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Soccer fields can be quite an unfriendly place for unsuspecting ankles. Often an uneven step, either from a hole in the ground, or your opponent's foot, can lead to a sprained ankle. The key to the resolve of an ankle sprain is proper evaluation and treatment -- beginning at the time of injury. Sprains are often taken for granted and treated (casually) only during the initial swelling period.
A sprain stretches the ligaments which hold the ankle together, causing pain and instability. If you sprain your ankle and cannot walk it off in a five minute period, please seek medical attention. The appropriate and timely care will effectively decrease the chance of re-injury, as well as speed the total healing time. Symptoms which may occur, in addition to pain and swelling, are black and blue "bruising" along the foot and behind the ankle.
The type of treatment, of course, depends on what damage is done. The goal of treatment is repair of the bones and ligaments in their proper, or "anatomical" alignment. A ligament healing in an over- stretched position can result in repeated sprains and risk of further damage. Long-term bracing and strapping needs can be avoided with thorough evaluation and appropriate aggressive therapy. At times, a sprain can accompany a fracture of one of the leg or foot bones, making X-Rays a necessary part of the evaluation.
Until the degree of injury is known, it is best to apply the general
R.I.C.E. principles:
The same type of first aid described by Dr. McGhee for knee injuries (SHOTS ON GOAL, Sept. '90) can be used on the ankle. While awaiting the proper evaluation, control the pain with aspirin, ibuprofen (advil, nuprin) or acetaminophen (tylenol, anacin 3)
Once the degree of injury is determined, a treatment plan can be started. A cast may be necessary if there is a fracture or several ligaments are severely torn. A milder sprain may be immobilized with a reinforced ace bandage, temporary ankle taping, or a brace (laceup or plastic styles). These braces, sometimes used in a chronic problem, fit into your shoe allowing only normal up and down motion of the foot on the leg, assuring that the ligaments heal in their proper position. Crutches may be needed, depending on how painful it is to walk.
Once past the painful stage, it is important to work on flexibility and strength to prevent a chronic problem. Walking is an excellent way to help both, without overly stressing the healing injury. Stretching the Achilles tendon, or heel cord, can prevent a repeat ankle sprain. Using a light weight around your foot can strengthen the muscles supporting the ankle.
When you are pain free, flexible and strong, and mentally eager to return to activity, do so cautiously. First test by standing on your toes. Assure pain free running in a straight line. The ultimate test before you go back on the field, is running in figures-of-eight. If this is pain free and without instability, you can probably resume all regular activities. Stiffness during your recuperation and return to activity can be reduced with massage and moist heat and stretching.
If you had a moderate or severe ankle sprain, the demands of soccer on your ankles necessitate the use of external support, like taping of the braces previously mentioned. An ankle brace is designed to limit excessive motion, while allowing normal ankle motion. In most cases, you can stop using the brace once you regain strength and flexibility of the ankle, and recover your confidence not to sprain it again.
Again, the benefit of immediate care of ankle sprains is a quick and complete recovery. Ten to fourteen days may be needed for a mild sprain, with moderate to severe injuries taking longer healing times. Professional advice and a conscientious approach to the process are essential for a safe return to activity.
Written By: Elle J. Merkle, DPM
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