mild 2nd degree sprain, rotated inwards.

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I think most people have sprained their ankle at least once in their lifetime, me included.  It can hurt like the dickens and for some unfortunate people it can require a visit to an orthopedic surgeon.

Thankfully, the vast majority of sprained ankles can be treated at home, and resolved 100% in time.

Most sprained ankles are inversion sprains.  Inversion refers to movement of the foot inwards relative to the ankle; i.e. “rolling inwards” of the foot while contacting the ground, bearing body weight.  Ankle sprains usually occur when the victim steps on or in something that he wasn’t expecting; for example a stone.  They also occur from sports activities.  Wearing the wrong kind of athletic shoes increases the chances of spraining an ankle; for example wearing running shoes while playing on a basketball court.

There are several ligaments that connect the foot to the distal fibula, also called the lateral malleolus, or “outer ankle.”  When the foot rolls in quickly as in an inversion sprain, some of these small ligamentous attachments tear; and some snap in half.  This sets in motion the body’s inflammatory response:  a cascade of biochemical substances are released and the ankle starts to swell quite quickly.  Here’s the thing about inflammation:  it is necessary for proper healing, but it can overcorrect causing unnecessary pain and prolonged resolution of the injury.  Bruising sometimes occur from ruptured capillaries and small vessels, and pooling of blood in the tissues.

TREATMENT:

The first order of business is to do a simple assessment of your injury.  This will determine if  you need to see a doctor.  Note how much your ankle bent:  was it a short and quick sprain that your reflexes were able to correct before serious damage occurred?  Was your sprain such that you felt your foot bend completely inwards and had little control over correcting; and perhaps you felt and/or heard a snap?  When you grab your foot and attempt to move it, does it feel like there is no resistance, as though you ruptured all the ligaments?

The second scenario warrants a visit to the doctor, the sooner the better.  These are the signs of ligament and possible tendon rupture, and even ankle or foot bone fracture.

The first scenario is likely a simple sprain/strain.  While the second scenario warrants a visit to the doctor, the following treatment can be done in both:

1.  Get home, take of your shoe and sock if you are wearing them.  See if you have swelling around the ankle bone (lateral, or outside ankle). Prepare an ice massager by filling a plastic cup with water and sticking a spoon in the middle, holding it in place with a cardboard support.   Put it in your freezer.

2.  The treatment for the first 3-5 days will be ice therapy.  Fill a small tub with enough tap water to cover a couple of inches aboveyour ankle.   Add just enough ice so that it is very cold, but not so cold that you have to remove your foot from the icewater solution.   You will need to keep your foot submerged for 20 straight minutes (adding the water allows you some control over the temperature).   Do this every two hours during the day, at least four (4) cycles.  The goal here is to temper the swelling and not let it get out of hand.  It will also cut the pain down by at least 50%.

Later in the day, and at night use the ice massager.   Take it out of the freezer; pull the spoon handle so the ice pops out of the plastic cup.  Massage your ankle, applying light downward pressure to squeeze the swelling out.  Do it for 10 minutes, every couple of hours.

3.  Get some ACE wrap from your local drugstore.  Do a couple of wraps just above the ankle bone, and pronate your foot (place it in the position opposite of the rolling-in angle).  Do a couple of wraps under your foot and back around the ankle to hold it in this position.  Wrap it so it places a firm pressure around the swollen ankle, but not so firm that it cuts off circulation and makes your foot blue or swell even more.

Take off the ankle wrap when icing, then re-apply afterwards.

You will likely have difficulty putting weight on the affected foot for a day or two, so consider getting a crutch, or a cane to assist you with walking.

Day 4, you can start to apply moist heat to the ankle in between icing to perfuse it with more oxygenated blood, which will aid in healing.  Heat water on a stove to about 150 degrees; add to a rubber hot water bottle.  Wet a face towel, place over your ankle, then place the hot water bottle on top.

Ligament injuries can take more than a month before the pain goes entirely away.  Generally, you can stop icing once all the swelling goes down; however, you can still ice for pain relief.  You will want to start exercising your ankle as soon as the pain permits.  Walking barefoot on a flat surface will do the job.  As the ankle pain dissipates, consider training on a wobble board to exercise in multiple angles.

If you find that you sprain your ankle relatively frequently, you may want to consider getting a pair of shoe orthotics.  Orthotics help by offering more support for the foot, and in some cases can help correct over pronation or supination.  The WalkFit orthotics are a good, off-the-shelf choice that you can start with.  You can upgrade to a customized shoe orthotic by visiting a podiatrist or chiropractor who can cast your foot and have one custom-manufactured for you.

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