Ankle Sprain or Pain

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Please note, for most ankle problems you do NOT need an x-ray.  Your doctor can tell what is most likely going on from talking to you about your symptoms and examining your foot. 

Inversion Injuriesankle - inversion

A lot of people injure their ankles by going in on them as show in the diagram on the right.  Doctors call this an inversion injury.  You’ll know when you’ve done it because it is very painful.   But the good news is that most ankles recover very well – i.e. back to normal health.   In a few cases, going in on your ankle can result in a fracture of one of your bones or you tearing one of your ligaments.   The way to tell whether you may have done this level of serious damage is if you have any of the following…

  • The pain is so bad that you can’t even bear to put any weight on it whatsoever.
  • There is obvious brusing over the outside of your ankle.

If you have either of these two things…. please see your doctor.

However, if you can walk a little (even though it is painful), it is likely that you’ve just sprained your ankle.  The good news here is that most ankles will recover if you follow the following rules….  (by the way, it will take 2 weeks even with the following)

  • REST the ankle joint  for about 2-3 days.  Then you can gradually start using it again – but don’t go back to sports straight away!
  • ICE – wrap some ice or a bag of peas in a damp towel and apply it to the swollen and painful area of the ankle to get the swelling down.   You should apply it for about 15-20 minutes four times a day.
  • COMPRESSION – you can buy an ankle bandage from the pharmacist or use an elastic bandage.  Wrapt it around your ankle so that there is a SNUG (but not tight) fit.   Take it off at night time before you go to sleep.
  • ELEVATION – during the day, try and keep your ankle and leg elevated – on a set of cushions or a footstool; but make sure it is above the level where your hip is.  This will help get the swelling down even further.
  • PAIN KILLERS – if you need some pain killers, just stick to paracetamol (which you can buy from your local pharmacy).   You ankle will be red and inflamed inside but this inflammation is necessary for healing.  Try not to use drugs like ibuprofen in the first 2 days because medication like these (the medical community refer to these as NSAIDs) – can delay the healing by settling the inflammation too quickly.
  • ANKLE EXERCISES – after 3-7 days, do the ankle exercises below to strengthen your ankle back up again.

Overpronation

There are people, however, who will end up with ankle pain because of the way their foot sits on the ground rather than because of any injury.   You may have heard of people who say they have dropped arches.   If you look at the yours or  your partner’s, friend’s, family member’s foot, you will see that they have an arch on the inside.    Some people don’t have this arch (hence the term ‘dropped’) and as a result the foot doesn’t sit straight as it should when on the ground.   Look at the diagrams below to see the difference.

ankle overpornation

ankle - overpronation again

This sagging inwards of the foot is called overpronation.  Many people have it.  However, for some, overpronation can cause ankle pain and sometimes pain elsewhere – like shin splints or knee pain when running.    Correcting this is fairly easy – get some ‘arch support insoles’.   Type ‘arch support insoles’ into Google Shopping and you’ll see that they don’t cost that much.   Put them in your shoes, trainers, walking boots etc and notice the difference after a few days.   The diagram below shoes how the insole (the black thing in the picture below) straightens the ankle position.ankle - with insole

Plantar Fasciitis

This is another common cause of pain in the foot.  The plantar fascia is a thin covering which runs from your heal to your toes at the base of your foot.  It can get inflamed very easily and we call this Plantar Fasciitis.   10% of the general population will get it.   30% of people with Plantar fasciitis will have it in both feet!  People get it for a number of reasons.   For example 40-60 year olds who are overwieght often get it (presumably because there is too much weight being exerted on this covering).   In a similar way, people who are on their feet all the time or who wear bad footwear can also get it.   And then there are those who have dropped inner foot arches – a term called overpronation – as discussed above.

You can tell if you have Plantar Fasciitis if you have….

  • Intense pain during the first steps after waking or a period of inactivity
  • Soreness or tenderness of the heel (sometimes extends to the inner arch of the foot)
  • Pain which lessens with moderate foot activity but worsening later during the day
  • Pain which worsens after long periods of standing or walking, especially when walking barefoot on hard surfaces

As a result, you may have a limp and you may prefer to walk on your toes!

The good news is that most cases of Plantar Fasciitis will settle by themselves within a year.    Here are a few things you can do to speed things up.

  • Pain relief – go to you pharmacist and ask for some adive.  Simple things like paracetamol and ibuprofen gel help.
  • Activity modification – avoid walking barefoot or in ill-fitting shoes. Avoid standing or walking for long periods
  • Protection – wear boots to protect the ankle from any further damage.   Put some cushioned insoles in.
  • Insoles – you may need to buy some ‘arch support insoles’ if you have dropped arches/overpronation of the foot (see above).
  • Exercises/Physiotherapy – do the ankle exercises below.
  • Prevention – Lose weight if you are overweight – your poor little feet are carrying all the weight and they can’t cope!  Look after your feet, you only ever get one pair for life.

Ankle Exercises

Here is a leaflet to help you with ankle exercises.

  • Ankle exercises
    • When waking up – before getting out of bed, loop a towel around the base of your foot.
    • Keeping your knees straight – pull your feet towards you (in medical terms, we call this dorsiflexion).
    • Repeat three times for each foot.
  • Stair stretches for Achilles tendon and plantar fascia
    • Stand on the bottom step of the stairs, facing upstairs using the stair rail for support.
    • The feet should be positioned so that both heels are off the end of this step with the legs slightly apart.
    • Now lower your heels keeping the knees straight until a tightly is felt in the calf.
    • Hold this position for 20 to 60 seconds and then raise your heels back to neutral.
    • Repeat six times twice a day.
  • Chair stretches for the Achilles tendon and plantar fascia
    • Sit in a chair with the knees bent at right angles and your feet and heels flat on the floor.
    • Lift the foot upwards with the heel kept on the floor (the calf muscles and the Achilles tendon should be felt to tighten).
    • Hold this position for 5 to 10 seconds, then relax.
    • Do ten in a session. Repeat five or six times throughout the day
  • Dynamic stretches for the plantar fascia
    • Roll the foot on a cool drink can or a tennis ball.
    • Repeat this at least twice a day.
         

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