FOOT PAIN & INJURIES

Ankle sprains in Truckee Tahoe


Ankle Sprains are also known as twisted ankle, sprained ankle, ankle injury, ankle strain.


Approximately 14% of all athletic injuries are ankle sprains and if not taken care of properly can lead to long term chronic ankle pain. The most common type is the inversion ankle sprain, in which the ankle rolls over on the outside. And you stretch and/or tear these ligaments. There is generally pain on the outside of the ankle. It can happen while hiking, playing sports walking on uneven surfaces, cross country skiing and dancing. All the usual things we do in the Truckee Tahoe area.
Sprained ankle causes:
A short or tight posterior calf muscles
Scar Tissue
Poor rehabilitation of a previous sprained ankle
Poor proprioception (proprioception is the ability to sense where a joint is .... if you don’t know where your ankle is, the muscles will not be able to prevent the ankle sprain)
Weak muscles (they are just not strong enough to prevent the sprain from occurring)
Poor control of the muscles and joints

A deeper look at ankle sprains

Dr. Emily Splichal  DPM goes into the anatomy, testing, and treatment of lateral ankle sprains this is a moderate depth look and if you want to skip the anatomy you can start at the 30 minute mark. 

 If you wanted a deeper dive into the ankle then Pieter D’Hooghe is great person to learn from, here is one of his articles "Return to Play After a Lateral Ligament Ankle Sprain" from Current Reviews in Musculoskeletal Medicine  Here is an in depth lecture to give you a deep understanding of the Ankle injuries by him.

Grade 2 Ankle Sprain
Shows the swelling from an ankle sprain
Grade 1 Ankle Sprain

Some stretching or mild tearing of the ligament.This pain would be on the outside of the ankle just below, in front of and in back of the lateral malleolus (commonly known as the ankle bone)
Little or no functional loss - the joint can still function and you can walk but with pain without limp
Mild pain
Some swelling
Some joint stiffness.
Takes 2-4 weeks to properly heal

Grade 2 ankle sprain:

Significant tearing of the ligament up to 75%
Moderate instability of the joint i.e. the joint feels loose
Moderate to severe pain - weight bearing is very painful in the above areas and onto the top of the foot and up the outside of the lower leg
Can not walk without severe pain
Swelling and stiffness
Muscle involvement indicated by the pain goes up the side of the leg
Takes 6-10 weeks to heal

Grade 3 ankle sprain:

Total rupture of a ligament - there is a loss of motion
Gross instability of the joint - joint function is lost
Severe pain initially followed by no pain
Severe swelling
Takes 16 to 20 weeks to heal

When you can Return to play 

We can return to play when the the injured side can do what the uninjured side can do. In this article 

"Return to Play in Athletes Following Ankle Injuries"

 by Thomas O. Clanton, In the journal of sport s health. They talk about measurable criteria for return to sport. They use the:

These are all well researched test and should be used.​

Agility T-test.png

A return-to-run program can be initiated once an athlete is pain free during daily activities for 5 consecutive days. Progress is directed by symptom provocation and initially focuses on increasing running volume before speed.  from https://www.researchgate.net/publication/351421121_Optimal_Load_for_Managing_Low-Risk_Tibial_and_Metatarsal_Bone_Stress_Injuries_in_Runners_The_Science_Behind_the_Clinical_Reasoning

Optimal Load for Managing Low-Risk Tibial and Metatarsal Bone Stress Injuries in Runners: The Science Behind the Clinical Reasoning

DOI:10.2519/jospt.2021.9982

Authors:

 

Stuart J Warden

Easy Rehab for ankle sprain

Use a rounded curb or build this ramp. According to this "Peroneal muscle activity during different types of walking" by Rok BavdekAnže ZdolšekVojko Strojnik, and Aleš Dolenec in the Journal of Foot and Ankle Research  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122778/

ankle ramp.jpg
ankle rehab balance challenge.png

 From A multi-station proprioceptive
exercise program in patients with
ankle instability https://scholar.google.com/scholar_lookup?title=A%20multi-station%20proprioceptive%20exercise%20program%20in%20patients%20with%20ankle%20instability&author=E.%20Eils%20&author=D.%20Rosenbaum&publication_year=2001

Practical applications and ideas

  1. Use a yoga mat or carpet folded over. The more folds the harder

  2. This a swinging device so go to the ply ground and use a swing

  3. Use a balance board like StrongTek Professional Wooden Balance Board, Rocker Board, Wood Standing Desk Accessory, Balancing Board for Under Desk, Anti Slip Roller, Core Strength, Stability, Office Wobble Boards https://www.amazon.com/dp/B079J6SQ6G?linkCode=ogi&tag=goodhousekeeping_auto-append-20&ascsubtag=[artid|10055.g.35367414[src|[ch|[lt| It has a single plain of motion or get your carpenter to make one for you.

  4. No clue

  5. Theraband exercise band, get it from me. Also great to vary position. Ankle , forefoot and above knee

  6. Theradisk or bosu

  7. Cut a lacrosse ball or dog play ball in half and connect it to a pair of shoes with a screw and 2 part epoxy. 

  8. Get one on craigslist or thrift store

  9. instead use a board with a piece of wood screwed to one end.

  10. Rock garden, a stream with rocks underneath

  11.  Slackline https://www.youtube.com/watch?v=hxyAYxIAG6A

  As you progress try combining different challenges. Try closing your eyes one or both.

 Do an activity like shoot basketballs, bounce a soccer ball, play catch, use a rebounder, lift weights, do squats or reaches like the star excursion balance test(especially those that put you into ankle inversion)

The Foot core

In this article they give an in depth look at the exercises, anatomy and how to access in both a low tech way and high t6ech way the foot arch, aka short foot, aka ion the British Journal of Sports medicine  foot the dome https://bjsm.bmj.com/content/49/5/290.long

Common causes
  • Improper movement 

  • Abnormal biomechanics 

  • Imbalance muscles 

  • Previous trauma injury 

  • Repetitive micro trauma 

  • Adhesions/scar tissue of Gluteals, Hamstrings, Psoas, Para-spinals

  • Spinal misalignment/subluxation of the Lumbar spine and Pelvis

  • Tight muscles 

  • Acute trauma 

  • Overuse injury 

  • Poor posture 

  • Arthritis

Solutions
Foot core short foot.jpg

Advanced rehab