What is a high ankle sprain?

A sprained ankle is the stretching or tearing of ankle ligaments, which support the joint by connecting bones to each other. A sprain occurs when your ankle is forced to move out of its normal position, which can cause one or more of the ankle’s ligaments to stretch, partially tear or tear completely.

Dr. Grant Lum, MD, CCFP, Dip Sports Med, Sports Medicine Physician, discusses treatment and prevention of high ankle sprains.

Dr. Tony Taylor, MD, EMBA, Emergency Physician, discusses treatment of ankle injuries.

Dale Harris discusses orthotic options for bracing ankle injuries.

Ankle and Lower Leg Bracing and Injuries

If you’ve got a fracture in your foot, or your lower leg, you have to determine what type of walker boot you need.

If you’ve got a fracture that’s in the forefoot, be it fifth metatarsal fracture, a stress fracture, maybe a bunion surgery recovery, the ankle walkers are a great product for this.

There’s a variety of different models that are available. We really like this one because it’s got a nice rocker profile on the bottom, three straps, and a nice wide base for support.

If you’ve got a lower leg fracture or a rear foot fracture, malleolar fracture, talus fracture, one of the things you want to look for is a longer boot that offers more support through the rear foot or leg, with the three straps on the front, again a nice wide base on the bottom and a great rocker profile.

When you’re ready to try on a walker boot, it’s really important to try some different ones on, they range in price quite dramatically, go to an experienced store and let them help determine what type of walker boot.

Presenter: Mr. Dale Harris, Bracing & Equipment Specialist, Vancouver, BC

Local Practitioners: Bracing & Equipment Specialist

The treatment and prevention of high ankle sprains

One variant of the typical ankle sprain, which is more serious, is the high ankle sprain.

So this involves a sprain of different ligaments. These are the ligaments that attach these two bones together, so the tibia and the fibula, and also the ligament that wraps around the front of the ankle and holds the tendons in place. A local physiotherapist might be able to help.

When those ligaments are sprained, it can make the entire ankle complex unstable causing these bones to spread apart from one another. So in a third degree or complete tear of those ligaments, a screw needs to be placed across these bones in order to hold them back together.

Most high ankle sprains that are less severe will require a few weeks of not bearing weight on the foot. So typically people will have to use crutches. Once you’re allowed to bear weight, then it takes somewhere between four and six weeks to be able to go back to do most of your normal activities. Local Physiotherapist 

With more serious injuries that requires surgery, you may not be weight-bearing for up to six weeks and then another six to 12 weeks after that before you can resume activity. The typical treatment for lesser sprains would include ice, anti-inflammatories,  local physiotherapy, and of course in terms of diagnosing these injuries, sometimes you will need an x-ray.

There are times where these kinds of injuries are hard to pick up even on an x-ray, and we may need to do an MRI, for example. The best way to prevent these kinds of injuries typically would be to make you’re doing a good ankle strengthening and balance program in advance of starting your season. Local Orthopedic Surgeon

If you think you have a high ankle sprain or have more questions, you could consult a sports medicine physician or a physiotherapist. Local Orthopedic Surgeon.

Presenter: Dr. Grant Lum, Sports Medicine Physician, Toronto, ON

Local Practitioners: Sports Medicine Physician

Larissa Roux, MD FRCP Dip Sport Med, MPH, PhD, discusses eversion ankle sprains in hockey.

Larissa Roux, MD FRCP Dip Sport Med, MPH, PhD, discusses ankle sprains, a common sports injury.

Local Orthopedic Surgeon

Anneliese Ruggeri

Anneliese Ruggeri

Physiotherapist
Middlebury, CT
Mr. Trevor Kwolek

Mr. Trevor Kwolek

Physiotherapist
Fonthill, ON
Chritine Bridle

Chritine Bridle

FCAMPT, CAFCI
Physiotherapist
St Catherines, ON
Paul Skiba

Paul Skiba

B.Kin. (Hons.), RKin, RHN, CEP
Physiotherapist
St. Catharines, ON

The Achilles tendon is the tendon that runs up from the calf muscle up and down to the calcaneus, or the heel. People commonly injure their Achilles tendon playing a sport, if they have a fall or as they age and tendons degenerate. An Achilles tendon injury can be complex, and is more difficult to treat later down the road, as the muscles become deconditioned.

What is Achilles Tendinitis?

Achilles tendinitis is pain felt in the region of the heel at the back of the foot. Pain can often be felt either at the region of the heel or anywhere up the tendon itself. In helping deal with Achilles tendonitis problems, physicians want to decrease inflammation and reduce tension on the calf muscles.

The most common way to treat an Achilles tendon injury is with non-surgical methods, including the RICE method (rest, ice, compression, and elevation) and anti-inflammatories. Your sports medicine physician or orthopedic surgeon may recommend a cast, which holds your foot in a toes-down position and allows the Achilles tendon to heal. Your healthcare provider may recommend that you see a physiotherapist, as you’ll benefit from stretching, doing self-massage or rolling on a ball.

Surgery for Achilles Tendon Injuries

Ambulatory care procedures

Ambulatory care procedures (also known as minor procedures) are operations that are done under local anaesthesia only, are less than 20 minutes duration, do not require preoperative fasting, and although we recommend that someone drive you home, this is not mandatory. The post operative course for the most common procedures will be presented

If you do require surgery following an Achilles tendon injury, it involves stitching and one end of the tendon onto the other so that it heals at the correct length. It’s very important that the tendons are at the right length so that the muscles that fire around those tendons can work properly. If most of the Achilles tendon is damaged, the surgeon can use the tendon that goes to the big toe to support the tendon.

physiotherapyTendon operations are often difficult to do, and they often lead to problems with wound healing. There are a number of techniques being developed to reduce the amount of skin incision that’s required to repair the tendon. You will need to wear a cast or walking boot for 6 to 12 weeks after surgery. People often undergo Achilles tendon surgery if their doctor feels that surgical options are better than non, or if non-surgical options don’t work.

Main operating room procedures

 

If you have been scheduled for a procedure in the main operating room, then likely you will have been asked to be fasting from the night before, and to have someone drive you home and be with you for the first 24 hours after surgery. Many procedures are performed after just freezing your arm. If requested, intravenous sedation will be administered so that you may even fall asleep during the procedure. A variety of narcotics are usually prescribed after surgery. Pain management usually starts with maximizing on non narcotics options. This usually starts with 1000mg of Tylenol along with 400mg of Ibuprofen (Advil) every 6 hours. If you are taking another anti-inflammatory (Aspirin, Naprosyn, Voltaren etc), then do not take Ibuprofen. A narcotic analgesic will likely have been prescribed. The most common is Tylenol #3. This medication contains a narcotic (codeine) along with Tylenol. If taking Tylenol #3, then do not take additional Tylenol, but please continue with the Advil. If only taking one tablet of Tylenol #3, then supplement with additional Tylenol up to a maximum of 1000mg every 6 hours. Other narcotics may not contain Tylenol (like oxycodone and hydromorphone), and you should be taking a full dose of Tylenol (1000mg) every 6 hours along with the Advil. Discontinue the narcotics as soon as you can.

Some procedures require immobilization after completion and seeing a physiotherapist can often help.. If you do not have a splint or cast after your surgery, you will be asked to keep your dressing on for 48 hours, followed by light bathing and washing of the wound. Do not soak your wound until after your suture have been removed. If your hand has not been immobilized, it is very important to move your fingers from fully straight to fully bent as frequently as possible.

Talk to your healthcare provider if you’d like more information on Achilles tendinitis.

Visit HealthChoicesFirst.com for more videos and resources on orthopedics.

Print this Action Plan and check off items that you want to discuss with your healthcare provider

  • The most common way to treat an Achilles tendon injury is with non-surgical methods, including the RICE protocol (rest, ice, compression and elevation) and anti-inflammatories. Your sports medicine physician or orthopedic surgeon may recommend a cast, which holds your foot in a toes-down position and allows the Achilles tendon to heal.
  • Your healthcare provider may recommend that you see a physiotherapist, as you’ll benefit from stretching, doing self-massage or rolling on a ball.
  • If you do require surgery following an Achilles tendon injury, it involves stitching and one end of the tendon onto the other so that it heals at the correct length. It’s very important that the tendons are at the right length so that the muscles that fire around those tendons can work properly.
  • Tendon operations are often difficult to do, and they often lead to problems with wound healing. There are a number of techniques being developed to reduce the amount of skin incision that’s required to repair the tendon.
  • You will need to wear a cast or walking boot for 6 to 12 weeks after surgery.

Local Sports Medicine Physicians

Dr. Ellen Smith

Dr. Ellen Smith

MD, FACEP
Sports Medicine Physician
Gaithersburg, MD
Dr. Vinay Chopra

Dr. Vinay Chopra

MD
Sports Medicine Physician
Freehold, NJ
Dr. Naresh Rao

Dr. Naresh Rao

Sports Medicine Physician
New York, NY

Orthopedics Now

Orthopedics Now

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