Ankle Sprain: An Overview
Guest: Dr. David Geier – Orthopedic Surgery
Host: Dr. Linda Austin –
Dr. Linda Austin: I’m Dr.
Linda Austin. I’m talking with Dr. David
Geier who is Director of MUSC’s Sports Medicine Clinic. Dr. Geier, surely one of the most common
sports injuries is an ankle sprain. What
is going on with a sprain? Everybody
knows they hurt, but what’s going on under the skin?
Dr. David Geier: What
typically happens is that the ankle, what people describe is that they roll
their ankle, they typically invert it, meaning, their foot kind of goes to the
inside of their ankle and they kind of land on the outside of their ankle. They may feel a pop. They may notice immediate swelling. But what typically happens, a sprain,
essentially, in varying degrees, is a partial or complete tear of one the
ligaments around the ankle, usually on the outside of the ankle. And the more ligaments you tear or injure,
the more severe the ankle sprain. That’s
essentially what it is. You tear the
stabilizing structures to the ankle.
Dr. Linda Austin: Should
one see a doctor if you’ve sprained an ankle?
Is that necessary?
Dr. David Geier: What’s
interesting is, no question, it’s the most common sports injury, but probably
one of the least common injuries actually seen in the physician’s office
because, fortunately, very rarely, does it need surgery or even a cast. The initial treatments of all injuries, rest,
ice, compression, elevation (RICE), people seem to know very well for ankle
sprains. And if it’s a mild sprain, one
to two days, their back walking and they do fine. Most of those never come to a physician’s
I think the question comes if you can’t walk or if you have very
specific tenderness and it’s extremely painful.
Then, it is reasonable to see a physician. The question is, is that four hours after you
get hurt, or is that a week or two after you get hurt? I think it’s it different for everybody.
Dr. Linda Austin: Are some
people prone to ankle sprains and do it repeatedly?
Dr. David Geier: I think
that’s a great question. Certainly, some
people are. You hear people talk about
being “double-jointed” or being very lax.
I think that those people, clearly, are more likely to invert and sprain
their ankles. I think more of what
happens is not that people are just born to have unstable ankles, but after
they have a very traumatic injury to their ankle, a very bad ankle sprain, then
they don’t rehab it appropriately and it doesn’t heal properly or they don’t
develop what we call proprioception of the ankle, I think, then, they’re more
likely to have recurrent injuries. So, I
don’t know that they’re kind of destined to have ankle instability. I just think some people don’t rehab
appropriately and then they set themselves up for recurrent injuries.
Dr. Linda Austin: So, are
you leading up to a pitch for physical therapy then?
Dr. David Geier:
Absolutely. I think physical
therapy is far and away the most important aspect of treating an ankle
sprain. We do it a lot with our
competitive athletes, have them work with a physical therapist on balance board
exercises and stabilization exercises, standing on the injured ankle only on
uneven surfaces and on soft forgiving surfaces to build up the strength in the
ankle and the stabilization effect of the ankle, the neuromuscular control of
the ankle. But I really think it’s also
important for just your everyday person that injures his ankle. Maybe not the first few days, but if this
gets to be a problem that’s gone on for a week or two weeks, or three weeks, I
think just one or two visits with a physical therapist to learn some simple
exercises to do at home is very valuable to get over it.
Most of the time that I see people in the office that have had an
ankle sprain and two months later, it’s still hurting. The most common reason that they’re still
having trouble is that it just wasn’t rehabbed appropriately. Now, there are some issues that look like
ankle sprains but, truly, are a different diagnosis, that if they’re not
getting better, it could have been one of those things. But most of the time, it’s just not enough
Dr. Linda Austin: So, let’s
imagine a person thinks it was an ankle sprain.
They may have done their physical therapy, it still isn’t getting
better, what then?
Dr. David Geier: I think
that’s where the sports medicine physician really becomes important. And it starts with, really, just a physical
exam to figure out where the discomfort is coming from. It’s not always right on just the inside or
just the outside of the ankle. It can be
further down the foot. I think just a
physical exam and some basic x-rays are a beginning to a workup. There are many injuries that can mask as an
ankle sprain that sometimes can be more severe or cause it to be a more
Some of these would be a fracture of one of the metatarsals, one
of the small bones in the foot. You can
cause what we call an osteochondral lesion of the talus, which is a fancy way
of saying a cartilage or bone injury in the bone supporting the lower bone of
the ankle. A lot of times you can have
that and have normal x-rays and, really, no signs early on of that, and that’s
potentially a surgical problem.
You could have what we call high ankle sprain, where the ligaments
between the two main bones of your leg get disrupted, so, literally, you’re
injury is higher, above where your typical ankle sprain causes discomfort. You can have a fracture of the calcaneous,
the heel bone, a fracture of the talus, just above the calcaneous, all
masquerading as ankle sprain. So,
sometimes it’s not just as simple as, oh, I’ve sprained my ankle, no big deal.
Dr. Linda Austin: So then,
how much time should you give a sprained ankle to clear up before you start
being concerned about something like that?
Dr. David Geier:
Absolutely. That’s a fantastic
question. It’s hard to say. I think if you give it two, three weeks and
you’ve worked to get the swelling down, you’ve worked with a physical therapist
to try to get through this and you’re still having a lot of discomfort, not
getting much better, I think, absolutely, it’s appropriate to see a physician
to make sure there’s not something else going on. Or, if in the first few hours or days, you’re
really having much more discomfort, much more limitation of your ability to
walk or do any of your normal activities than you think typically an ankle
sprain would cause, then I think, early on, in the first hours or day, it may
even be appropriate to see a physician.
Dr. Linda Austin: Dr.
Geier, thank you so much.
Dr. David Geier: Thank you.
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