Today's News

Saturday, March 3, 2001

Sprained ankle may not be a minor injury

By Laura Lane

A sprained ankle isn't just a sprained ankle, San Francisco orthopaedist Glenn Pfeffer, MD, said Thursday. He introduced a panel of orthopaedists who presented research showing that the run-of-the-mill injury requires much more treatment and attention than it usually receives.

Without the proper prescription of edema control, protective splints, and rehabilitation exercises, 15 percent to 40 percent of the 10 million ankle sprains that occur every year in the country become chronic disabilities. This leaves millions of Americans living with ankle pain and swelling, and the sensation that the ankle is giving way. Worst of all, they're at especially high risk of spraining the ankle again.

The solution, said Dr. Pfeffer, who is also assistant clinical professor in the University of California, San Francisco's orthopaedic surgery department, is to properly treat the first sprain.

"The most common reason for an ankle sprain is having had one already," he said. "The best prevention of a second sprain is appropriate treatment of the first."

Proper treatment also includes treating other injuries that sometimes occur in association with ankle sprains, the most common of injuries, said Michael J. Shereff, MD, president of the American Orthopaedic Foot and Ankle Society. In his study, he found that the associated injuries included tears and inflammation of the peronal tendons, synovitis of the ankle joint, as well as impingement liasons, loose bodies and fractures.

Physicians, Dr. Shereff said, should be aware that patients who complain of ankle pain could have any one of the associated injuries. "Potentially treatable problems are being missed," he said.

Appropriate rehabilitation can also prevent lingering disability, said Michael W. Bowman, MD, an orthopaedist from Wexford, Pa. Patients may not even have to go to a physical therapist, showed his study, which found that the benefit of a home kit and physical therapy is about the same.

Kits that he used in the study con-tained an ankle brace, ice packs, an elastic ankle wrap, elastic bands to help strengthen the ankle, information about ankle sprains, and directions on performing strengthening exercises. At about $100, kits could be far more cost effective than physical therapy, which costs an average of $650 for similar results.

Ankle braces, however, can prevent sprains from happening in the first place, said Carol Frey, MD, an orthopaedist from Manhattan Beach, Calif. She studied more than 400 high school volleyball players, some of whom wore braces and others that didn't. Those that wore a brace were far less likely to incur a sprain than those who didn't wear one. In addition, the brace protected volleyball players who already had sprained an ankle in the past from incurring another.

Dr. Frey pointed out that wearing brace is much better protection than taping, the effectiveness of which wears out in the first 10 minutes of activity. Taping also becomes expensive because tape isn't reusable and trainers must be hired to apply it.

Some high school students, however, use tape to be "cool," Dr. Pfeffer said. Or, they might be lulled into a false sense of security when they buy hi-top shoes but don't take advantage of the ankle support by not lacing them up completely.

"They've got a seatbelt that's not working right," he said.

Dr. Pfeffer said he hopes to get high school students on the right track with a six-minute video that he helped to produce with the American Orthopaedic Foot and Ankle Society and the National Federation of High School Associations. Entitled "Stay in the Game" the video advises students of how to treat an ankle sprain and encourages them to use a protective brace.

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Last modified 03/March/2001 by IS