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Sprained Ankle
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Scenario:
Most ankle sprains occur, not while crashing, but when stepping off the bike or walking
alongside the bike. In adults, the sprain occurs when the foot lands on a log or rock, and
the foot tips inward.In children, ankle sprains occur when riding a bike that's too
big. As the child tries to step off, the bike must tilt far to the side before the foot
can touch down. (The child's body also travels sideways as the bike tips.) This lateral
motion causes the ankle to pull under when the foot touches the road. |
Description:
A sprain is a stretching injury to ligaments (the bands of tough tissue that control which
direction joints can bend). A minor sprain may swell slightly, but does not significantly
interfere with using the injured part. Bruising in the area of the sprain indicates
tearing of ligament tissue. Sprains can be serious if the ligament is ruptured.Serious ankle sprain, caused by stepping on a rock while walking
the bike up a steep hill. Note the swelling on the outer side of the left ankle. |
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Here we see the typical swelling of an "inversion" sprain of the
ankle. Most of the swelling is just in front and slightly below the bony bump on the outer
side of the ankle. The back of the bone isn't tender. Typically,
any swelling will be in front of the bony prominence on the outer side of the ankle. |
| If some ligament fibers have been torn, a bluish discoloration may appear
in the swollen area. This is blood. Bruising indicates tearing
of deeper tissues. This means a more serious injury, and a longer rehabilitation time. |
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After a few days, the area may appear more intensely bruised. The bruising
can cross behind the achilles tendon to appear on the inner side of the ankle and heel. It
can even travel down to the toes. Bruising indicates a more severe ligament injury. Here we see bruising appearing on the INNER side of the ankle --
the blood came from the outer side of the ankle, crossing over behind the achilles tendon. |
Concerns:
A serious sprain can take a long time to heal. It can leave the ankle weak. If there are
signs of serious injury, you should have the doctor help you.One
week after this serious sprain, the entire foot remains bruised and swollen. Note the
"pit" in the swelling created by pressure. |
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See the doctor if:
there's deformity or severe swelling
the ankle can't be walked on after an hour of rest
you can't move the joint fully
there's continued severe pain
there's numbness or weakness below the injured area.
Immediate care:
The treatment of a sprain is "RICE:" Rest, Ice, Compress, and Elevate.
Immediately elevate the injured part and apply an ice bag. Once the area is thoroughly
cooled, apply an elastic wrap to compress the injury.Coban
wrap is a light, efficient wrap that you can carry in your biking backpack. It compresses
and stabilizes sprains, and can hold a dressing over cuts and scrapes while you ride your
bike back to civilization. |
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Ongoing care:
For the first 48 hours, repeat ice and elevation 1/4 of the time (for example, 30 minutes
of ice every two hours). As the pain subsides, return to activities. The rule is: "If
it hurts, don't do it." You can usually stop using the elastic wrap after 2 to 3
days. If the ankle seems weak, wobbly, or painful in routine use, go to the doctor.If you need support while an ankle sprain heals, there are a
variety of ankle braces, ranging from a simple pull-on elastic sock, to strong braces like
the one at left. The worse the sprain and the harder your activities, the more protection
you need. |
Ankle rehab:
After about a week, start strengthening the muscles on the front and side of the lower
leg. Continue the exercises for up to six months, until the ankle seems fully strong and
secure.
Strength and tightening: Pull your foot up (towards your face) against resistance. A
two-pound dumbell taped to the toe of a shoe works great as an ankle-exercise machine.
Lift about 20 times, twice a day.
Balance and control: Stand on the injured foot. Raise the heel up, standing on the ball of
your foot. Start the ankle shaking side-to-side. Go slowly up and down, while looking
straight ahead. Keep your balance while raising and lowering your body as the ankle
shakes, for a total of 1 minute twice a day.
Restoration of mobility:
If the ankle remains stiff and swollen, try contrast baths. Soak the ankle in warm water
for 10 to 15 minutes, then begin gentle range of motion. Stretch 30 seconds up, then 30
seconds down. Repeat this 10 times. Now soak the ankle in cold water for 10 minutes,
followed by elevation while your ankle rewarms. |
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Watch for:
If the injured area doesn't improve promptly, see the doctor.
[First Aid Index Page]
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