Are you suffering from a potential sprained ankle?
The Omaha Foot & Ankle Specialists at MD West ONE are able to properly diagnose and treat a sprained ankle injury through both surgical and non-surgical treatments. If you have the following symptoms, you may want to make an appointment with one of our Board Certified Specialists.
- Pain when weight bearing
- Swelling in ankle/foot region
- Sound of a pop or snap at the time of injury
Meet MD West ONE's foot and ankle specialists and learn more about how they treat a sprained ankle injury.
Sprained Ankle Causes, Treatments & Surgery
How does a sprained ankle happen?
The most common mechanism is rolling the ankle inward, also known as an inversion injury. This can injure the lateral ankle ligaments. If the foot turns inward under the leg there is stretching force on the outer or lateral ankle ligaments. The common activities that can lead to this include stepping on an uneven surface that turns the foot in and under, jumping and landing on the outer margin of the foot and having the weight of the body turn the foot completely on its side, cutting and stopping suddenly as the foot is planted and the body keeps moving. These mechanisms are common in athletic activities but also can occur when we slip on the stairs, step down off a curb, step in a hole, or twist on a slippery surface. An Eversion force is what injures the deltoid ligament on the inner aspect of the ankle. In this injury the foot rolls or twists outward from under the leg. This injury is much less common than the lateral ankle injury and usually more force is needed to injure the deltoid ligament. In addition to an isolated severe twisting force, mechanisms here may involve some type of contact with another individual or a fall from a height. Tearing of the syndesmotic ligaments, the ligaments between the tibia and fibula, can occur when the foot is rotated outward as the leg turns or rotates inward. As this mechanism is similar to that for a deltoid ligament injury it is not uncommon to sprain the deltoid and syndesmotic ligaments at the same time.
How are sprained ankles diagnosed?
A diagnosis is determined after a thorough history and physical examination are performed. The history is important as knowing the mechanism of injury helps the evaluator to have a full understanding of the structures most at risk. Also, any pre-existing symptoms or conditions may aid in making an accurate diagnosis. The physical exam should not include the direct area of pain, but also structures within the leg up to the knee and down into the foot. Injuries can be more complex than just a single process and it is important to make sure structures in the region are thoroughly evaluated. Locations of tenderness or lack of tenderness are key findings in additions to a check of motion, strength, and stability. Sometimes early following the injury process the muscles may guard and protect and the true extent of instability/ligament looseness may not be evident. If there is a concern regarding a fracture of bone then x-rays are indicated, but certainly not all ankle sprains need to be x-rayed. Advanced imaging such as an MRI scan is not needed to make the diagnosis in most cases of a ligament sprain in the ankle. If the evaluator has concerns regarding the presence of a tendon injury or there is uncertainly about the extent of a more serious ligament process then MRI scanning is usually the imaging test of choice. MRI or CT scanning can also be requested if there is suspicion of a bone injury not seen or x-rays.
The following factors put you at an increased risk for an Achilles Tendon Rupture:
Age - The peak age for Clayton ruptures is from the age of 30 to 40.
Sex - Achilles tendon ruptures are five times more likely to occur in men than women.
Recreational Sports - Achilles tendon injuries often occur during sports that involve running, jumping, and sudden start and stop. This includes soccer, basketball, and tennis.
Steroid Injections - Injections around the tendon can sometimes weaken the tendon, increasing the risk of an Achilles tendon rupture
Certain Antibiotics - Fluoroquinolone antibiotics, such as ciprofloxacin or levofloxacin have been shown to increase the risk of an Achilles tendon rupture
Obesity - Increased weight puts more strain upon the tendon, increasing the risk of rupture.
Ways to Decrease Your Risk of Developing Achilles Tendon Problems:
- Stretch Your Calf Muscles - Stretch your calf until you feel a noticeable stretch but not pain. Calf stretching exercises can help the muscle and tendons to prevent injury.
- Vary Your Exercises - Alternate high impact sports, such as running, with lower sports such as walking, biking, or swimming.
- Choose Running Surfaces Carefully - Avoid or limit running on hard and slippery surfaces. Make sure to dress warm for cold-weather training and wear well-fitting athletic shoes with cushioned heels.
- Increase Training Intensity Slowly - Achilles tendon injuries often occur after an abrupt increase in training intensity. For this reason, increase your distance, duration, and frequency of training by no more than 10% per week.
To diagnose an Achilles tendon tear, a foot and ankle orthopedic surgeon will perform a physical exam. This will include questions about when and how the injury occurred, whether you have previously injured the tendon, or whether there were any pre-existing symptoms in the tendon such as pain and swelling.
The surgeon will also examine the foot and ankle, feeling for a defect in the tendon to suggest a chair. They will also evaluate the range of motion and muscle strength compared to the uninjured side. Here they will also perform a specialist test, called a Thompson test, to evaluate the tendon tension and whether the tendon is completely torn. This entails lying face down with your knees flexed 90° and your feet extended into the air. When an Achilles tendon is not torn, the ankle rests in a toes down position of approximately 20°. Squeezing the upper calf muscle will cause the toes to point down even further. If the tendon is torn, the affected side will have less tension causing the ankle to hang down at about a 90° angle. Squeezing the upper calf muscle will cause weak or no movement. The surgeon will also feel for a palpable gap.
Special tests such as ultrasound, x-rays, MRI scans are typically not necessary to make the diagnosis, but sometimes can be useful.
NON-SURGICAL TREATMENT OPTIONS
Non-surgical treatment starts with a period of rest in a cast with your toes pointed. During this time, you will be non-weightbearing and need to use crutches, a walker, or a wheelchair in order to keep weight off the leg. After two weeks in a cast, you will be transitioned into a boot with an Achilles wedge to keep your toes pointed down. After transition to the boot, you’ll begin some physical therapy exercises to allow increased movement and support tendon healing. Gradually, you will be allowed to put weight on on the leg and eventually start progressive strengthening exercises over the span of a few months. This process is often guided by a physical therapist who is in close communication with the orthopedic surgeon.
SURGICAL TREATMENT OPTIONS
If non-surgical treatments don’t alleviate Achilles tendon pain, then surgical treatments may be recommended. The MD West ONE Foot & Ankle Specialists pride themselves on approaching foot and ankle care conservatively and will only recommend surgery if absolutely necessary.
If surgery is absolutely necessary, your foot and ankle orthopedic surgeon will place stitches in the tendon, above and below the ear of the tear, that will bring the tendon ends back together. The actual tendon often appears much like a wet mop with multiple uneven strands that are impossible to sew back together. For this reason, sutures are often placed outside your zone of injury to bring the ends of the tendon together and reestablish the appropriate tension of the calf muscle. This can be done either through a more traditional method that requires a slightly longer incision, or through newer minimally invasive techniques that require shorter incisions and passing the stitches through small poke holes in the skin.
After surgery you will follow a similar rehabilitation process as with nonsurgical treatment, at a slightly faster rate since you have sutures in the tendon to strengthen the tendon during the initial rehabilitation process. In randomized control studies this has been shown to allow patients to get back to work approximately three weeks sooner than with non-surgical care.
Since tendons do not have a great blood supply, healing is a slow process. Patient can usually begin light jogging between three and six months after the injury with return to sports involving cutting and jumping between 9 to 12 months following the injury. Full return of strength and the feeling of returning to normal often take more than one year.
Achilles Tendon Surgical/Non-Surgical Outcomes
Both surgical as well as non-surgical management of Achilles tendon injuries have been shown resulting in good outcomes. Patients are often able to return to their pre-injury level of activity. Surgical and nonsurgical management with a functional rehabilitation program have been shown to result equal re-rupture rates. They have also been shown to result in equivalent strength, calf size, and functional outcomes. Surgical management, however, has been shown to allow patients to return to work approximately three weeks sooner than none surgical management.
Frequently Asked Questions?
Is there anything I can do to prevent tearing of the Achilles tendon?
Achilles tendon injuries are a rather rare occurrence so there has been no prospectus but study that has been ever able to answer this question well. However, common sense would dictate that a stretching program for the Achilles tendon decrease the chance of rupture, however this has not been able to be shown in studies. Smoking has been shown to have negative effects on tendon’s health and as such smoking cessation should also help decrease the risk of rupture.
After an Achilles tendon tear, how likely am I to tear the other side?
Approximately 6% of patients with an Achilles tendon tear will have the same injury on the other leg.
Is there anything I can do to make the tendon heal faster?
Studies have shown that starting range of motion exercises and putting weight on the injured leg have shown better results than long periods of immobilization on crutches. For this reason, whether you choose surgical or non-surgical management of your Achilles tendon tear, and functional rehabilitation program should accelerate your recovery, with the added benefit of decreasing the risk of re-rupture.
AMERICAN ORTHOPAEDIC FOOT & ANKLE SOCIETY
All of the foot and ankle surgeons in the practice are recognized members of the American Orthopaedic Foot & Ankle Society. It is the oldest and most prestigious medical society dedicated to the foot and ankle. The mission of the society is to advance science and practice of foot and ankle surgery through education, research, and advocacy on behalf of patients and practitioners. These physicians dedicate their time and energy to improving the patient experience and their knowledge in their field. For more information visit http://www.aofas.org.