History of Ankle Injuries - Member Case Study

author : AMSSM

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It is very common for athletes who have sustained previous ankle injuries would continue to struggle with ankle problems and disabilities.

Question from fraggle:

My ankles suck. I can remember as far back as cub scouts, hiking through the woods, I'd step on a root and $!@#* - turned ankle. (I didn't learn that punctuation until later in life). I cannot recall the number of times that I have twisted one or the other. Everytime I've injured either ankle, the foot turns in and the tenderness and swelling develop on the lateral side of the joint. Most times it's just a minor annoyance, I sit or fall down, then I get back to whatever I was doing with only a slight limp -- next day, aside from my shoe fitting a little tight, no problemo.

However, twice in my life I've had more serious episodes, once 12 years ago when I thought for sure I'd broken the left ankle after jumping off of a wall - serious swelling and ecchymosis. A visit to the orthopedist and plain films confirmed the lack of fracture. I was off of the leg for 2 weeks during that episode, but didn't mean so much to me because I wasn't training for anything except the east coast beer drinking championship. More recently, however, (December 2004) while walking down the driveway to go for a run, I stepped on a pinecone and turned the right ankle...badly - it hurt so bad I got vasovagal, saw stars, went to ground, puked, & crawled back to the house several minutes later.

I'm finally back on my feet after RICE and some hard time away from training. I bought an "aircast" brace which I'm using while running. Mostly that brace is my security blanket because I've never turned my ankle while training, it always seems to happen when I'm just going about the activity of life: yardwork, stomping around with the kids, etc...but I can't wear the brace 24/7, it's starting to rub blisters.

I'm 5'11", 192 pounds (down from 254, thank you very much). I'm only logging 12-15 miles/week on the feet, 90-180 minutes on the bike, and 2 miles in the pool, but I hope to increase that volume significantly over the next 12 weeks. Currently I do no weight training (but will sell my soul to avoid another serious ankle sprain). I stretch a bit after each run (4 sessions for about 10 minutes each/week) typical beginner stuff: achilles, hams, quads. Right now I am pain free. I told my woes to the folks at my local running store several months ago when I first started to run, and they fitted me with shoes designed for motion control, claiming that I pronate too much. Clearly, the shoes didn't help with the pinecone.

Hoping that's enough background, here's my request: what can I do with regards to body mechanics, weight training, proprioceptive training, or anything to try and maximize my chances that I'll NOT suffer another ankle injury as severe as the one I've just recovered from?

Answer:

Your problem with your ankles is not an uncommon problem seen in a sports medicine practice. It is very common for athletes who have sustained previous ankle injuries would continue to struggle with ankle problems and disabilities. Before going any further with any training, it may be advisable to seek medical attention, because this is the second episode of trauma that you experienced. It sounds as if you did not obtain new x-rays after the second injury. It would be advisable to seek evaluation that would assess ankle joint stability and obtain new x-rays to insure that there has been no change from your previous exam. A physician visit may also allow for a prescription for more formal physical therapy. Possibly a brace could be prescribed that would not blister your ankle and foot but allow increased stability while you continue to train.

However, if you have had a second evaluation, here are some more specifics regarding your questions.

1. Regarding body mechanics, I do believe that a shoe with “motion control” could be helpful in an individual who pronates, such as you. However, custom orthotics might also be a consideration if your pronation is excessive.

2. A good strengthening program for the ankle and the intrinsic muscles of the foot would also be recommended. A good home therapy program usually includes strengthening of the muscles of the ankle and foot in all planes of direction using a rubber band system that provides resistance.

3. Proprioception and balance are key components of a good rehab program. Studies indicate that if these functions are not restored, that the ankle is at increased risk of undergoing subsequent injury. Balance boards, sports cords, and pillows can all be used to improve balance, proprioception, and coordination.

4. A functional brace may also be very helpful in preventing further injury.

On closing, I would also mention that there are times when surgical intervention is necessary to stabilize an ankle that has become one on which you cannot depend.


Tracy Ray, MD
Member AMSSM

www.amssm.org

 

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date: April 9, 2005