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Patients come in to the office<\/a> (and sometimes call or email) about their ankle injuries.\u00a0 Often it’s basketball, but it can be running at night, stepping off a curb, or “horsing around”.\u00a0 In any event, the ankle has suffered a twisting or tilting motion that pushes it past its desired range of motion.\u00a0 And it hurts, it may swell, and you may be limited in what you can do.<\/p>\n <\/p>\n Most people are familiar with the First Aid mnemonic “RICE”\u00a0 (rest, ice, compression, elevation) which summarizes what you can do at home for the injury.\u00a0 Perhaps adding an N for non-steroidal anti-inflammatory (ibuprofen, naproxyn… i.e. advil, aleve) would flesh out the options a bit.<\/p>\n <\/p>\n But how do you know if you’re hurt worse than a mild sprain?\u00a0 You may wonder if you’ve broken or torn something.\u00a0 You may suspect you need an x-ray or a brace or physical therapy to make a diagnosis and a speedy recovery.<\/p>\n <\/p>\n The Ottawa Rules were developed in Canada (no surprise there) to address the issue of x-ray for acute ankle trauma.\u00a0 If the patient cannot immediately bear weight, that’s a red flag.\u00a0 For example, after the injury you walk it off and continue to play the rest of the game– that’s okay.\u00a0 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.<\/p>\n Another red flag is if you can’t bear weight in a few hours, or the following day.\u00a0 Again, a mild limp is not unexpected, but a real difficulty in bearing weight is a significant red flag.\u00a0 Another red flag is tenderness over the bone near the ankle rather than in the soft tissue.\u00a0 Bone tenderness makes x-ray more important; lack of bony tenderness, less so.<\/p>\n So prioritize seeing a doctor (office or urgent care) for an evaluation and possible x-ray in these cases.<\/p>\n Ultimately a well-trained Sports Medicine doctor or Emergency Room\/Urgent Care physician should be able to make the decision<\/p>\n Sprain or Broken ankle<\/p>\n about imaging.\u00a0\u00a0 The Sports Medicine<\/a> doctor will know a lot about prognosis, rehabilitation, return to activities, etc.<\/p>\n How about cane\/crutches?\u00a0 If it hurts a lot, get off of it.\u00a0 Crutches are readily available at pharmacies (and some doctor’s offices) and so are canes.\u00a0 Sometimes friends can lend you a pair when needed.\u00a0 If you use a cane, put it in the opposite hand to the injured foot.\u00a0\u00a0 This is more effective for supporting weight as you walk.<\/p>\n The faster you improve the less likely it is to be something serious.<\/p>\n <\/p>\n Let’s summarize:\u00a0 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.\u00a0 Stay off the foot, elevate, ice and use crutches.\u00a0 If you can easily walk on it right after the injury and the following day, it’s unlikely to be broken.\u00a0 If it hurts a lot and the bone is tender, stay off it, and see a doctor.<\/p>\n <\/p>\n Home care:\u00a0 ice, rest, crutches or cane if needed, some anti inflammatory medication, perhaps an ace wrap or ankle support<\/p>\n <\/p>\n 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.<\/p>\n <\/p>\n I hope this is helpful.<\/p>\n <\/p>\n Truly,
\nDavid Schechter, MD<\/a>
\nSports Medicine<\/a> (Culver City<\/a>, Beverly Hills<\/a>) and Family Medicine<\/a><\/p>\n