Medical Library: Foot & Ankle – Foot and Ankle Trauma

There are a variety of traumatic conditions that can occur in the foot or ankle, including fractures of the ankle, heel, toes, or the bones in the foot, as well as ankle sprains. Treatment of fractures varies per area and severity, but most often includes immobilization via cast or support of some type. Surgery may be needed in certain circumstances. More common than fractures and in some ways worse are ankle sprains.

Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments to stretch beyond their normal length. If the force is too strong, the ligaments may tear.

An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged or how many ligaments are injured. An ankle sprain is given a grade from 1 to 3 depending on the amount of ligament damaged. A grade 1 sprain is mild, grade 2 is moderate, and grade 3 is severe.

ANKLE SPRAINS ALSO ARE CLASSIFIED AS ACUTE, CHRONIC, OR RECURRENT:

  • An acute sprain occurred recently—usually within the past few weeks—and is in an active stage of healing.
  • A chronic sprain continues to cause symptoms beyond the expected time for normal healing.
  • A recurrent sprain occurs easily and frequently, usually with only minimal force.

WITH ACUTE ANKLE SPRAIN, YOU MAY HAVE:

  • Pain
  • Swelling
  • Inability to bear weight on the ankle

With most sprains, you feel pain right away at the site of the ligament tear. Often the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch and, when you move the ankle, it hurts.

In more severe sprains, you may hear or feel something tear, along with a “pop” or “snap.” You probably have extreme pain at first and are not able to walk or even put weight on your foot. Usually, the more pain and swelling you have, the more severe your ankle sprain is, and the longer it will take to heal.

Your physical therapist can perform a full evaluation. Manual tests are used to determine how unstable your ankle is. The therapist also will decide whether further tests are required or whether consultation with another health care provider is necessary. In some cases, x-rays might be needed to determine whether there is a broken bone. Occasionally, with severe sprains, magnetic resonance imaging (MRI) might be ordered to determine the extent of the damage.

The First 24 to 48 Hours

For the first 24 to 48 hours after injury, ankle sprains usually are treated by resting the ankle on a pillow or stool, using elastic bandages or supports, and 10-minute ice treatments. A physical therapist can decide if you should use crutches or a cane to protect your ankle while it is healing.

The therapist can design a specific treatment program for you to follow at home to help speed your recovery. Some sprains may require physical therapy treatments to help relieve swelling and pain, such skilled hand movements called manual therapy, special exercises, ice or heat treatments, and electrical stimulation. More severe sprains may require a special brace to provide extra support to your ankle.

As You Start to Recover

Your physical therapist’s overall goal is to return you to the roles you perform in the home, at work, and in the community. Without proper rehabilitation, serious problems—such as decreased movement, chronic pain, swelling, and joint instability—could arise, severely limiting your ability to do your usual activities.

YOUR PHYSICAL THERAPIST WILL SELECT FROM TREATMENTS INCLUDING:

  • Range-of-motion exercises. Swelling and pain can result in limited mobility of the ankle. A physical therapist teaches you how to do safe and effective exercises to restore full movement to your ankle.
  • Muscle-strengthening exercises. Ankle muscle weakness may cause long-term instability of the ankle and new ankle injuries. Your physical therapist can determine which strengthening exercises are right for you based on the severity of your injury and where you are in your recovery.
  • Body awareness and balance training. Specialized training exercises help your muscles “learn” to respond to changes in your environment, such as uneven or unstable surfaces. When you are able to put full weight on your foot without pain, your physical therapist may prescribe these exercises to help you return to your normal activities. For instance, your physical therapist might teach you how to do this: with or without your eyes closed, stand on one leg or stand on a wobble board to challenge the muscles around your ankle.
  • Functional training. When you can walk freely without pain, your physical therapist may begin “progressing” your treatment program to include activities that you were doing before your injury, such as walking in your neighborhood, jogging, hopping, or modified running. This program will be based on the physical therapist’s examination of your ankle, on your goals, and on your activity level and general health.
  • Activity-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation that is tailored for your job or sport and the demands that it places on your ankle. Your physical therapist can develop a program that takes all of these demands—as well as your specific injury—into account.