Ankle Pain Archives - New Mexico Orthopaedic Associates

Causes of Ankle Popping and Clicking

Article featured on Orthopedic Institute of Pennsylvania

No matter your age, you might have heard a crackle or pop in your joints when sitting down, standing up or simply walking. Luckily most popping cases are not detrimental to your physical health. However, if left untreated, they could cause mobility complications.

Medically, popping in your joints is known as crepitus. If you’re experiencing a bout of crepitus, it could be from overworking your joints through exercise or stiffness in the joints after a long period of inactivity. While these causes may sound contradictory, it’s how our bodies adapt to certain stimuli — or lack thereof.

Why Does My Ankle Keep Popping?

Ankle popping on its own is very common. If your popping ankle isn’t painful, it is likely caused by a gas release or tendon rubbing. However, if it is accompanied by pain or swelling, there may be an underlying cause.

The most common causes of ankle clicking or popping include:

Gas release: Every time your ankle moves, the joint capsule filled with lubrication fluid is stretched. The fluid in the capsule can contain bubbles of nitrogen that can pop when you move, causing a loud popping sound — similar to when you pop your knuckles in your hand. Tight muscles can also contribute to gas buildup in the fluid, especially after inactivity like sleeping or binging a TV show. This is normal and does not signify an underlying cause.
Tendon slip: The peroneal tendons in the lower outside of your leg work to stabilize the ankle joint. Sometimes, these tendons slip from the muscle surrounding them, resulting in a snapping sound or feeling. A recent ankle injury could increase the ankle popping frequency. This is also common and not a cause of concern unless it is painful.

Less common reasons that may signify an underlying health condition include:

Tendon dislocation: The peroneal muscles surrounding the tendons can be pushed from their usual location, causing popping and snapping sounds in your ankle every time you move. This can happen during an ankle sprain. The inflammation, swelling and pain that occurs will need medical attention.
Osteochondritis dissecans: This condition causes a small segment of bone to separate and causes the cartilage in the ankle joint to wear away. This cracking sound could be painful after a lot of movement, like walking or running.
Osteochondral lesion: Lesions can form on the cartilage on the ends of your joint bones. Clicking and locking the ankle can occur, limiting the range of motion and causing swelling.
Ankle osteoarthritis: Osteoarthritis refers to a joint deterioration similar to osteochondritis with the wearing down of joint cartilage over time. While most common in the knees, it can also occur in the ankle.
Peroneal tendon injury: The peroneal tendons that may slip to make a cracking noise can also become injured.

Prevention and Remedies of Ankle Popping and Cracking

You can do several exercises at home to strengthen your popping ankles. These stretches both prevent ankle popping and reduce cracking sounds that already exist.

ANKLE CIRCLES

Performing ankle circles can warm up your joints and increase mobility. You can do this exercise from a seated or lying position:

Sit or lay with your legs stretched out front. Prop your leg on a stable surface with the ankle hanging off the edge.
Rotate your foot in clockwise circles 10 times with your ankle.
Switch to counterclockwise circles 10 more times.
Swap feet and repeat with the other ankle.

TOWEL STRETCHES

Relieve tight ankles with these simple towel stretches you can do at home:

Sit on a flat surface with your legs straight out in front of the body.
Loop a towel horizontally around the sole.
Gently pull the towel ends toward the body, stretching the foot.
Hold this position for 20 seconds.
Repeat as needed.

CALF RAISES

Strengthen your calf muscles to reduce pressure on the ankles in motion.

Stand on the edge of a platform or the bottom stair step with the heels hanging off.
Slowly rise onto the toes, driving the body fully upward with the calves.
Let the heels gently fall, stretching slightly below the ledge.
Repeat 10 times.

When to See a Doctor

When your ankle popping begins to cause discomfort or pain, consider getting a proper diagnosis from a doctor. They may order tests like an MRI or CT scan to look inwardly at the bone and cartilage.

If you recently had an ankle injury, rest is a major proponent of healing. A doctor may recommend anti-inflammatory medications to help with the pain and swelling.

A doctor can stabilize the ankle with a brace or orthotic to promote faster healing for more serious conditions. Physical therapy also works alongside any stabilization devices to slowly get your ankle back to regular functioning. If necessary, surgical options are available, including arthroscopy and total joint replacements.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Simple Ankle Fractures Explained

in Ankle Pain, Fractures

Article featured on Foot Health Facts

What Is an Ankle Fracture?

A fracture is a partial or complete break in a bone. Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula or both.

Ankle fractures are common injuries most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.

Symptoms of an Ankle Fracture

An ankle fracture is accompanied by one or all of these symptoms:

Pain at the site of the fracture, which in some cases can extend from the foot to the knee.
Significant swelling, which may occur along the length of the leg or may be more localized.
Blisters may occur over the fracture site. These should be promptly treated by a foot and ankle surgeon.
Bruising that develops soon after the injury.
Inability to walk; however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether or not a bone has been fractured.
Change in the appearance of the ankle—it will look different from the other ankle.
Bone protruding through the skin—a sign that immediate care is needed. Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.

Diagnosis of an Ankle Fracture

Following an ankle injury, it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment.

The affected limb will be examined by the foot and ankle surgeon who will touch specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.

Nonsurgical Treatment of an Ankle Fracture

Treatment of ankle fractures depends on the type and severity of the injury. At first, the foot and ankle surgeon will want you to follow the RICE protocol:

Rest: Stay off the injured ankle. Walking may cause further injury.
Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
Compression: An elastic wrap should be used to control swelling.
Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.

Additional treatment options include:

Immobilization. Certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
Prescription medications. To help relieve the pain, the surgeon may prescribe pain medications or anti-inflammatory drugs.

When Is Surgery Needed?

For some ankle fractures, surgery is needed to repair the fracture and other soft tissue-related injuries, if present. The foot and ankle surgeon will select the procedure that is appropriate for your injury.

Follow-Up Care

It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis and chronic pain.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Achilles Tendinitis: What is it?

in Ankle Pain, Foot Pain

Article featured on Mount Sinai

Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It allows you to push your foot down. You use your Achilles tendon when walking, running, and jumping.

Causes

There are two large muscles in the calf. These create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.

Heel pain is most often due to overuse of the foot. Rarely, it is caused by an injury.

Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.

Achilles tendinitis may be more likely to occur if:

There is a sudden increase in the amount or intensity of an activity.
Your calf muscles are very tight (not stretched out).
You run on hard surfaces, such as concrete.
You run too often.
You jump a lot (such as when playing basketball).
You do not wear shoes that give your feet proper support.
Your foot suddenly turns in or out.

Tendinitis from arthritis is more common in middle-aged and older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling. Flat feet will put more tension on the tendon.

Heel pain can be a common problem. Though the cause is rarely serious, the pain can be severe and sometimes disabling.

Heel pain is often the result of overusing your foot. Causes may include, running, especially on hard surfaces like concrete, tightness in your calf, or from Achilles tendonitis (inflammation of that large tendon that connects your calf muscle to your heel), shoes with poor support, sudden inward or outward turning of your heel, or landing hard or awkwardly on your heel after a jump or fall.

Problems related to heel pain include bursitis (inflammation of the bursa at the back of the heel), bone spurs in the heel, and plantar fasciitis (swelling of the thick band of tissue on the bottom of your foot). Heel pain is something you can usually treat at home.

If you can, try resting as much as possible for at least a week. Apply ice to the painful area twice a day or so, for 10 to 15 minutes. If you need to, you can buy a heel cup, felts pads, or shoe inserts to comfort your heel.

You should call your doctor if your heel pain does not get better after two or three weeks of home treatment. But also call your doctor if your pain is getting worse, or your pain is sudden and severe, your feet are red or swollen, or you can’t put weight on your foot.

If you visit the doctor, you may have a foot x-ray. Your treatment will depend on the cause of your heel pain. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. To prevent future heel pain, we recommend you exercise.

Maintaining flexible, strong muscles in your calves, ankles, and feet can help ward off some types of heel pain. And do yourself a favor, trade those sleek high heels in for a comfortable, properly fitting pair of shoes.

Symptoms

Symptoms include pain in the heel and along the length of the tendon when walking or running. The area may feel painful and stiff in the morning.

The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on your toes. You may also have trouble finding shoes that fit comfortably due to pain in the back of your heel.

Exams and Tests

The health care provider will perform a physical exam. They will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.

X-rays can help diagnose bone problems.

An MRI scan of the foot may be done if you are considering surgery or there is a chance that you have a tear in the Achilles tendon.

Treatment

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.

Try putting ice on the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the area gets numb.

Changes in activity may help manage the symptoms:

Decrease or stop any activity that causes pain.
Run or walk on smoother and softer surfaces.
Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your provider or physical therapist can show you stretching exercises or eccentric loading exercises for the Achilles tendon.

You may also need to make changes in your footwear, such as:

Using a brace, boot or cast to keep the heel and tendon still and allow the swelling to go down
Placing heel lifts in the shoe under the heel
Wearing shoes that are softer in the areas over and under the heel cushion

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help ease pain or swelling.

Other treatment include injections, such as platelet rich plasma or steroids, to reduce the inflammation. However, the tendon can become even weaker following injection and should be protected after the injections.

If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur.

Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Outlook (Prognosis)

In most cases, lifestyle changes help improve symptoms. Keep in mind that symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.

Possible Complications

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition most often causes a sharp pain that feels as if you have been hit in the back of the heel with a stick. Surgical repair is often necessary. However, the surgery may not be as successful as usual because there is already damage to the tendon.

When to Contact a Medical Professional

Contact your provider if:

You have pain in the heel around the Achilles tendon that is worse with activity.
You have sharp pain and are unable to walk or push-off without extreme pain or weakness.

Prevention

Exercises to keep your calf muscles strong and flexible will help reduce the risk for tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What is Chronic Ankle Instability?

in Ankle Pain

Article featured on Foot Health Facts

What Is Chronic Ankle Instability?

Chronic ankle instability is a condition characterized by a recurring giving way of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually, the giving way occurs while walking or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability.

People with chronic ankle instability often complain of:

A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
Persistent (chronic) discomfort and swelling
Pain or tenderness
The ankle feeling wobbly or unstable

Causes of Chronic Ankle Instability

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and retrain the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.

Repeated ankle sprains often cause—and perpetuate—chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle.

Diagnosis of Chronic Ankle Instability

In evaluating and diagnosing your condition, the foot and ankle surgeon will ask you about any previous ankle injuries and instability. Then s/he will examine your ankle to check for tender areas, signs of swelling and instability of your ankle as shown in the illustration. X-rays or other imaging studies may be helpful in further evaluating the ankle.

Nonsurgical Treatment

Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient’s level of activity. Nonsurgical treatment may include:

Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport.
Bracing. Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains.
Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation.

When Is Surgery Needed?

In some cases, the foot and ankle surgeon will recommend surgery based on the degree of instability or lack of response to nonsurgical approaches. Surgery usually involves repair or reconstruction of the damaged ligament(s). The surgeon will select the surgical procedure best suited for your case based on the severity of the instability and your activity level. The length of the recovery period will vary, depending on the procedure or procedures performed.

Why choose a foot and ankle surgeon?

Foot and ankle surgeons are the leading experts in foot and ankle care today. As doctors of podiatric medicine – also known as podiatrists, DPMs or occasionally “foot and ankle doctors” – they are the board-certified surgical specialists of the podiatric profession. Foot and ankle surgeons have more education and training specific to the foot and ankle than any other healthcare provider.

Foot and ankle surgeons treat all conditions affecting the foot and ankle, from the simple to the complex, in patients of all ages including chronic ankle instability. Their intensive education and training qualify foot and ankle surgeons to perform a wide range of surgeries, including any surgery that may be indicated for chronic ankle instability.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Symptoms and Treatments for Ankle Arthritis

in Ankle Pain, Arthritis

Article featured on University of Michigan Health

Ankle arthritis occurs when there is a breakdown of cartilage in the ankle joint. It can result from a variety of causes, including trauma (such as a car accident), autoimmune diseases (such as rheumatoid arthritis) or infection. In most cases, ankle arthritis is due to the degeneration of the cartilage from an old injury.

If you have – or suspect you have – ankle arthritis, we can provide you with a complete diagnosis and a personalized treatment plan. Experience is crucial in treating ankle arthritis, and we see many patients with complicated foot and ankle conditions.

Ankle Arthritis Symptoms

Pain that may increase with activity
Stiffness or loss of mobility
Swelling
Deformity of the ankle

Ankle Arthritis Diagnosis

So we can understand your condition, during your office visit:

We will take a complete history and conduct a physical examination to assess skin changes, the presence or absence of pulses and nerve sensations, the range of motion in your ankle, and the areas of discomfort.
We will take X-rays to evaluate your degree of arthritis and any associated ankle problem.
We may order further testing, such as a CT scan or MRI if we are considering surgery as an option.

Ankle Arthritis Treatments

Your individualized treatment plan is based on any previous treatments you have had, your current level of disability, the presence of other medical conditions, and our findings from your health history, exam and X-rays.

Non-Surgical Treatments

We always look at non-surgical treatments first, especially if you have never received any other treatments. Treatments can include:

Ankle bracing – Either a custom-made or pre-fabricated ankle brace will stabilize your ankle joint and provide support for your ankle.
Cortisone injections – Cortisone injected into the ankle can reduce pain and swelling during a flare-up.
Activity modifications – Limiting high-impact activities, such as running, jumping or court sports, or switching out high-impact activities for low-impact options may be an option for you.
Ice and anti-inflammatory medications – We may give you these as needed to decrease symptoms.

Surgery

Surgery is only considered if all appropriate non-surgery treatments have failed. The types of surgeries we do include:

Ankle fusion (arthrodesis) – This procedure can be done either inpatient or outpatient, depending on your condition. Ankle fusion fuses together the two bones that make up the ankle joint – the tibia and talus – to make one solid block of bone. Fusion is an excellent pain-reliving procedure for arthritic joints. It involves removing the cartilage from a joint so it grows into one bone, eliminating the pain of bones rubbing against each other. Fusion of the ankle does result in loss of approximately 75% of ankle motion, but some motion is kept through the joints underneath the ankle and into the mid-foot.
Total ankle joint replacement (arthroplasty) – This ankle joint replacement treatment utilizes the newest implants (prosthesis) available. The surgery is only appropriate for certain patients with ankle arthritis, but for the right candidate, it can be very successful in preserving function and providing excellent pain relief. We are one of the few health care providers to offer total ankle replacement to our patients, and our surgeons are highly experienced in this procedure.
Bone spur removal (debridement) – Arthritis can cause bone spurs to develop on the ankle joint, and removal of these bone spurs, either through an open ankle incision or through an ankle scope (arthroscopy), may relieve pain and improve range of motion.
Distraction arthroplasty – This is a new joint restoration technique that uses an external frame (applied surgically) placed around the outside of the leg to spread the surfaces of the ankle joint, to encourage new cartilage growth. This procedure maintains ankle motion and relieves pain.

Our surgeons will be happy to discuss the pros and cons of surgery, and to let you know if they think surgery is the best option for you.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

How to Prepare for Ankle Replacement Surgery

in Ankle Pain, Joint Replacement

Article featured on WebMD

After you’ve scheduled your ankle replacement surgery, you need to take some steps to make sure the operation goes smoothly. First, set up some time with your doctors to make a plan and get yourself ready:

Your primary care doctor.

It’s a good idea to get a physical exam to make sure you’re healthy enough to have surgery. This is especially important if you have long-term health conditions, such as diabetes.

Your physical therapist.

They’ll measure how well your ankle works before surgery. This will help them check your progress as your joint heals and you start to move again. They can teach you how to use the crutches or walker you’ll need to get around after the operation, too.

Your anesthesiologist.

They are the doctor who will keep you pain-free during surgery. Usually you meet with them on the day of your operation. They’ll explain the type of anesthesia they’ll use and will ask you if you’ve had any bad reactions in the past.

Get Your Body Ready

You might need to do some things that will let you heal quickly:

If you smoke, stop. It hurts your heart and blood vessels and will make your recovery time longer.
Changes in medication . If you take blood thinners or anticoagulants, your doctor will discuss when to stop taking them before having surgery. These include anti-inflammatory pain relievers like aspirin and ibuprofen. They can cause extra bleeding if you take them too close to surgery.
Tell your surgeon about other prescription and over-the-counter drugs that you take. You might need to temporarily stop them or take an alternative treatment.
Watch for illness. If you get sick or have symptoms of infection in the week before surgery, let your doctor know right away.
Keep clean. Stick to any directions you’re given for showering or bathing before surgery. Your surgeon might ask you to wash with a special soap that kills the bacteria on your skin.

Prepare Your Home for Recovery

You won’t be able to walk for a period of time after surgery. Before you go to the hospital, you can make your home a safe place to recover by following these tips:

Prepare for “one-floor” living. If you have a multi-level home, make arrangements to spend your time on the first floor while you recover so you aren’t climbing stairs. This may mean moving furniture so you have a place to sleep.
Get rid of tripping hazards. Pack away throw rugs, and move any cords or other obstacles on the floor.
Bathroom changes. Get a chair for your tub or shower so you can bathe safely.
Keep must-have items handy. Throughout your home, put things you use often within easy reach. Set them in places where you don’t need to bend over or reach up to get to them.
Arrange for help. Make sure someone will be with you for at least the first few days after surgery. You’ll need to stay off your feet and keep your ankle elevated. Your surgeon will tell you how long.

Going to the Hospital

Don’t eat or drink after midnight the evening before your surgery.

Don’t wear any makeup or jewelry to the hospital. Pack a small bag to bring with you, though. Your surgeon might give you a list of suggested items to pack. These might include:

Insurance information
A copy of your advance medical directives and medical history
Medicines you regularly take
Personal care items, such as your toothbrush and hairbrush
Comfortable clothing to wear home, including shorts or pants that are very loose around the ankles

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Ankle Sprain Rehab Exercises to Get You Back on Your Feet

in Ankle Pain

Article featured on verywellfit

One of the most common sports injuries, an ankle sprain occurs when the ligaments surrounding the ankle joint are stretched or torn as the ankle joint and foot is turned, twisted, or forced beyond its normal range of motion.

If you suspect an ankle sprain, there are things you can do immediately after being injured to protect your ankle. Once the initial injury begins to heal, use exercises to rehabilitate your ankle and get back to the activities you love.

Ankle Sprain Causes and Grades

The most common cause of an ankle sprain in athletes is a missed step or a missed landing from a jump or fall. Ankle sprains vary in severity and are classified by the degree of severity:

Grade I: Stretch and/or minor tear of the ligament without laxity (loosening)
Grade II: Tear of ligament plus some laxity
Grade III: Complete tear of the affected ligament (very loose)

For immediate relief, you can use the R.I.C.E. treatment plan: rest, ice, compression, and elevation.1 While there is general agreement that the best approach to an ankle sprain is immediate rest, there is some conflicting advice about what comes next.

Until definitive answers are available, the following approach is still the most widely recommended:

Rest: Avoid weight bearing for 24 hours, or longer for a severe sprain. You may need to use crutches.
Ice: Apply ice (bagged, crushed ice wrapped in a thin towel) to the ankle joint. To avoid frostbite, ice should not be left in the area longer than 20 minutes at a time. Ice for 20 minutes every two hours for the first 24 hours to control swelling.
Compression: Wrap the ankle with an elastic bandage (start at the toes and wrap up to the calf) to help prevent swelling and edema.
Elevation: Raise the ankle above the hip or heart to reduce swelling.

If the swelling doesn’t subside in 48 to 72 hours, or if you are unable to bear weight on the injured ankle within 48 hours, seek medical treatment for a complete evaluation.

Ankle Sprain Rehab

After the initial 24 to 48 hours of rest and icing, slowly begin bearing weight over several days as tolerated. Avoid full weight bearing during this phase. Gradually progress to full weight bearing. Try to use a normal heel-toe gait.

Start doing rehabilitation exercises as soon as you can tolerate them without pain. Range of motion (ROM) exercises should be started early in the course of treatment. Gradual progression to other weight-bearing exercises should follow shortly after.

Assessment of the Ankle Joint

After an ankle injury, the joint should be assessed for misalignment or structural defects caused by the sprain. A physician will check the joint and test for weakness or deficits in soft tissues (tendons, ligaments, and cartilage).

Your injury may require taping or bracing. If a fracture or dislocation is suspected, an MRI or an X-ray will confirm the diagnosis and determine the most appropriate treatment.

Any ankle injury that does not respond to treatment in one to two weeks may be more serious. Consult a physician for a thorough evaluation and diagnosis.

Types of Rehab Exercises

Specific exercises are prescribed to help restore ankle stability and function. These exercises are progressive (they should be done in order) and are generally prescribed for range of motion, balance, strength, endurance, and agility.

Range of motion (flexibility) exercises
Progressive strength exercises
Balance (proprioception) exercises
Progressive endurance exercises
Agility (plyometric) exercises

The following exercises can be used to rehab a Grade I ankle sprain. If your sprain is more severe, you should follow the plan prescribed by your physician and physical therapist. Your physical therapist can design the best program for your specific injury and your limitations.

Flexibility and Range of Motion Exercises

As soon as you can tolerate movement in the ankle joint and swelling is controlled, you can begin gentle stretching and range of motion exercises of the ankle joint.

Towel stretch: The towel stretch is a simple and effective way to improve the flexibility of your calf muscles. While seated on the floor, simply wrap a towel around the ball of the foot and gently pull the towel so the toes and ankle flex up.
Standing calf stretch: Stretching your calf muscles is important to help loosen the muscles and prevent further injury. While facing a wall, place one leg behind. Lean toward the wall until you feel a slight stretch in the calf of your extended leg.
Achilles soleus stretch: Slowly stretching your Achilles tendon can help you prevent injury and keep the tendon flexible. To stretch your tendon, stand an arm’s length away from the wall and place one leg back. Keeping the leg slightly bent at the knee, slowly lean forward and press your heel to the floor.
Toe circles: Move your ankle through its entire range of motion—up and down, in and out, and in circles. Move only the ankle and not the leg.
Alphabet exercise: With your leg extended, try to write the alphabet in the air with your toes.

Strengthening and Endurance Exercises

Once you have a good range of motion, joint swelling is controlled, and pain is managed, you can begin strengthening exercises.

Step-ups: Begin on a short step and slowly step up in a controlled manner while focusing on contracting the muscles of the foot, ankle, and leg. Turn around and slowly step down in the same manner. Repeat 20 times, several times per day.
Towel curls: To perform a towel curl, you will need to be seated and barefoot. Place a small towel on a smooth surface in front of you. Grab the towel with your toes. Keep your heel on the ground and curl your toes to scrunch the towel as you bring it toward you. Let go and repeat until you’ve moved the towel to you. Then, do the action in reverse to push the towel away from you. Repeat 10 times, several times a day.
Isometric exercises: Gently push against an immovable object in four directions of ankle movement—up, down, inward, and outward. Hold for 5 seconds. Repeat 10 times, several times a day.
Tubing exercises: Use elastic tubing to create gentle resistance. Wrap the elastic band around the ball of the injured foot and resist the band as you move your ankle up, down, inward, and outward. These exercises incorporate the four movements of the foot: inversion, eversion, plantar flexion, and dorsiflexion. Perform three sets of 15 repetitions for each movement and repeat several times a day to build endurance.
Toe raises: Stand with your heel over the edge of a step. Raise up on the ball of your foot, hold for 3 seconds, and slowly lower your heel to the starting position. Perform 20 repetitions several times a day.
Heel and toe walking: Walk on your toes for 30 seconds. Switch and walk on your heels for 30 seconds. Build up to 1 minute on toes and heels alternating for 5 to 10 minutes. Perform several times per day.

Proprioception Exercises

After you are able to place your full weight on the injured ankle without pain, you may begin proprioceptive training to regain balance and control of the ankle joint.

One-leg balance: Try to stand on one leg for 10 to 30 seconds. Increase the intensity by doing this with your eyes closed.
One-leg squat: Stand on the affected leg with your foot pointing straight ahead and the knee of the other leg slightly bent. Extend your arms for balance if necessary. Lift the non-supporting foot slightly off the floor and lower to a squat position.
Balance board ball toss: While balancing on a wobble board, balance board, or BOSU, catch and toss a small (5-pound) medicine ball with a partner.
Balance board with half-squats: While balancing on a wobble board, perform 10 slow, controlled half-squats.
Step up onto balance board: Place a balance board (or soft pillow or foam pad) 6 to 8 inches higher than your starting point. Step up 10 times.
Step down onto balance board: Place a balance board (or soft pillow or foam pad) 6 to 8 inches lower than your starting point. Step down 10 times.
One-leg squat and reach: Stand on the affected leg and raise the other leg slightly. As you squat, reach toward the floor with the hand opposite your standing leg.

Agility Exercises

Once you have regained balance, strength, and control, you can begin working on agility.

Lateral step up and down: Step up sideways to a step bench and then step down sideways.
Plyometric exercises: These can include single-leg hops (hop forward and concentrate on “sticking” the landing), single-leg spot jumps (hop from spot to spot on the floor), or reactive spot jumps (place numbered pieces of tape on the floor and as a partner calls out a number, hop to that number).
Sport-specific skills and drills: Sport-specific drills can be added as long as return to sports guidelines are followed.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Rheumatoid Arthritis within Foot and Ankle

in Ankle Pain, Arthritis, Foot Pain

Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

Cause

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.
As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.
The bunion is typically severe and the big toe commonly crosses over the second toe.

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.
Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.
Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.
Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.
Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:
X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.
Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.
Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

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Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.
Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.
Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/
For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

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Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.
Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.
During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.
Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.
Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.
Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.
Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.
Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.
If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.
There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.
Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.
If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.
If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.
Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.
There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.
This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.
This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Recovering from an ankle sprain

in Ankle Pain, Sprained Ankle

Article featured on Harvard Health Publishing
All it takes is a simple misstep, and suddenly you have a sprained ankle. An ankle sprain is one of the most common musculoskeletal injuries in people of all ages, athletes and couch potatoes alike. The injury occurs when one or more of the ligaments in the ankle are stretched or torn, causing pain, swelling, and difficulty walking. Many people try to tough out ankle injuries and don’t seek medical attention. But if an ankle sprain causes more than slight pain and swelling, it’s important to see a clinician. Without proper treatment and rehabilitation, a severely injured ankle may not heal well and could lose its range of motion and stability, resulting in recurrent sprains and more downtime in the future.

Anatomy of an ankle sprain

The most common type of ankle sprain is an inversion injury, or lateral ankle sprain. The foot rolls inward, damaging the ligaments of the outer ankle — the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament. (Ligaments are bands of fibrous tissue that connect bone to bone; see illustration.)

Ankle ligaments

Less common are sprains affecting the ligaments of the inner ankle (medial ankle sprains) and syndesmotic sprains, which injure the tibiofibular ligaments — the ligaments that join the two leg bones (the tibia and the fibula) just above the ankle. Syndesmotic sprains, which occur most often in contact sports, are especially likely to cause chronic ankle instability and subsequent sprains.
The severity of an ankle sprain depends on how much damage it does and how unstable the joint becomes as a result. The more severe the sprain, the longer the recovery (see “Grades of ankle sprain severity”).

Grades of ankle sprain severity
Severity	Damage to ligaments	Symptoms	Recovery time
Grade 1	Minimal stretching, no tearing	Mild pain, swelling, and tenderness. Usually no bruising. No joint instability. No difficulty bearing weight.	1–3 weeks
Grade 2	Partial tear	Moderate pain, swelling, and tenderness. Possible bruising. Mild to moderate joint instability. Some loss of range of motion and function. Pain with weight bearing and walking.	3–6 weeks
Grade 3	Full tear or rupture	Severe pain, swelling, tenderness, and bruising. Considerable instability and loss of function and range of motion. Unable to bear weight or walk.	Several months

Immediate ankle sprain treatment

The first goal is to decrease pain and swelling and protect the ligaments from further injury. This usually means adopting the classic RICE regimen — rest, ice, compression, and elevation. If you have severe pain and swelling, rest your ankle as much as possible for the first 24–48 hours. During that time, immerse your foot and ankle in cold water, or apply an ice pack (be sure to cover the ankle with a towel to protect the skin) for 15–20 minutes three to five times a day, or until the swelling starts to subside.
To reduce swelling, compress the ankle with an elasticized wrap, such as an ACE bandage or elastic ankle sleeve. When seated, elevate your ankle as high as you comfortably can — to the height of your hip, if possible. In the first 24 hours, avoid anything that might increase swelling, such as hot showers, hot packs, or heat rubs. Nonsteroidal anti-inflammatory drugs such as ibuprofen can help reduce pain and swelling and may also speed recovery.

Ankle sprain medical evaluation

Unless your symptoms are mild or improving soon after the injury, contact your clinician. He or she may want to see you immediately if your pain and swelling are severe, or if the ankle feels numb or won’t bear weight. He or she will examine the ankle and foot and may manipulate them in various ways to determine the type of sprain and the extent of injury. This examination may be delayed for a few days until swelling and pain improve; in the meantime, continue with the RICE regimen.
X-rays aren’t routinely used to evaluate ankle injuries. Ligament problems are the source of most ankle pain, and ligaments don’t show up on regular x-rays. To screen for fracture, clinicians use a set of rules — called the Ottawa ankle rules, after the Canadian team that developed them — to identify areas of the foot where pain, tenderness, and inability to bear weight suggest a fracture. A review of studies involving more than 15,000 patients concluded that the Ottawa rules identified patients with ankle fractures more than 95% of the time.

Ankle sprain functional treatment

To recover from an ankle sprain fully, you’ll need to restore the normal range of motion to your ankle joint and strengthen its ligaments and supporting muscles. Studies have shown that people return to their normal activities sooner when their treatment emphasizes restoring ankle function — often with the aid of splints, braces, taping, or elastic bandages — rather than immobilization (such as use of a plaster cast). Called functional treatment, this strategy usually involves three phases: the RICE regimen in the first 24 hours to reduce pain, swelling, and risk of further injury; range-of-motion and strengthening exercises within 48–72 hours; and training to improve endurance and balance once recovery is well under way.
Generally, you can begin range-of-motion and stretching exercises within the first 48 hours, and should continue until you’re as free of pain as you were before your sprain. Start to exercise seated on a chair or on the floor. As your sprained ankle improves, you can progress to standing exercises. If your symptoms aren’t better in two to four weeks, you may need to see a physical therapist or other specialist.

Exercises to help restore function and prevent injury

Range-of-motion, stretching, and strengthening: First 1–2 weeks

Flexes. Rest the heel of the injured foot on the floor. Pull your toes and foot toward your body as far as possible. Release. Then point them away from the body as far as possible. Release. Repeat as often as possible in the first week.

Ankle alphabet. With the heel on the floor, write all the capital letters of the alphabet with your big toe, making the letters as large as you can.

Press down, pull back. Loop an elasticized band or tubing around the foot, holding it gently taut (A). Press your toes away and down. Hold for a few seconds. Repeat 30 times. Tie one end of the band to a table or chair leg (B). Loop the other end around your foot. Slowly pull the foot toward you. Hold for a few seconds. Repeat 30 times.

Ankle eversion. Seated on the floor, with an elasticized band or tubing tied around the injured foot and anchored around your uninjured foot, slowly turn the injured foot outward. Repeat 30 times.

Ankle inversion. Seated on the floor, cross your legs with your injured foot underneath. With an elasticized band or tubing around the injured foot and anchored around your uninjured foot, slowly turn the injured foot inward. Repeat 30 times.

Stretching and strengthening: Weeks 3–4

Standing stretch. Stand one arm’s length from the wall. Place the injured foot behind the other foot, toes facing forward. Keep your heels down and the back knee straight. Slowly bend the front knee until you feel the calf stretch in the back leg. Hold for 15–20 seconds. Repeat 3–5 times.

Seated stretch. Loop an elasticized band or tubing around the ball of the foot. Keeping the knee straight, slowly pull back on the band until you feel the upper calf stretch. Hold for 15 seconds. Repeat 15–20 times.

Rises. Stand facing a wall with your hands on the wall for balance. Rise up on your toes. Hold for 1 second, then lower yourself slowly to the starting position. Repeat 20–30 times. As you become stronger, do this exercise keeping your weight on just the injured side as you lower yourself down.

Stretches. Stand with your toes and the ball of the affected foot on a book or the edge of a stair. Your heel should be off the ground. Use a wall, chair, or rail for balance. Hold your other foot off the ground behind you, with knee slightly bent. Slowly lower the heel. Hold the position for 1 second. Return to the starting position. Repeat up to 15 times, several times a day. This exercise can place a lot of stress on the ankle, so get your clinician’s go-ahead before trying it.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Treating Ankle Injuries

in Ankle Pain, Injuries, Sprained Ankle

Article featured on UCSF Health

Ankle sprains are the most common ankle injury among regular athletes and weekend warriors. The top orthopedic complaint, sprains occur in an estimated 27,000 Americans a day.
Many athletes, however, who suffer from ankle sprains tend to play right through their injury, which can lead to lifelong problems with recurring sprains, unstable joints, arthritis-like pain or other complications like tendon or cartilage damage. And the earlier in life a sprain occurs, the higher the chance of recurrence. Therefore, it’s important to properly treat initial sprains, especially in young athletes.
If you sprain your ankle and it hurts to run, you should sit out the rest of the game. Once a sprain has occurred, follow these three steps to help you recover:

Step 1: RICE

Follow the instructions represented by the acronym RICE as often as possible for three days. RICE stands for rest, ice, compression (with an elastic ankle wrap) and elevation (toes above the nose). For significantly swollen ankles or if limping persists for more than three days, you should see a doctor.

Step 2: Rehabilitation

To prevent permanent damage to the ankle, take steps to achieve better range of motion (flexibility), balance and strength. Many of these exercises can be done at home.

Range of motion exercise

Place one foot on a stairway step. Allow the back heel to stretch downward over the edge of the step. Hold each foot in this position for 30 seconds.

Balance restoration exercise

Stand on one leg with your eyes closed. Gradually build up to standing 30 seconds on each leg. Repeat three times.

Strength exercise

Lie on your side on the sofa, with the upper leg hanging over the edge. Place the top of your foot through the handles of a plastic shopping bag filled with one to two pounds of weight (one or two cans of soup). Slowly lift your toes toward the ceiling and hold for three seconds. Repeat 10 times.

Step 3: Supportive devices

When back to playing sports, previously injured athletes should probably wear an ankle brace, no matter how much they have rehabilitated their ankle or how good their sneakers. An injured ankle will never have the same support again, so a brace should be considered.

Step 4: If pain continues

For ankle pain and significant instability that persists despite adequate rehabilitation or physical therapy, you should see a doctor for further evaluation. You may have injured the cartilage or tendons in your ankle, which may require special testing.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.