Ankle Injuries Among Teenagers and Young Adults

By Blake Barber, DO

Pediatric Resident at The University of Texas at Austin Dell Medical School

Member, Texas Medical Association

A severe ankle injury is a common reason patients visit the emergency department or a doctor’s office. According to “The Epidemiology of Ankle Sprains in the United States,” teenagers and young adults have the highest rates of ankle injuries. Most occur among people aged 15 to 19, with about 7.2 ankle injuries per 1,000 people.

Half of all ankle sprains occur while playing sports – basketball being the most common sport blamed on ankle injuries. The greatest risk factor for an ankle injury is having a previous ankle injury.

How will my doctor determine what kind of injury I’ve had?

When you visit the emergency department or physician’s office with such an injury, your doctor will first gather a thorough history of the event that caused the injury. He or she may ask you questions about when the injury happened, what you were doing when it happened, sounds made during the injury, and the ankle’s appearance afterward. Your doctor may also ask about your ability to walk and whether you’ve injured your ankle before. The most common ankle injury is a sprain of the lateral (outer side) of your ankle. This area has several weaker ligaments compared with the medial (inner side) of your ankle, which has very strong ligaments to protect it from injury. (A ligament is the connective tissue that connects bones to other bones.) With a classic lateral ankle sprain, the ankle will be tender, and there will be notable bruising and swelling, primarily over the outer side of the injured ankle. If you do not see your doctor right away, that bruising and swelling can spread to the top of your foot as well. Gravity can cause swelling and bruising to spread over time.

How will my doctor determine what kind of tests, if any, are needed?

Your doctor will evaluate your ankle injury using what physicians call the “Ottawa Ankle Rules” to determine if an ankle x-ray is needed to look for a fracture. An ankle x-ray is needed if a patient has pain at the inner side ankle bone (medial malleolus) or the outer side ankle bone (lateral malleolus) as well as at least one of the additional findings:

·      Bone pain with pressure applied to the back part of either the medial or lateral malleolus, and/or

·      Patient is unable to put weight on injured ankle. (Can the patient walk four steps immediately after the injury or in the emergency department or doctor’s office?)

If neither of these tests are positive, your doctor ideally will not order an x-ray of your ankle as you more likely have sprained an ankle ligament without a bone fracture. In this case, an x-ray would not be helpful because those images do not show ligament injury.

What are my treatment options?

Applying ice or cold packs directly to the injured ankle
improves pain and return of function.

If your doctor determines you have an ankle sprain, the classic treatment is known as the “RICE” method.

·         R: Rest until the pain is tolerable. Once bearable, start moving around gradually by putting weight on injured ankle for daily activities, as long as the pain is not too severe. Doctors find movement helps improve a return to sports and overall return of ankle function.

·         I: Apply ice or cold packs directly to injured ankle. Ice helps improve pain and return of function. Apply ice as often and for as long as you can tolerate it, ideally 10 to 20 minutes every two hours while awake for three to seven days.
 

·         C: Compression. Wrap the ankle using an elastic bandage to help reduce swelling and improve function. Don’t wrap it too tightly, however, because doing so will interrupt blood flow.

·         E: Elevate your foot while putting ice on the ankle. Ideally, have the ankle raised up higher than your waist while sitting. This will help move fluid out of your ankle and reduce swelling

Anti-inflammatory medications, such as ibuprofen, are the best medication options for pain control because they help decrease inflammation at the site of injury. Read the instructions on the medication bottle to make sure you are taking an appropriate dose every six to eight hours as you need for pain.

How can I best prevent future injuries?

Having a previous ankle injury increases the risk of another one. You can do certain things to protect yourself from getting another ankle injury, especially once you return to sports:

·    Wear an ankle brace or ankle taping to help support your ankle.

·    Do rehabilitation exercises to help build ankle strength after injury. Examples include:

·    Balancing on one leg for 30 to 60 seconds,

·    Performing balance exercises on a wobble board,

·    Doing one-legged mini-squats with other leg extended in different directions,

·    Performing range-of-motion exercises of the ankle using a resistance band, and

·    Doing calf raises.

Again, ankle injuries are one of the most common reasons teenagers go to the emergency department. Be mindful that not every ankle injury will require an x-ray of the ankle, and more commonly, ankle injuries are due to ligament sprains that will improve on their own. Your ankles are an essential part of daily movement. They support the weight of your entire body, so it’s important to take care of them as best as possible.