Foot and Ankle Injury Prevention and Treatment Options
By Dr. Damien Richardson
Foot and ankle injuries are among the most common injuries affecting millions
of people every year. Hoag Orthopedic Institute foot and ankle orthopedic
surgeon Dr. Damien Richardson answered some questions about what types
of injuries are most common, how to prevent injury and surgical and non-surgical
treatment options available.
Q: What are the most common foot and ankle injuries affecting Americans?
A: Acute low ankle sprains are one of the most common injuries affecting
Americans. Studies have shown that In the U.S. there close to one million
ankle sprains per year and more than half of these occur during athletic
activity. This injury can affect a number of structures on the outside
or lateral portion of the ankle. However, the anterior talofibular ligament
(ATFL) and the calcaneal fibular ligament (CFL) are the soft tissue structures
typically affected when somebody "rolls" their ankle with a
low ankle sprain when the foot sustains an outward roll of the ankle (supination)
beyond your normal range of motion and it causes stress or tears to the
ligaments in your shin, ankle and foot (tibia). A sprain of the ankle
is really thought of as a tear of the ligament that occurs along a continuum
from micro tears (grade I), to partial tears (grade II), to complete tears
(grade III). The grade of a sprain is typically determined by history
and physical exam alone. Rarely, higher level imaging such as an MRI is
needed when injury to other structures is suspected or confounds the clinical picture.
Q. What are the latest advancements for treating foot and ankle injuries
A. Acute low ankle sprains are one of the most common injuries affecting Americans.
In fact, U.S. studies have shown that close to one million ankle sprains
occur every year and more than half of these occur during athletic activity.
When somebody "rolls" their ankle, the foot sustains an outward
roll of the ankle beyond your normal range of motion, which causes stress
or tears to the ligaments in your shin, ankle and foot. The grade of a
sprain is typically determined by your history and doctor examination.
Higher level imaging such as an MRI is rarely needed when injury to other
structures is suspected. Unless the tear is grade III (a complete tear)
most ankle sprains recover through a regimen of exercises that focus on
mobilization, stabilization and balance. Ensuring you are moving early
on in rehabilitation leads to faster recovery compared to being in a cast
or walking boot. Patients can be back to their normal activities anywhere
between 2-12 weeks depending on the severity of the sprain. To help prevent
future ankle sprains, patients should engage in strengthening exercises,
specifically with the tendons around the foot and ankle, help to increase
mobility, strength and balance, which help prevent injury.
Q. What is the typical course of treatments for people experiencing these injuries?
A. Once an ankle sprain has been diagnosed, and other bony or soft tissue
injuries have been ruled out, treatment typically follows based on the
grade of injury. Patients with low grade ankle sprains do not require
crutches and recover best with early rehabilitation regimen such as physical
therapy. Ensuring you are moving early on in rehabilitation leads to faster
recovery compared to immediate immobilization with a cast or walking boot.
Timing of return to sport and higher impact activities in these lower
grade injuries is based on the level of patient discomfort and ability
to perform sports specific or activity related movements. Grade III injuries
on the other hand typically benefit from a brief period of immobilization
and protected weight bearing with crutches. Recent randomized trials have
shown that immobilization with a walking boot for 3 weeks with conversion
to functional brace treatment did better than immediate mobilization with
functional bracing treatment. Once symptoms improve after 3-4 weeks of
immobilization with decreased swelling and pain formal physical therapy
is started to improve range of motion and strength to the ankle. As symptoms
improve therapy exercises advance to more advanced movement exercises
and sports specific functional drills. The return to sport for typical
grade III ankle sprains is 6-12 weeks with non-operative treatment.
Q. What are the latest advancements in treatment?
A. While non-operative management of acute grade III ankle sprains is the
standard of care in the U.S. there is a growing body of evidence in the
Europe that suggesting faster to return play, better functional results,
and fewer recurrent sprains with surgical repair of these ligaments. However,
more studies are needed to substantiate these findings.
Q: Are there any exercises people can do to prevent reinjury?
A. Acute ankle rehabilitation protocol that focuses on strengthening and
awareness of the dynamic stabilizers of the ankle, namely the peroneal
tendons, helps to prevent future instability events.