ANKLE SPRAIN TREATMENT

Black and blue. Ouch!

Few of us will escape the need for Ankle sprain treatment on one or another occasion. A soft-ball slide, standing unexpectedly on the edge of the pavement, or uneven ground can and does from time to time cause awesome injuries to the ankle. Note the swelling, and the bruising from torn tissues. It could be from a fracture, but more likely torn ligaments or tendons.

Like all sportsmen and women, I have had my shares of sprains and strains. Of the three major events I have experienced, THE sprained ankle, a calf muscle strain and a slipped disc I think, perhaps by a small margin, the ankle was the worst. Ouch! Treatment of a sprained ankle will include careful chiropractic management of any subluxation of the talus bone in the ankle mortice joint. Other joints in the foot, leg and even pelvis too, of course. During such a sudden sprain, a chain events often shakes up the whole spine.

I was playing an important squash match when, at full stretch, I put my foot clumsily into the crack between the floor and the wall. The stab of pain as my ankle turned was one of the most painful things I have ever experienced. Sadly, I had to concede, there was absolutely no possibility of continuing.

Within half an hour the ankle was very swollen and the next day there was bruising spreading down into the toes. Those were pre-chiropractic days, and I had no idea what to do. The only suggestion of the school nurse for ankle sprain treatment was to use ice. Placing weight on the foot caused sharp stabs of pain within the ankle, and I had to use crutches for a week.

The ankle was extremely unstable, and for about six months, it would turn suddenly and unexpectedly, with sharp pain, and swell just whilst walking on level ground. After a few months the side of my knee started to ache.

It's a myth that, if you can walk on the walk on the ankle, that nothing is broken. Fortunately mine was not broken, though it should have been x-rayed.

What occurs in a sprained ankle?

First and foremost the talus bone, which connects the foot to the lower leg, subluxates. This is the cause of the incredibly sharp, stabbing pain.
Secondly, the ankle ligaments are frequently sprained, and may very occasionally completely rupture. Fortunately this is very exceptional. This sprain is the most likely cause of the bruising frequently associated with a sprained ankle.
Thirdly, the muscles or a tendon may be strained.
Fourthly, a fracture may occur, usually the lateral malleolus or the head of the fifth metatarsal (called a Jones fracture). The ligaments and tendons are so strong that the bone fractures before the ligament or tendon ruptures. This is called an avulsion fracture. Can you spot the fractures on these x-rays? Occasionally they may need to be pinned.

TIP: Every day is a good day to quit smoking, but particularly today - avulsion fractures in smokers usually need to be pinned. The bone doesn't get enough oxygen, so after 6 weeks when the cast comes off, if it's still not healed, you have an operation and another two months in a cast to look forward to. Your call.

Can you spot the Jones fracture (below) on the side of the foot? There is a little white marker. This has to be cast, or it won't heal. The first priority in the treatment of a sprained ankle is the management of any fractures obviously. There are very few chiropractors equipped to do this, though the introduction of the post-graduate FICS programme is changing that. (see below)

TREATMENT

An x-ray is important before chiropractic treatment if there is any suggestion of possible fracture, as adjusting the ankle would obviously aggravate the condition.

To facillate normal quick healing, the first treatment is to adjust the subluxated talus bone . This is not usually particularly painful, and can be done with a standard chiropractic technique. Restoring the normal biomechanics enhances the normal healing time.
If there is fracture, usually of the large bony bump on the side of the ankle (called the lateral malleolus) or a bone on the very side of the foot (head of the fifth metatarsal), then casting of the ankle by an orthopaedist is recommended.
Sprain and strain of ligaments and tendons is done using the standard RICE ankle sprain treatment method: Rest, Ice, Compression bandage, Elevate.

Usually more than one tissue is injured and unfortunately the treatment of one (eg a fracture) may contra-indicate the treatment of another (eg ice on the sprain, or adjusting the talus). Fracture will always take precedence. The talus can always be adjusted once the fracture has healed.

Sports chiropractic is now an integral part of the profession since the establishment of Federation International Chiropractic Sports (FICS) , a training course for chiropractors interested in treating sportsmen and women.

Rehab.

Ankle sprain treatment should ALWAYS include rehabilitation. Otherwise another sprain is just around the corner! Strengthening weak muscles, stretching damaged ligaments so they remain flexible, mobilising the subluxated joint, and finally re-establishing what is called proprioception are all important parts of ankle sprain treatment. Do it! Wobble boards are easily available, and really make a difference. Ask your chiropractor where you can buy one locally, or very easy to turn on a lathe if your are at all handy.

Whilst not every sprained ankle necessarily needs professional care, I am finding more and more patients complaining of foot and ankle pain, that has its origins in a long forgotten sprain sprain (years). When in doubt, treatment of a sprained ankle should include a chiropractic examination. The subluxated bone was never corrected, which alters the gait and inevitably leads to changes in the foot. This is particularly true for sportsmen and women - footflare occurs and your performance will drop off. Plantar myofascitis often has its origin in a long forgotten injury that really should have had ankle sprain treatment.

An aside: A report in a geriatric medicine research journal reveals that older persons who do balance exercises every day (such as a wobble board, though just standing on one foot makes a good start) are much less likely to fall and break a hip. When you're done with it, give it to mum for a birthday present. She will bless you in time. Tell her to be careful, or she may be needing ankle sprain treatment!

For more interesting cases from the Chiropractic Coalface, click here.

Useful links

Choosing the right shoes is vital if you plan to walk or jog. At this site you will get some straight forward advice in what is really quite a difficult topic. Ankle sprain treatment begins with the right shoes.

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