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Ankle Sprains, Strains, and Fractures: All these injuries involve pain, but knowing when to self-treat and when to see a physician can reduce future complications.

Tripping on a rug or stumbling during a fatiguing tennis match can both result in a twisted, injured ankle. But what actually happens when you twist that ankle? You've probably heard of sprains and strains, but given how similar these words are, it's easy to confuse them. These terms define what was injured. A sprain is a stretch or tear in a ligament, which is a tough band of fibrous tissue that attaches bone to bone. The ankle is the most common site for a sprain. A strain, on the other hand, results from an over-stretched or torn tendon or muscle. Tendons attach muscle to bone. In any of these cases, if the injury is mild, you can treat them at home using the RICE protocol: rest, ice, compression, elevation. NSAIDs, like Ibuprofen, can reduce swelling, whereas acetaminophen (Tylenol) can reduce pain (but doesn't quell swelling.)

The same actions that cause a sprain or strain, however, can also cause a more serious fracture. "Given that bone density decreases with age, older adults may mistake a sprain for what may be a fracture, which can take longer to heal," explains Joan Williams, MD, an orthopaedic surgeon at UCLA Medical Center specializing in foot and ankle injuries.

Stress and Avulsion Fractures

Stress fractures occur from overuse. Ankle bones as well as the bones of the feet are common sites for stress fracture. Runners and dancers spend a lot of time doing the same movements and are prone to such injuries. Unlike a full break in a bone, a stress fracture isn't always immediately obvious. In fact, it can take several weeks for a stress fracture to show up on an x-ray. That is because they often begin as microscopic cracks. These hairline cracks can get worse as fatigue sets in because when muscles get tired more load is placed on bones. Thus, pain at the end of an activity is indicative of a stress fracture. Without treatment, it can progress to pain at the start of the activity and tenderness on the bone. Treatment usually involves wearing a cast, boot, or brace, depending on the severity of the stress fracture.

An avulsion fracture is when a small chunk of bone is pulled away by trauma to the tendon or ligament. To allow the bone to fuse back together naturally, a boot or cast is the standard treatment. In most cases the body repairs itself with this kind of stabilization. But, according to Dr. Williams, in some bone fracture cases physicians may recommend bisphosphonates to help heal the bone. These medications are typically used to treat osteoporosis, as they help increase bone strength.

Avoiding Ankle Arthritis

The ankles sustain more weight-bearing force per unit area than any other joint. Treating ankle injuries immediately and allowing them ample time to fully heal can help reduce the risk of developing ankle arthritis. This type of arthritis typically results from prior injuries, including sprains, strains, and fractures. Ankle arthritis may be less common than hip and knee arthritis, but Dr. Williams says it can be more painful and lead to decreased function.

Preventing Ankle Injuries

Proper and supportive footwear can protect you from both foot and ankle mishaps. If you play tennis for example, investing in tennis shoes is wise because they are made to support the side-to-side motions common to the sport. Likewise, good dance shoes have cushion in the ball of the foot area and the sole allows the foot to pivot easily, which helps avoid twisting injuries to the ankle and knee. Running shoes with heavy treads provide useful surface grip, but they are a tripping hazard when worn indoors, especially on carpeted areas.

"It's important to keep both sides of the ankle strong by doing exercises that work on stability and balance," says Dr. Williams. In addition, awareness of where you are in space can help you avoid injuries that seem to arise from sheer clumsiness. Some forms of exercise, such as Pilates, qi gong, tai chi, and yoga, emphasize full body awareness. Practicing these methods can build strength, flexibility and proprioception, the ability to sense the position and motion of the body without having to look at it. Physical therapy can also be very helpful in achieving these goals.

Most injuries do get better in time with proper care and patience. It can take six months or more to recover from a severe sprain or strain and longer for a fracture. If you can walk with just a little bit of discomfort, self-care may be enough. If you have difficulty walking and can't bear much or any weight, or swelling doesn't subside in a few days, it's time to see your doctor. Sports medicine doctors and orthopaedic physicians can diagnose and treat ankle injuries.
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Title Annotation:BONES & JOINTS
Publication:Healthy Years
Date:Feb 23, 2018
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