High Ankle Sprain
I treat a lot of athletes in my practice. I see many long-distance runners and came across an interesting case that all of you runners should be aware of. There is a specific kind of ankle sprain that is different from the normal inversion spain. It’s different not by mechanism of injury, but by severity and prognosis.
Let’s start with anatomy. There is a connective tissue membrane that separtaes the fibula and tibia (the long bones of the lower leg). It can sometimes tear a little with a bad enough sprain. When this membrane (the interosseous membrane) tears it not only hurts, but it makes the entire ankle complex less stable. Here’s the kicker, if you don’t let it heal it will be painful for much longer than needed and the ankle joint will become less and less stable leading to long term effects and predisposing one to injury in the future.
Here is what the American Family Physicians journal has to say about it:
Acute ankle injury, a common musculoskeletal injury, can cause ankle sprains. Some evidence suggests that previous injuries or limited joint flexibility may contribute to ankle sprains. The initial assessment of an acute ankle injury should include questions about the timing and mechanism of the injury. The Ottawa Ankle and Foot Rules provide clinical guidelines for excluding a fracture in adults and children and determining if radiography is indicated at the time of injury. Reexamination three to five days after injury, when pain and swelling have improved, may help with the diagnosis. Therapy for ankle sprains focuses on controlling pain and swelling. PRICE (Protection, Rest, Ice, Compression, and Elevation) is a well-established protocol for the treatment of ankle injury. There is some evidence that applying ice and using nonsteroidal anti-inflammatory drugs improves healing and speeds recovery. Functional rehabilitation (e.g., motion restoration and strengthening exercises) is preferred over immobilization. Superiority of surgical repair versus functional rehabilitation for severe lateral ligament rupture is controversial. Treatment using semirigid supports is superior to using elastic bandages. Support devices provide some protection against future ankle sprains, particularly in persons with a history of recurrent sprains. Ankle disk or proprioceptive neuromuscular facilitation exercise regimens also may be helpful, although the literature supporting this is limited. (Am Fam Physician 2006;74:1714-20, 1723-4, 1725-6.)
If in fact you are afraid that you have torn the interosseous membrane in a bad sprain that refuses to go away there is a simple test you can do to confirm it. It is called the crossed-legged test.
If this test is positive, you have a much more serious sprain on your hands and you should see someone for it.
I’m here to help.
Dr. Clark
