If you read many sports headlines, you know that ankle sprains are all over the place. NBA star Dwayne Wade suffered a mild sprain several weeks ago, and there were over 620 foot and ankle injuries in the 2004 Athens Olympics-many of which were sprains. The best, most coordinated athletes in the world suffer from ankle sprains, but they plague the rest of us as well.

A “sprain” is a stretching or a tearing of ligaments around a joint, and the ankle is the most commonly sprained joint in the body. The majority of sprains are “inversion-type” in which the ankle rolls inward, thus stretching the ligaments on the outside of the ankle. In more serious cases, however, even the muscle tendons can be stretched or torn.

Several factors can predispose an ankle to sprains. Weak muscles, poor rehab from a prior sprain, and a diminished sense of position are all common causes. Sprains range in their severity from 1^st degree which includes mild stretching and swelling to 3^rd degree which involves the complete rupture of a ligament and excruciating pain. Regardless of their degree, ankle sprains should be treated as soon as possible to promote a better outcome and minimize long-term pain and instability. A good pneumonic to remember is R.I.C.E. which stands for Rest the ankle, Ice it for 15-20 minutes several times per day, Compress it with wraps or bandages, and Elevate the ankle above the level of the heart as much as possible for 48 hours. Be careful not to apply ice directly to elderly individuals or those with blood-flow problems.

2^nd and 3^rd degree ankle sprains should receive professional treatment immediately. Your podiatrist can perform X-rays to confirm the diagnosis and rule out an avulsion injury which is a fracture of the ligament’s attachment site to bone. He or she can also screen for potential causes of long-term future pain such as fractures, impingements, or bony fragments within the joint.

There are also several steps you can take to prevent your ankle from re-spraining. Continue to stretch your calf muscles-particularly on the affected leg-and wear an ankle brace or strapping device. Balancing exercises are good if tolerable. A wedge can also be placed in your shoe to prevent your ankle from tipping over. Finally, for individuals with chronic ankle sprains, surgery is available to tighten the ligaments and shift the tendons in order to stabilize your foot.

for more information

www.inmotionfootandankle.com

www.brucewerberdpm.com

ankle hurt? check this out

Ankle Pain/Sprains:

Chronic ankle pain can cause a severe limitation in daily activities as well as sport activities. Ankle pain can be caused by a wide variety of problems, however more commonly it is due to ankle instability. The ankle as with most joints is stabilized and held in place by a myriad of soft tissue structures including ligaments and tendons. When these ligaments or tendons become stretched or strained by repetitive motions or injury, they do not perform optimally and allow the ankle joint to become unstable. The loosened tendons and ligaments allow increased motion in all directions across the ankle joint and may even allow the ankle joint to become temporarily dislocated during activity. This temporary dislocation of the ankle joint is known as an ankle sprain. Multiple ankle sprains in an individual are an indication that the ankle joint is very unstable and no longer functions appropriately. This requires treatment to rebalance and stabilize the ankle.

Treatments vary and can range from conservative non-surgical techniques to surgical repair of ankle ligaments or tendons. A common non-surgical intervention involves ankle bracing or strapping. An ankle brace or strap may be applied to the ankle during periods of increased activity and functions as a bolster that supports the ankle and allows the joint to function correctly.

Another conservative treatment method may include the use of arch supports that are inserted into the patient‘s shoe, and offer stability to the ankle by providing a stable platform and support for the foot. Arch supports are available in generic type devices which are made to fit a variety of individuals or in a custom device that is tailored to fit the specific individual.

Ankle braces and arch supports may also be used in combination to produce a superior result than either treatment alone and when coupled with physical therapy can be quite effective.

Bruce Werber DPM, FACFAS
www.arizonafeet.com

Ankle Joint replacement - artificial ankle

Advancements in orthopedic technology continue to revolutionize surgical options. Todays surgical instruments and implants make orthopedic surgery more precise and more effective than ever before. One such advancement can now be seen in the Salto Talaris tm which has been modeled after the human anatomy and is positioned to redefine the classic approach to ankle arthroplasty.

The innovative Salto Talaris now provideds surgeons the ability to reproduce the natural flexion/extension axis of the ankle with an anatomic design. The Salto Talaris tm implant design and instrumentation is founded on the Salto mobile-bearing ankle prosthesis, which has been in clinical use since 1997 and at 6.4 year mean followup has a 93% survivorship. The Salto Talaris provides accuracy and reproducibility with the precision instrumentation that has evolved to allows a fixed-bearing implant design and represents the philosophy "Less is Sometimes More"

Anatomic design to restore normal anatomy for optimal range of motion.
Highly accurate and reproducible instrumentation.

A total ankle replacement may be needed for those patients with chronic ankle arthritis causing pain that conservative measures such as rest, physical therapy, or medications were unable to correct.

How can Ankle replacement surgery (Ankle arthroplasty) help?

If you are considering ankle joint replacement surgery or ankle arthroplasty [ARE-throw-plas-tee], this brochure may contain some helpful information.

Reduce or eliminate ankle pain and regain range of motion.

Return to normal daily activities that were previously limited by the ankle damage. Success will depend on your age, activity level, as well as other factors.

The ankle joint absorbs four times the body weight with each step, that’s more than double what the hip and knee absorb. As you age, your ankles may develop osteoarthritis, rheumatoid arthritis, or arthritis resulting from injury such as fractures or frequent sprains.

While ankle fractures and ankle sprains may heal, they can lead to problems much later in life. These injuries can cause long-term damage to the cartilage that cushions the ankle joint. Sometimes the cartilage surface is damaged so severely, surgery may be the most effective option to relieve pain.

To learn more about ankle surgical options including ankle replacement.

If your ankle pain is debilitating, you should Dr. Werber (480-948-2111) regarding your treatment options.

10900 N. Scottsdale Road

Scottsdale, AZ 85254

480-948-2111

WWW. InMotionfootandankle.com

Ankle Sprain

For rapid healing of a severely sprained ankle, think below-knee cast, according to investigators here. Action Points Explain to patients that this study showed that a below-knee cast leads to more rapid improvement in recovery from ankle sprain compared with other commonly used mechanical supports. Severe ankle sprains healed significantly more quickly with a below-knee cast or air-cell brace compared with a Bledsoe boot or a tubular compression bandage, investigators here reported. The 10-day below-knee cast and the Aircast resulted in 8% to 9% improvement in the quality of 90-day recovery compared with a tubular compression bandage, Sarah Lamb, D.Phil., of the University of Warwick, and colleagues reported in the Feb. 14 issue of The Lancet. The degree of improvement with the Bledsoe boot did not differ significantly from that of the tubular compression bandage, which was the least effective device. The quality of recovery at nine months did not differ among the four devices. "Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts." "Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device," they added. "Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment." Severe ankle injuries (grade II-III) can cause significant incapacitation and require three to nine months for recovery in most affected individuals, the authors noted. Systematic reviews have revealed lack of high-quality evidence to aid clinical decision-making related to management of severe ankle injuries. In an attempt to fill some of the data void, Dr. Lamb and colleagues performed a multicenter, randomized clinical trial involving 584 patients treated in eight emergency departments for severe ankle sprain. Participants were randomized to tubular compression bandage (reference), Bledsoe boot, 10-day below-knee cast, or Aircast. All patients began wearing the supports within three days of their injury. Trained healthcare professionals provided advice about use of the supports and strategies to reduce swelling and pain. The primary outcome was the quality of ankle function at three months, as determined by the standardized Foot and Ankle Score (FAOS). Evaluation of functional outcomes continued for nine months. After three months, patients assigned to tubular compression bandage had an average FAOS score of 54. Patients given the below-knee had a 9% improvement in recovery compared with the reference group (95% CI 2.4 to15, effect size 0.36). Support with the Aircast resulted in an 8% difference compared with the reference (95% 1.8 to14.2, ES 0.33) but there were little differences for pain, symptoms, and, activity. The Bledsoe boot led to a 6% improvement in FAOS versus the compression bandage, but the difference did not achieve statistical significance (95% CI 0 to12.3, ES 0.25). The below-knee cast and Aircast also led to greater improvement compared with the compression bandage on the FAOS subscales related to symptoms, pain, activities of daily living, and sports. although the Aircast brace was not as wide-ranging in its benefits as the below-knee cast, Patients assigned to the Bledsoe boot had mixed results on the subscales, including some scores that were worse than those of patients assigned to the compression bandage. The superior results in evidence at three months with the below-knee cast and Aircast were not sustained at nine months, as the four groups had similar levels of recovery. Scores on the physical and mental components of the SF-12 scale differed little among the four treatment groups. The results demonstrate advantages for the 10-day below-knee cast for patients with acute ankle sprains, Jay Hertel, Ph.D., of the University of Virginia in Charlottesville, said in a commentary. However, the results also failed to support widely used approaches to management of ankle sprains. "Since the short-term benefits were identified at three months, but the intermediate-term benefits at nine months follow-up were not found, the results of this study call into question the current standard of aggressive functional treatment of patients recovering from acute ankle sprains," said Dr. Hertel. The study was funded by the Department of Health in England. The authors and Dr. Hertel reported no potential conflicts of interest.

Primary source: The Lancet Source reference: Lamb SE, et al "Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomized controlled trial" Lancet 2009; 373: 575-581. Additional source: The Lancet Source reference: Hertel J "Immobilization for acute severe ankle sprain" Lancet 2009; 373: 524-526.