracture. The fact is, it’s almost impossible to tell without a professional evaluation.
We sprain our ligaments “The most common ankle injury is a sprain,” says Dr. James Shapiro of Kenosha Orthopedics. “This is usually when the ankle is turned side-to-side and one of the ligaments — typically the outside of the ankle — is stretched.” A ligament stretch can lead to a rupture, where it is completely torn in half.
We strain our tendons A strain is a stretching injury of the tendon. Like ligaments, tendons can also rupture when they are torn and/or become detached.
We fracture our bones Fractured bones around the ankle may resemble the look and feel of a sprain or strain. “You’ll need an x-ray to rule out a fracture, because clinically sprains and strains look very similar,” says Dr. Shapiro. “They may all have localized tenderness, swelling and bruising.”
When should an ankle be evaluated? Many minor sprains, when left untreated, will heal on their own. The problem is determining if it’s a minor sprain or something worse. “Pain is not a reliable indicator,” explains Dr. Shapiro. “We see a lot of injuries where the patient thought it was just a sprain, and then months later, we see there was a fracture all along.” Generally, “If there’s a significant injury that causes immediate swelling and bruising, and if the patient has difficultly bearing weight, then they should get it professionally evaluated,” Dr. Shapiro advises. “If there’s little swelling and the patient can bear weight, then it’s probably okay to wait a few days to see if the injury improves on its own.”
How are ankle injuries treated? An ankle sprain would typically be treated with a brief period of rest, ice, compression and elevation followed by early weight-bearing and range of motion exercises. “The first goal of treatment is to get the swelling down. Then, the sooner we can get the joint moving and weight-bearing, the quicker the recovery,” says Dr. Shapiro. But keep in mind, that’s for ankle sprains. Treatment for a fracture may be completely different. “With a serious fracture, you want to avoid weight-bearing all together,” Dr. Shapiro says. An ankle fracture may require a removable brace, a walking boot, a cast or an operation to internally hold bones together.
What happens when an ankle fracture isn’t treated properly? About two weeks post-injury, the fractured bone begins to heal itself naturally. Dr. Shapiro explains the process: “When bones break, blood is released; that blood slowly converts to new bone. During a six to eight week process, the blood clot that formed gets progressively stickier, much like putty. Then it hardens into bone.” Once the clot solidifies — whether in the correct position or not — the bone is there to stay. At that point, treatment correction is more difficult, further prolonging the recovery process.
How to prevent future ankle injuries?
Wear the right shoes – Like preventing sports injuries of the knee, wearing the proper, sport-specific shoes can make all the difference. With cutting or twisting sports, shoes with a wider surface are less likely to tip than running shoes — designed for forward movement, not side-to-side.
Strengthen ankle muscles – Overstretched ligaments and tendons make the ankle weak and unstable, often resulting in subsequent injuries. “You can’t strengthen ligaments or tendons,” says Dr. Shapiro. “You can surgically tighten them, but first we try to strengthen the muscles around the ankles to compensate.”
Wear extra support – During athletic events, taping or bracing a “weak” ankle can add support for athletes with a history of recurring instability. “They don’t have to wear it 24/7, but it’s a way to reduce the severity of a sprain if they were to have another one,” says Dr. Shapiro.
Know your limits – Sometimes a training injury is purposely overlooked in anticipation of a big game or event. “Many times, we’ll fight through the pain, because the event is so important to us,” says Dr. Shapiro. He advises, “Get it evaluated by a professional, so you know what injuries you can play or fight through, and what would lead to bigger problems if left untreated.”