Foot and Ankle Injury Prevention and Treatment Options

Foot and Ankle Injury Prevention and Treatment Options

By Dr. Damien Richardson

Foot and ankle injuries are among the most common injuries affecting millions of people every year. Hoag Orthopedic Institute foot and ankle orthopedic surgeon Dr. Damien Richardson answered some questions about what types of injuries are most common, how to prevent injury and surgical and non-surgical treatment options available.

Q: What are the most common foot and ankle injuries affecting Americans?

A: Acute low ankle sprains are one of the most common injuries affecting Americans. Studies have shown that In the U.S. there close to one million ankle sprains per year and more than half of these occur during athletic activity. This injury can affect a number of structures on the outside or lateral portion of the ankle. However, the anterior talofibular ligament (ATFL) and the calcaneal fibular ligament (CFL) are the soft tissue structures typically affected when somebody "rolls" their ankle with a low ankle sprain when the foot sustains an outward roll of the ankle (supination) beyond your normal range of motion and it causes stress or tears to the ligaments in your shin, ankle and foot (tibia). A sprain of the ankle is really thought of as a tear of the ligament that occurs along a continuum from micro tears (grade I), to partial tears (grade II), to complete tears (grade III). The grade of a sprain is typically determined by history and physical exam alone. Rarely, higher level imaging such as an MRI is needed when injury to other structures is suspected or confounds the clinical picture.

Q. What are the latest advancements for treating foot and ankle injuries

A. Acute low ankle sprains are one of the most common injuries affecting Americans. In fact, U.S. studies have shown that close to one million ankle sprains occur every year and more than half of these occur during athletic activity. When somebody "rolls" their ankle, the foot sustains an outward roll of the ankle beyond your normal range of motion, which causes stress or tears to the ligaments in your shin, ankle and foot. The grade of a sprain is typically determined by your history and doctor examination. Higher level imaging such as an MRI is rarely needed when injury to other structures is suspected. Unless the tear is grade III (a complete tear) most ankle sprains recover through a regimen of exercises that focus on mobilization, stabilization and balance. Ensuring you are moving early on in rehabilitation leads to faster recovery compared to being in a cast or walking boot. Patients can be back to their normal activities anywhere between 2-12 weeks depending on the severity of the sprain. To help prevent future ankle sprains, patients should engage in strengthening exercises, specifically with the tendons around the foot and ankle, help to increase mobility, strength and balance, which help prevent injury.

Q. What is the typical course of treatments for people experiencing these injuries?

A. Once an ankle sprain has been diagnosed, and other bony or soft tissue injuries have been ruled out, treatment typically follows based on the grade of injury. Patients with low grade ankle sprains do not require crutches and recover best with early rehabilitation regimen such as physical therapy. Ensuring you are moving early on in rehabilitation leads to faster recovery compared to immediate immobilization with a cast or walking boot. Timing of return to sport and higher impact activities in these lower grade injuries is based on the level of patient discomfort and ability to perform sports specific or activity related movements. Grade III injuries on the other hand typically benefit from a brief period of immobilization and protected weight bearing with crutches. Recent randomized trials have shown that immobilization with a walking boot for 3 weeks with conversion to functional brace treatment did better than immediate mobilization with functional bracing treatment. Once symptoms improve after 3-4 weeks of immobilization with decreased swelling and pain formal physical therapy is started to improve range of motion and strength to the ankle. As symptoms improve therapy exercises advance to more advanced movement exercises and sports specific functional drills. The return to sport for typical grade III ankle sprains is 6-12 weeks with non-operative treatment.

Q. What are the latest advancements in treatment?

A. While non-operative management of acute grade III ankle sprains is the standard of care in the U.S. there is a growing body of evidence in the Europe that suggesting faster to return play, better functional results, and fewer recurrent sprains with surgical repair of these ligaments. However, more studies are needed to substantiate these findings.

Q: Are there any exercises people can do to prevent reinjury?

A. Acute ankle rehabilitation protocol that focuses on strengthening and awareness of the dynamic stabilizers of the ankle, namely the peroneal tendons, helps to prevent future instability events.