Patients come in to the office (and sometimes call or email) about their ankle injuries. Often it’s basketball, but it can be running at night, stepping off a curb, or “horsing around”. In any event, the ankle has suffered a twisting or tilting motion that pushes it past its desired range of motion. And it hurts, it may swell, and you may be limited in what you can do.
Most people are familiar with the First Aid mnemonic “RICE” (rest, ice, compression, elevation) which summarizes what you can do at home for the injury. Perhaps adding an N for non-steroidal anti-inflammatory (ibuprofen, naproxyn… i.e. advil, aleve) would flesh out the options a bit.
But how do you know if you’re hurt worse than a mild sprain? You may wonder if you’ve broken or torn something. You may suspect you need an x-ray or a brace or physical therapy to make a diagnosis and a speedy recovery.
The Ottawa Rules were developed in Canada (no surprise there) to address the issue of x-ray for acute ankle trauma. If the patient cannot immediately bear weight, that’s a red flag. For example, after the injury you walk it off and continue to play the rest of the game– that’s okay. But if you need to be carried off and can’t put weight on your ankle over the next 10-15 minutes that is a red flag for a more serious injury.
Another red flag is if you can’t bear weight in a few hours, or the following day. Again, a mild limp is not unexpected, but a real difficulty in bearing weight is a significant red flag. Another red flag is tenderness over the bone near the ankle rather than in the soft tissue. Bone tenderness makes x-ray more important; lack of bony tenderness, less so.
So prioritize seeing a doctor (office or urgent care) for an evaluation and possible x-ray in these cases.
Ultimately a well-trained Sports Medicine doctor or Emergency Room/Urgent Care physician should be able to make the decision
Sprain or Broken ankle
about imaging. The Sports Medicine doctor will know a lot about prognosis, rehabilitation, return to activities, etc.
How about cane/crutches? If it hurts a lot, get off of it. Crutches are readily available at pharmacies (and some doctor’s offices) and so are canes. Sometimes friends can lend you a pair when needed. If you use a cane, put it in the opposite hand to the injured foot. This is more effective for supporting weight as you walk.
The faster you improve the less likely it is to be something serious.
Let’s summarize: if you can’t bear weight on an injured foot at all, then DON’T and get to a medical facility as soon as feasible. Stay off the foot, elevate, ice and use crutches. If you can easily walk on it right after the injury and the following day, it’s unlikely to be broken. If it hurts a lot and the bone is tender, stay off it, and see a doctor.
Home care: ice, rest, crutches or cane if needed, some anti inflammatory medication, perhaps an ace wrap or ankle support
X-rays–doctor’s decision, but Ottawa rules described above can help the doctor (and you) to understand how likely a fracture is to have occurred.
I hope this is helpful.
Author, Think Away Your Pain
(blog discussions are for general information purposes. medical decisions should be made in consultation with your doctor and typically involve a hands-on examination of the injured area)