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
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:
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​The Dorsiflexion Lunge Test
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Agility T-Test
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Sargent/Vertical Jump Test (chalk on the finger method)
These are all well researched test and should be used.​
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
Authors:
Easy Rehab for ankle sprain
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Use a rounded curb or build this ramp. According to this "Peroneal muscle activity during different types of walking" by Rok Bavdek, Anže Zdolšek, Vojko Strojnik, and Aleš Dolenec in the Journal of Foot and Ankle Research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122778/
Advanced rehab
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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
Achilles Tendon
https://dynamicchiropractic.com/article/55777-achilles-injuries-part-1-insertional-tendinitis
https://dynamicchiropractic.com/article/59367-new-concepts-in-managing-achilles-tendinopathy
Ankle joint self mobilization
This is a great article that tested the use of 3 ankle joint self mobilizations. There is video is under supplementary materials and pictures are in the body of the article. I like the first one demonstrated best.
A way to monitor your progress and help me do a better job Your foot and ankle score.
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Common causes
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Improper movement
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Abnormal biomechanics
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Imbalance muscles
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Previous trauma injury
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Repetitive micro trauma
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Adhesions/scar tissue of Gluteals, Hamstrings, Psoas, Para-spinals
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Spinal misalignment/subluxation of the Lumbar spine and Pelvis
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Tight muscles
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Acute trauma
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Overuse injury
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Poor posture
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Arthritis
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Solutions
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Postural correction
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Stretching therapy
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Biomechanical analysis