Diagnosing Ankle Injuries

This is a transcript of a Dr. Jay Show broadcast on 1560TheGame in Houston, TX. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician serving patients from Katy, Fort Bend County, Metro Houston and Southeast Texas from offices in Houston and Sugar Land, TX. Call 281-633-8600 for an appointment.

Our special guest is Dr. Mark Vann, a Board Certified Orthopedic Surgeon specializing in foot and ankle injuries.

Here’s the transcript of the second portion of the Show:

So Dr. Vann, what kind of ankle injuries are there?  We talked about strains, sprains, and you can have cartilage injuries and tendon injuries.  What are the more common injuries you’re going to see out there when you’re talking about your typical patient?  And also tell us what are the typical types of patients you see these injuries in.

DR. VANN:  I guess we can start with the basic and straightforward and get into the more complex injury. 

1. The straightforward ankle sprain is going to involve the swelling, pain either on the inner or outside of the ankle, and the ability to bear weight is going to be different based on the severity.  With a straightforward ankle sprain the treatment is pretty much what we mentioned before, the RICE protocol.  The way to differentiate a severe problem, something that may be a little more difficult to treat, is if that ankle sprain doesn’t get better in about two weeks, if they’re still having a lot of pain at two weeks and maybe they’ve even had an X-ray and it showed no evidence of fracture, that’s when I get a little more concerned.  I’ll have them come for a physical exam and I’ll check and make sure they don’t have a more severe ankle injury such as a high ankle sprain.
2. A high ankle sprain, as you may recall, is one of those injuries that was made infamous by Terrell Owens in the Super Bowl a few years back.  His injury actually did require surgery; it was one of those rare occasions when an ankle sprain can require surgery.  
3. Aside from that there are different issues that may occur.  You can actually damage some of the cartilage that is inside the ankle during that sprain.  Typically you wouldn’t know that until a little farther down the road when you start to try and rehabilitate and you continue to have pain.  

DR. BENNETT:  In regards to ankle sprains, you have to understand that there are different types.  You can have a very mild ankle sprain which requires a little bit of rest and

The mucous sheaths of the tendons around the ankle. Medial aspect. (Photo credit: Wikipedia)

rehabilitation or the more severe ankle sprains.  And it all depends on the ligaments, and the ligaments are kind of like the ropes that hold the bones together.  That’s the way I describe it.  And if you have a torn ligament, it usually depends on where that ligament is torn and that’s going to determine your method of treatment.  You have three sets of ligaments that stabilize the ankle joint and Dr. Vann had mentioned a high ankle sprain which involves the higher ligament which we call the syndesmosis, which is a ligament between the two bones of the leg, the tibia and the fibula bone.  And if those split apart, that’s a problem.  And then you have ligaments on the inside of the ankle, and ligaments on the outside of the ankle.  You can have those sprained as well and swell up on you, too.  

There are symptoms and signs to look for in regards to ankle injuries, and there’s some red flags that pop up and you need to take into consideration if you have an ankle problem:

1. Any kind of locking.  That’s one symptom and it means your ankle kind of catches on you. 
2. Mechanical symptoms.  When you feel a popping or clicking in the ankle joint. 
3. If you have no resolution.  Like Dr. Vann mentioned, if your symptoms do not improve, if you’re hobbling around for a week or two and your ankle looks like a cantaloupe, you’ve probably got something going on there. It’s not one of these things where you can say, “Ah, I’m going to run through it, it’s going to get better.  If I think about it hard enough, it’s going to get better.”  Go see a doctor.  Get it evaluated and get an X-ray, because obviously something is wrong and it’s not getting better.  
4. Any numbness or tingling in your feet.  I see this in a lot of patients, particularly in runners.  We get a lot of runners that come through the clinic and they say that while they’re running they’re feeling great until they get to the third or fourth mile when they start feeling some tingling in their toes.  That can actually mean a build up in the pressure in the legs.  Dr. Vann, can you tell us exactly what numbness and tingling in the feet can mean in regards to running and athletics?

DR. VANN:  There are a couple of commonly seen ailments that involve some of that numbness and tingling. On the top of the foot we can see runners who actually lace their shoes up too tight.  Lacing up the shoes too tight can cause an increase of pressure on the top of the foot.  Unfortunately the foot doesn’t have a lot of fat on it.  Unlike that fat that the rest of the body sometimes has in certain places, you don’t have a lot of padding over the nerves.  And

there’s one nerve in particular that can be compressed by your shoelaces if you tie them too tight.  One of the more common ones is what we call the “Jogger’s Foot.”  Jogger’s Foot is a swelling of the muscles in and around the foot, in particular around a couple of tendons, that can then compress the nerve on the underside of the foot.  Now this is going to be on the side that’s in contact with the shoe and the ground.  When those swell up that can cause additional numbness especially in the toes.  This is a common problem.  I’ve seen it a lot on people who are using an elliptical trainer or even a StairMaster.  They often complain that their feet, and especially the soles of their feet, go numb after they’ve been on it a little while.  The muscle starts to swell a little bit as the blood flow increases and unfortunately your foot just doesn’t have a lot of room to expand.  It wasn’t designed to do that.  

DR. BENNETT:  Can you get around that with certain stretches or maybe anti-inflammatories?  There’s certain times when surgery is indicated but for the most part can you treat it non-operatively?

DR. VANN:  Absolutely.  This is more of an exertion problem.  There is, I guess you could say, a “relative” of this that is seen more in trauma situations, but in people who are active and running they typically can help this by doing things like shoe wear modification, changing the type of shoe that they’re wearing so it doesn’t constrict the foot so much; and anti-inflammatories can help; but overall, it’s a difficult problem.  

1. Bruising.  If your foot is looking purple or you’ve got a lot of swelling.
2. If you feel a pop.  If you’re running and boom, you feel a pop in the back of your leg or it feels like someone just nailed you in the back of the leg with a tennis ball or something like that, that usually means that you might have a tendon injury.  
3. If you can’t rise off that foot.  If you notice a lot of weakness, you may have an injury to a couple of tendons at the back of your foot.  One of them is the Achilles tendon and the other is the plantaris.  

Author

Dr. J. Michael Bennett