When does your sprained ankle need rest and ice, and when do you need to see a doctor?
Learn more from Dr. Winston Gwathmey, a UVA expert in sports medicine whose specialties include foot and ankle injuries.
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Ankle Sprains: When Should They Be Checked by a Doctor?
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Winston Gwathmey, MD
Dr. Winston Gwathmey is fellowship trained in sports medicine; his specialties include caring for athletic injuries and conditions of the shoulder, hip, knee, and foot/ankle.Learn more about Dr. Winston Gwathmey
Learn more about UVA Orthopedics
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Ankle Sprains: When Should They Be Checked by a Doctor?
Melanie Cole (Host): A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes and non-athletes, children and adults. My guest today is Dr. Winston Gwathmey. He is fellowship trained in sports medicine and his specialties include caring for athletic injuries and conditions of the shoulder, hip, knee, foot and ankle at UVA Health System. Welcome to the show, Dr. Gwathmey. An ankle sprain – people hear the word “strain” and “sprain” and they don’t know what any of those mean. Please explain it for us.
Dr. Winston Gwathmey (Guest): There is actually a common misconception about strain versus sprain. Technically, a strain includes a muscle. So, if you strain your hamstring or strain your calf muscle or something like that it simply involves a muscle. You ice it, rest it or those kinds of things to get that better. A sprain – with a “P” as opposed to a “T” – usually involves a ligament, which is the structure that connects two bones together. You can sprain the ligaments in your ankle. You can sprain your knee and that involves a joint typically speaking, the ankle being, by far, the most commonly sprained joint.
Melanie: Why is it so common? Is it that unstable? What are we doing to our ankles?
Dr. Gwathmey: We’re walking on them. We spend a whole lot of time – a lot of steps. If you imagine how many exposures your ankle has in a given day to injury. People these days count every step they take. People are doing 5,000 to 10,000 steps per day. That’s a lot of potential chances to take a bad step and sprain your ankle. It doesn’t take much with the force of gravity and just an awkward step to injury the ankle.
Melanie: If we’re looking at the mechanism of injury as you’re saying, there are so many opportunities every single day. When you see it, is it usually something that is relatively minor or is it something that tears? Tell us a little bit about that mechanism.
Dr. Gwathmey: When I see it, it’s usually a little bit more severe. Everyone has tweaked their ankle or taken a misstep. The way the ankle is built, it’s a joint that connects your shin bone and your foot. There are really three bones involved here. The tibia or the shin bone, the fibula or the small bone on the outside part of the leg, and then the ankle bone we call the “talus”. They are connected by ligaments. When you roll your ankle, generally speaking, most people roll their ankle inwards. So, they take a misstep off of a curb or something like that and they roll their ankle inward and they feel discomfort on the outside portion of the ankle. That’s really where the ligaments have been stretched or strained or torn. That’s generally what we speak about when we talk about an ankle sprain. When I see them, they are typically more high-grade. They are involving athletic type injuries or higher energy mechanisms. Those are people who get big and swollen and they can’t put weight on it and those kinds of things. I guess what we have to determine is whether or not you’ve got a simple low-grade ankle sprain that you can heal in a couple of days or something that needs more treatment or x-rays or MRI. That’s where I come in and try to help you figure out exactly what you should do.
Melanie: First line of defense, if someone does step off the curb or women in high heels--my goodness that’s a big source of problems right there – and the heel slips out. We feel that in our ankle. Is RICE still what we’re using or is there an “M” in front of it now? Are we using a little movement as well?
Dr. Gwathmey: Of course. RICE is always sort of the first line – rest, ice, compression, elevation. Let’s take a step back. People roll their ankle and what ends up happening is the ligaments on the outside portion of the ankle get stretched or even torn. It’s really critical for the inflammation associated with that to be controlled and get the swelling down. That’s where the rest and the ice, the compression and the elevation comes in because you want to get the ankle comfortable. As long as the body’s responds to an injury is to create inflammation in that region, that’s really what hurts. At the same time, we also want to make sure that we stabilize the ankle and allow it to heal in a functional position. That’s where the “M” comes in. We’re trying to get the ankle mobilized and moving so that as the ankle heals, it heals in a functional situation so that it can continue moving and you can get back to your activities as quickly as possible. At the same time, it does take some time to heal so it’s not like just by moving the ankle you’re suddenly going to be better. There is some healing that needs to take place and we’ve got to make sure that we control that. We monitor it to make sure that we are doing the right things to immobilize it and provide a safe treatment option.
Melanie: Are some people more susceptible, Dr. Gwathmey, to unstable ankles? You see people with really little, thin ankles. If they are, then every time they do that do they develop scar tissue and then, as a result, an arthritic condition?
Dr. Gwathmey: There are some people who have a higher propensity to injure their ligaments. People who have loose joints, for instance, you have people who are double jointed. Sometimes, they can put their joints in positions that allow them to become injured more easily. I certainly see a lot more ankle sprains with women who are really flexible, who have these loose joints. If they have repetitive ankle sprains, they certainly can build up scar tissue in the front of the ankle or on the outside of the ankle. There are really two conditions to be worried about before we worry about arthritis. One is chronic instability where the ankle is just unstable and two is the scar tissue that you talked about that builds up in the ankle that creates impingement inside the ankle. That can be a painful condition.
Melanie: What about bracing if people feel like, oh, they are going to play tennis and they are worried about rolling their ankle? Can we use those ankle braces or do you not recommend that?
Dr. Gwathmey: We recommend them in certain situations. Obviously, people who have a propensity to sprain their ankles, it’s nice to protect them and immobilize them. I’m not sure I’ve ever seen a basketball player play a game without his ankles taped just because that is such a high exposure to ankle injuries. But at the same time, you want the muscles and the dynamics of the stability of the joint to be there so I don’t like people to rely too heavily on braces. To some degree, your body needs to be able to stabilize your joints dynamically and your muscles are really involved there. People who are in high risk situations, we certainly support bracing or taping or ankle support or even high topped shoes, boots – those kinds of things. I often tell people who have ankle instability that a supportive shoe can be very helpful as opposed to a high heel. Maybe wearing something that actually supports the ankle a little bit better.
Melanie: It’s certainly true. Speaking of high topped shoes, what about prevention? Are there some exercises we can do to strengthen those tendons and ligaments in the ankle or calf raises or do the shoes help a lot? Give us some prevention.
Dr. Gwathmey: The key to prevention, there are a couple things. One is strengthening the dynamic stabilizers, the muscles of the calf, the muscles of the shin and those kinds of things to help to stabilize the ankle. Number two is something we do a lot with our athletes and that is neuromuscular training where we try to train the ankle to land properly with jumping and with pivoting and stuff like that so that people can keep a good foundation when they are doing athletic activities. As far as footwear, there is certainly footwear that we prefer over others that provides support and stability of the ankle. High heels not being one of them. For the most part, we do try to train our athletes, especially those who are rehabbing from an ankle injury, how to strengthen the muscles around the ankle as much as possible and how to train the joints so that it doesn’t put itself at risk for injury. That is called “neuromuscular training” and a good therapist can work with that pretty well.
Melanie: In the last few minutes, Dr. Gwathmey, what great information. You’re so good at what you do. Can you please just give us your best advice about ankle sprains that people do every single day and why should they come see you at UVA Health System?
Dr. Gwathmey: There are a couple of things that you certainly want to worry about. Sometimes you roll your ankle and you try to walk it off and it still hurts. Sometimes you do need to get it looked at to make sure you haven’t broken a bone or something like that because that might be a different treatment all together. Not all ankle rolls are just simple ankle sprains. It is certainly good to be looked at by somebody who specializes in ankles just to make sure you don’t have something worse. There is also a different kind of ankle sprain. Sometimes you may have heard of it and it’s called a “high ankle sprain” which is a little bit different and it acts a little bit differently. You might want to deal with it a little different as far as how you treat that. That can be diagnosed by a good orthopedic surgeon. Lastly, if you have a high-grade ankle sprain and four, five or six weeks and it isn’t getting any better, a lot of times we recommend getting looked at, maybe even getting an MRI to make sure you don’t have a complete rupture of your ligament or even cartilage damage inside your ankle joint which may be something we would consider doing surgery for more acutely then just a general ankle sprain. I think if you just roll your ankle and the swelling isn’t too bad and you are able to put weight on it, then it’s probably okay to see if it will just heal on its own. But, if three, four or five days after your injury, if it is still big and swollen and you can’t put a whole lot of weight on it, you probably ought to see somebody and make sure you don’t have something that’s more severe.
Melanie: Thanks so much. What great information. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Ankle Sprains: When Should They Be Checked by a Doctor?
Melanie Cole (Host): A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes and non-athletes, children and adults. My guest today is Dr. Winston Gwathmey. He is fellowship trained in sports medicine and his specialties include caring for athletic injuries and conditions of the shoulder, hip, knee, foot and ankle at UVA Health System. Welcome to the show, Dr. Gwathmey. An ankle sprain – people hear the word “strain” and “sprain” and they don’t know what any of those mean. Please explain it for us.
Dr. Winston Gwathmey (Guest): There is actually a common misconception about strain versus sprain. Technically, a strain includes a muscle. So, if you strain your hamstring or strain your calf muscle or something like that it simply involves a muscle. You ice it, rest it or those kinds of things to get that better. A sprain – with a “P” as opposed to a “T” – usually involves a ligament, which is the structure that connects two bones together. You can sprain the ligaments in your ankle. You can sprain your knee and that involves a joint typically speaking, the ankle being, by far, the most commonly sprained joint.
Melanie: Why is it so common? Is it that unstable? What are we doing to our ankles?
Dr. Gwathmey: We’re walking on them. We spend a whole lot of time – a lot of steps. If you imagine how many exposures your ankle has in a given day to injury. People these days count every step they take. People are doing 5,000 to 10,000 steps per day. That’s a lot of potential chances to take a bad step and sprain your ankle. It doesn’t take much with the force of gravity and just an awkward step to injury the ankle.
Melanie: If we’re looking at the mechanism of injury as you’re saying, there are so many opportunities every single day. When you see it, is it usually something that is relatively minor or is it something that tears? Tell us a little bit about that mechanism.
Dr. Gwathmey: When I see it, it’s usually a little bit more severe. Everyone has tweaked their ankle or taken a misstep. The way the ankle is built, it’s a joint that connects your shin bone and your foot. There are really three bones involved here. The tibia or the shin bone, the fibula or the small bone on the outside part of the leg, and then the ankle bone we call the “talus”. They are connected by ligaments. When you roll your ankle, generally speaking, most people roll their ankle inwards. So, they take a misstep off of a curb or something like that and they roll their ankle inward and they feel discomfort on the outside portion of the ankle. That’s really where the ligaments have been stretched or strained or torn. That’s generally what we speak about when we talk about an ankle sprain. When I see them, they are typically more high-grade. They are involving athletic type injuries or higher energy mechanisms. Those are people who get big and swollen and they can’t put weight on it and those kinds of things. I guess what we have to determine is whether or not you’ve got a simple low-grade ankle sprain that you can heal in a couple of days or something that needs more treatment or x-rays or MRI. That’s where I come in and try to help you figure out exactly what you should do.
Melanie: First line of defense, if someone does step off the curb or women in high heels--my goodness that’s a big source of problems right there – and the heel slips out. We feel that in our ankle. Is RICE still what we’re using or is there an “M” in front of it now? Are we using a little movement as well?
Dr. Gwathmey: Of course. RICE is always sort of the first line – rest, ice, compression, elevation. Let’s take a step back. People roll their ankle and what ends up happening is the ligaments on the outside portion of the ankle get stretched or even torn. It’s really critical for the inflammation associated with that to be controlled and get the swelling down. That’s where the rest and the ice, the compression and the elevation comes in because you want to get the ankle comfortable. As long as the body’s responds to an injury is to create inflammation in that region, that’s really what hurts. At the same time, we also want to make sure that we stabilize the ankle and allow it to heal in a functional position. That’s where the “M” comes in. We’re trying to get the ankle mobilized and moving so that as the ankle heals, it heals in a functional situation so that it can continue moving and you can get back to your activities as quickly as possible. At the same time, it does take some time to heal so it’s not like just by moving the ankle you’re suddenly going to be better. There is some healing that needs to take place and we’ve got to make sure that we control that. We monitor it to make sure that we are doing the right things to immobilize it and provide a safe treatment option.
Melanie: Are some people more susceptible, Dr. Gwathmey, to unstable ankles? You see people with really little, thin ankles. If they are, then every time they do that do they develop scar tissue and then, as a result, an arthritic condition?
Dr. Gwathmey: There are some people who have a higher propensity to injure their ligaments. People who have loose joints, for instance, you have people who are double jointed. Sometimes, they can put their joints in positions that allow them to become injured more easily. I certainly see a lot more ankle sprains with women who are really flexible, who have these loose joints. If they have repetitive ankle sprains, they certainly can build up scar tissue in the front of the ankle or on the outside of the ankle. There are really two conditions to be worried about before we worry about arthritis. One is chronic instability where the ankle is just unstable and two is the scar tissue that you talked about that builds up in the ankle that creates impingement inside the ankle. That can be a painful condition.
Melanie: What about bracing if people feel like, oh, they are going to play tennis and they are worried about rolling their ankle? Can we use those ankle braces or do you not recommend that?
Dr. Gwathmey: We recommend them in certain situations. Obviously, people who have a propensity to sprain their ankles, it’s nice to protect them and immobilize them. I’m not sure I’ve ever seen a basketball player play a game without his ankles taped just because that is such a high exposure to ankle injuries. But at the same time, you want the muscles and the dynamics of the stability of the joint to be there so I don’t like people to rely too heavily on braces. To some degree, your body needs to be able to stabilize your joints dynamically and your muscles are really involved there. People who are in high risk situations, we certainly support bracing or taping or ankle support or even high topped shoes, boots – those kinds of things. I often tell people who have ankle instability that a supportive shoe can be very helpful as opposed to a high heel. Maybe wearing something that actually supports the ankle a little bit better.
Melanie: It’s certainly true. Speaking of high topped shoes, what about prevention? Are there some exercises we can do to strengthen those tendons and ligaments in the ankle or calf raises or do the shoes help a lot? Give us some prevention.
Dr. Gwathmey: The key to prevention, there are a couple things. One is strengthening the dynamic stabilizers, the muscles of the calf, the muscles of the shin and those kinds of things to help to stabilize the ankle. Number two is something we do a lot with our athletes and that is neuromuscular training where we try to train the ankle to land properly with jumping and with pivoting and stuff like that so that people can keep a good foundation when they are doing athletic activities. As far as footwear, there is certainly footwear that we prefer over others that provides support and stability of the ankle. High heels not being one of them. For the most part, we do try to train our athletes, especially those who are rehabbing from an ankle injury, how to strengthen the muscles around the ankle as much as possible and how to train the joints so that it doesn’t put itself at risk for injury. That is called “neuromuscular training” and a good therapist can work with that pretty well.
Melanie: In the last few minutes, Dr. Gwathmey, what great information. You’re so good at what you do. Can you please just give us your best advice about ankle sprains that people do every single day and why should they come see you at UVA Health System?
Dr. Gwathmey: There are a couple of things that you certainly want to worry about. Sometimes you roll your ankle and you try to walk it off and it still hurts. Sometimes you do need to get it looked at to make sure you haven’t broken a bone or something like that because that might be a different treatment all together. Not all ankle rolls are just simple ankle sprains. It is certainly good to be looked at by somebody who specializes in ankles just to make sure you don’t have something worse. There is also a different kind of ankle sprain. Sometimes you may have heard of it and it’s called a “high ankle sprain” which is a little bit different and it acts a little bit differently. You might want to deal with it a little different as far as how you treat that. That can be diagnosed by a good orthopedic surgeon. Lastly, if you have a high-grade ankle sprain and four, five or six weeks and it isn’t getting any better, a lot of times we recommend getting looked at, maybe even getting an MRI to make sure you don’t have a complete rupture of your ligament or even cartilage damage inside your ankle joint which may be something we would consider doing surgery for more acutely then just a general ankle sprain. I think if you just roll your ankle and the swelling isn’t too bad and you are able to put weight on it, then it’s probably okay to see if it will just heal on its own. But, if three, four or five days after your injury, if it is still big and swollen and you can’t put a whole lot of weight on it, you probably ought to see somebody and make sure you don’t have something that’s more severe.
Melanie: Thanks so much. What great information. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.