Interviewer: You've injured your ankle, but you don't know if it's just a sprain or maybe it's something else. How can you tell?
Dr. Chris Gee is a primary care sports medicine and an emergency medicine physician at Ï㽶ÊÓƵ of Utah Health, he's diagnosed and treated ankle injuries for professional athletes and people just like you and me, and we're going to find out more from him right now. So, Dr. Gee, broadly, what are the general categories of ankle injuries? I think most of us are familiar with sprains. Are there other ones as well?
Common Types of Ankle Injuries
Dr. Gee: Yeah. So the other thing that can happen occasionally is not only a sprain where you get the ligament injury, but fractures. There's basically a bony contour of the ankle that kind of holds it in place, and sometimes you pull it far enough or the ligament tears and it puts a lot of force on the bone and it'll crack that bone. You can also get tendon injuries. Tendons are actually connected to muscles that help to stabilize the ankle. Sometimes those tendons can tear. They'll usually tear kind of the long way. So it's more of an overuse kind of an injury. And then, you can also get some cartilage injuries. There's cartilage that lines the edges of the bone in the joint, and that can be damaged and fractured at times.
Diagnosing Ankle Injuries
Interviewer: So if somebody comes in with an ankle injury, how do you diagnose that issue to determine what the issue is? Is there a way that you can kind of go through and figure out if it's one of those four that we talked about?
History and Physical Examination
Dr. Gee: Yeah. So, first of all, we want to go through the history. You know, it's important to try to figure out what exactly happened. Was there any additional force? You know, if you were just walking and twisted the ankle, that's a little different than if you were, you know, on a motorcycle and you fell and, you know, that leg got twisted up. There's a lot more force involved. So the history is important, as well as the physical exam. That can be really difficult initially because the ankle is just so swollen and tender after an injury that it can be difficult to know if it's broken or if it actually is just sprained. So we try to push on certain areas around the ankle to try to determine if there's bony tenderness that maybe needs an X-ray that can help guide us with what the extent of the injury is.
Ottawa Ankle Rules
Interviewer: And is this approach like when you're pushing on different parts of the bone, what you do the same as what all doctors do? Is there, like, some sort of a systematic approach that most of you take?
Dr. Gee: Yeah, it's fairly systematic. Most of us have a way that we will approach it, but it's similar kind of things we're pushing in certain areas. There was a study done, gosh, I think it was probably back in the '90s now, but it was a while ago called the Ottawa Ankle Rules, where they basically looked at various areas in the ankle that are tender, that if they are tender, then they have a higher chance of having a fracture. And so those areas are common areas that we'll push on. And if you have tenderness in those areas, then we say, "Yeah, you probably need an X-ray." If you don't have any tenderness there and it's just sore over the ligament, you don't need an X-ray. That's probably just a sprain, and we can treat it as such until . . . you know, give it a few weeks and see how it does.
Interviewer: Other than the Ottawa Ankle Rules, are there other types of approaches that are evidence-based? I find that fascinating, right, that research has been done to show that if you do these things, you can kind of assess the severity or the type of ankle injury there is.
Conservative Treatments for Ankle Injuries
Dr. Gee: Yeah, the biggest one, we know that so many of these ankle sprains do well on their own, that most of the time, we will try to put people through a course of some conservative treatment, meaning ice and elevation and anti-inflammatories, followed by doing a few weeks of therapy before we do any advanced imaging like MRIs or CT scans to determine if there's more injury there because even if they had a small injury to a tendon or part of the bone, they'll oftentimes do fairly well.
Interviewer: All right. So a conservative approach to kind of figuring out how bad this thing is is okay.
Dr. Gee: Yeah, it's totally fine to give it a week or two and see how it does. If there's any kind of concern that there was more force to it or it seems more swollen or more painful than you've had before, I would definitely get in and be seen. One of the benefits of being seen is not only can we rule out any kind of a more significant injury, but we can also get you started on some treatment like physical therapy to get that ankle better quicker.
Interviewer: For a sprained ankle, it's really important to get that ankle elevated and ice it and take some anti-inflammatories because you're trying to get rid of that fluid, which can . . . it makes it painful and it also . . . Does it inhibit healing, that fluid?
Dr. Gee: Yeah, for sure. It's going to just keep things irritated and inflamed. And if you can get it out of there, it's going to feel better.
Interviewer: So, for sprained ankles, that's what you want to do. Is that kind of the same that you'd want to do for fractures, tendon injuries, or cartilage injuries as well?
Dr. Gee: Yeah, it's going to be the same kind of treatment because you want to get that fluid down to see what the rest of the injury is.
Interviewer: Oh, okay.
Dr. Gee: So once you get that calmed down, and I see patients back, you know, a month or so later, if they are continuing to have maybe catching or popping in the ankle, or they've got some instability when I pull on the ankle, or they're noticing, "Gosh, every time I try to walk on an even ground, this ankle gives way," maybe at that point we need to do more investigation with an MRI.
Interviewer: Got it. So if I'm understanding correctly, getting rid of that inflammation and that fluid is almost necessary for you to do your job accurately.
Dr. Gee: Right, right. Yeah, and it helps them get better so much faster.
When to Seek Professional Medical Care for Ankle Injuries
Interviewer: All right. So to kind of wrap this up, if somebody's listening and they're not exactly sure what they've done to their ankle, what would you tell them just as kind of a takeaway message from here, how should they proceed?
Dr. Gee: It's easy for us to say, "Oh, you just sprained it. It's no big deal." But there's a lot of soft tissue damage that can occur with that. You know, you can get a lot of bruising, a lot of swelling, and sometimes just getting . . . you know, sometimes we can underestimate how long it's going to take for that to get better. And that's where I really stress to people being good about icing and anti-inflammatories and trying to keep it elevated early on to get that fluid down so that it feels better quicker.
Whenever you've got an injury to the ankle, it's important to start with those basic kinds of things, keeping it elevated, icing it, wrapping it, using ibuprofen, and then gently starting to move it as you feel comfortable. If there's any kind of additional concern with it, meaning, you know, increased trauma or increased swelling or other weird symptoms, you should get in and be seen right away. The vast majority of these do well, and you can start to get back on it, but you don't want to have any long-term problems. And so if there's any concerning symptoms, then get in and be seen.
