By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER'S ANKLE SPRAIN DID NOT RECEIVE PROPER HOME TREATMENT

Question: I stepped off a curb and twisted my ankle recently. After limping around for a week, I went to the doctor. She said it was a sprain and that it would be much better now if I had actively taken care of it. I didn’t do anything after I hurt it because I could still walk on it. What should I have done?

Answer: An ankle sprain is a very common injury. Most ankle sprains involve the outside surface of the ankle, or what doctors call the “lateral” surface. Typically, a mild to moderate sprain will resolve by itself over time.

The most common sprains occur when you roll your foot to the inside while stepping down -- but you know that now. This generally injures the anterior talofibular ligament. It is also possible to fracture the outside foot bones in this type of injury. This is called a Jones’ fracture. There are other injuries, as well, that can be associated with an ankle sprain, so your trip to the doctor after not getting better was the right thing to do.

Generally, its rather obvious when you have suffered a rollover ankle injury. In addition to the immediate pain, you may hear a loud pop and experience swelling and decreased function in the affected ankle. How people treat these injuries varies widely. Some people go straight to the hospital emergency department. Others wait to see what will happen in a few hours and then seek medical care if the swelling and pain don’t significantly subside. Still others, like you, wait a week or more to see if the injury will heal on its own. Depending on the circumstances, each of these approaches has merit. But, if you take one of the “wait” alternatives, you do need to know something about home treatment of ankle sprains.

In order to help you remember in the future what to do in the first 48 hours after a sprain, I’m going to give you an acronym that we teach our medical students. The word is “RICE”:

• “R” is for rest. Stay off the injured ankle as much as possible either by limiting walking or using crutches.
• “I” is for ice. You should avoid using heat on this injury for the first 48 hours, instead use ice bags, or 10 minute soaks in cold water every hour.
• “C” is for compression. A soft but firm dressing, like an ace bandage, can help support the ankle. Be sure that this is not too tight.
• “E” is for elevation. While you are limiting your activity, as much as possible keep the ankle elevated so it is higher than your hip.

We sometimes add an “M” for range of motion and medication. Don’t keep your ankle too still. It’s a good idea to try and gently move it for a few minutes every hour or so, paying particular attention to pointing your toes and flexing your ankle. Medications such as ibuprofen can be helpful but should not be overused.

If you had done these things, your ankle might very well have healed more quickly. Now, you need to follow your physician’s advice. As a first step, she may recommend additional conservative measures. If these don’t bring relief within a short time and you still have a great deal of pain and limitation of function, you may have more than a mild sprain. In this case your physician will recommend other specific treatments that could range from splints to surgery.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.