Modern, flexible boots may be just as good as old-school plaster casts when it comes to treating broken ankles, new research suggests.
Often related to sports, traffic accidents or falls, broken ankles can be simple breaks in one bone or more complicated fractures that involve several bones, according to the American Academy of Orthopaedic Surgeons. Ankle fractures don’t always require surgery, but most folks will need to keep their foot immobilized in a cast or removable boot for around six weeks so bones can heal.
And people in the new study reported similar levels of pain and function after 16 weeks whether they received a cast or a removable boot to treat their ankle fracture.
“Keeping the broken ankle rigidly still in a cast is no better than allowing it to move,” said study author Rebecca Kearney, a professor of trauma and orthopedic rehabilitation at the University of Warwick in Coventry, United Kingdom.
Many people prefer the brace, she said. “Functional braces can be removed to allow early movement and for patients to look after their skin and basic hygiene,” she noted. By contrast, casts are rigid and can cause stiff joints and weakened muscles.
As part of the trial, about 670 people with broken ankles received a below-the-knee cast or a removable brace. People who got a brace were told how and when to remove the boot and asked to perform ankle strengthening exercises.
After about four months of follow-up, patients were asked about their pain when walking, climbing stairs, running, jumping and squatting as well as stiffness, swelling and use of any support devices. Their answers were combined into the Olerud Molander Ankle Score.
The bottom line? There was no difference in scores between the two groups. “When choosing a cast or brace, you need to consider patient preference and cost,” Kearney said.
The study was published online July 6 in the BMJ.
Dr. Andrew Elliott is a foot and ankle surgeon at the Hospital for Special Surgery in New York City. He said there are merits to both casts and removable boots when treating a broken ankle.
“It winds up being a discussion between the patient and surgeon as to what they feel is the best course of treatment,” said Elliott, who had no ties to the new research.
The new study did show that those people who received boots were more likely to develop an infection and/or need further surgery, but it was not designed to look at these issues specifically so no conclusions can be drawn. It does make sense though, he said.
“These wounds can occur with early motion, and the boot doesn’t fit as snuggly as a cast so you can develop microtraumas and wound issues,” Elliott explained.
SOURCES: Rebecca Kearney, PhD, professor, trauma and orthopedic rehabilitation, associate director, Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom; Andrew Elliott, MD, foot and ankle surgeon, Hospital for Special Surgery, New York City; BMJ, July 6, 2021, online
Do you have an ankle sprain or an ankle fracture? Learn how to spot the signs for each condition.
Considering how much weight our ankles carry and the mobility this hard-working joint provides, it’s not surprising that ankle sprains and fractures are quite common. Sports injuries, car accidents, and bad falls can wrench the ankle joint out of alignment and result in either a fracture or a sprain. But how do you know which one it is?
Severe pain, swelling, and impaired mobility all indicate significant ankle trauma. An orthopedic specialist can determine with an X-Ray or other imaging tests whether your ankle is sprained or broken. But before you book your appointment, here are some clues as to which injury you may have suffered.
Ankle Sprain Vs. Fracture
Both injuries cause similar symptoms — pain, swelling, and an inability to put weight on the joint. At the same time, there are some key differences. It’s important to know these differences and get a quick diagnosis so you can receive the proper treatment.
Ankle Fracture. Your ankle consists of three main bones: the tibia (shinbone), fibula (lower leg), and the ankle bone (talus). All three join together at the ankle to give the joint its wide range of motion. Ankle fractures occur most often due to a car accident or a severe fall that breaks or chips one or all three bones. A swollen, painful ankle is a sign of an ankle fracture, particularly if the area over the ankle bone is tender to the touch. If you’ve fractured your ankle, you may also experience numbness in your toes and notice your ankle appears misshapen. An ankle fracture is usually accompanied by a cracking sound.
Ankle Sprain. Holding the ankle bones together is a network of flexible but strong ligaments. When those ligaments are stretched or twisted beyond their normal range of motion, they can become strained, partially torn, or completely torn. Soreness, tenderness, bruising, swelling, stiffness, and pain when trying to put weight on the ankle are signs of an ankle sprain. Depending on the severity of the sprain, you may hear a popping sound, although in most cases there is no discernable sound. If you feel pain when you touch the soft part of the ankle, it’s most likely a sprain.
How to Treat Ankle Fractures and Sprains
An immediate diagnosis of either a sprain or fracture prevents the injury from worsening and doing more damage to the ligaments or bones. Do not delay treatment if you think you’ve broken your ankle, or your ankle sprain doesn’t improve in a day or two.
Treatment for an ankle sprain begins with the PRICE method: Protecting the ankle from further harm, Rest, Ice, Compression, and Elevation. You may need to wear to a brace to support the ankle and use crutches to take weight off the joint as you heal. Over-the-counter pain medications can alleviate the discomfort. Mild sprains clear up in about two weeks, but it may take longer for more significant sprains to heal. Surgery is not recommended unless there is a severe ligament tear. Physical therapy can also help restore flexibility and range of motion to the joint.
How an ankle fracture is treated depends on whether the bone is stable — meaning it’s broken but not out of alignment — or knocked out of place. A stable fracture can heal in about six weeks immobilized in a cast. If the bones are shattered into small bits and/or out of place, surgery may be necessary to attach the bones together with plates, screws, rods, or wires in a procedure known as reduction. Similar to ankle sprains, treatments for fractures include PRICE, taping around the ankle or a boot to stabilize the joint, crutches while walking to reduce pressure on the ankle, and physical therapy to strengthen and increase flexibility in the joint.
Treat Your Ankle at Comprehensive Orthopaedics
Ankle injuries can be especially debilitating. Fortunately, the physicians at Comprehensive Orthopaedics have years of experience in diagnosing and treating orthopedic injuries like ankle sprains and fractures. We use the latest equipment and techniques to quickly heal your ankle. Contact us today to set up an appointment.
Ankle injuries can keep you from enjoying the activities you love. If you participate in any of these sports or athletic activities that put players at a higher risk of damaging the joint, here are the steps you can take to avoid getting hurt.
For many athletes, ankle injuries are a common cause for concern. While most sprains can heal in less than two months through rest, icing, and bracing, that still means time off from playing sports and enjoying other aspects of an active lifestyle.
In addition to the pain and discomfort they cause, sprains can put you at risk for developing more serious conditions. Even after they heal, they can leave the ankle weaker and more prone to dislocations, fractures, or osteochondral defects formed by cracks in the cartilage.
Whether you’ve had sprains before or simply want to avoid this painful condition, careful prevention is key to maintaining your health and continuing to enjoy your favorite sports. Here’s what it takes to avoid ankle injuries while playing soccer, running, and more.
In sports and in life, it’s a good idea to look before you leap. Aside from being on the receiving end of an unexpected slide tackle, the most common way to sprain your ankle is jumping — perhaps for a contested header — and landing badly. If you jump in a crowded area, spare some attention to where you touch down. While in competitive leagues it’s expected that you go for every ball you can, weekend warriors might exercise some caution and avoid risky jumps.
Soccer is a sport of quick acceleration, and the rapid directional changes it requires can also cause ankle injuries. Preemptive balance training can help you avoid sustaining any damage. This training consists of exercises like standing on one foot with your other ankle behind your back, catching and throwing a ball while on one foot, and one-legged squats.
As much as fans and announcers talk about “ankle-breaking” ball handling, the main cause of ankle injuries in basketball is actually rebounds. Be careful of risky leaps, whether it’s a heavily covered jump shot or a battle at the rim. Similar to soccer, landing on an uneven surface after a jump causes the most problems. So if the area is too congested, don’t be afraid to fall.
In addition, the stiff floor and rapid pivots of basketball are a recipe for ankle strain. Basketball shoes are designed with this in mind, so someone playing on a competitive team can take comfort in that layer of ankle protection. However, if you’re playing a pickup game in a regular pair of sneakers, watch out for quick stops and turns.
In any sport, it’s important to know your risks — and in football, those can vary by position. The causes of injury for a lineman are going to be different from those for a receiver or defensive back. For open-field positions that make rapid cuts and go up for the ball, the primary risk is landing unevenly. For those closer to the line of scrimmage, the bigger worry is getting forced into an unnatural position by the weight of a pileup.
Football is a contact sport, so some risks must be accepted. Still, a consistent stretching and strengthening regimen can go a long way. Jumping and skipping exercises can both strengthen the ankle and prepare it to absorb the impact of hitting the ground with force. Band exercises are useful for stretching your ankle beyond the normal pressures of practice, and could make all the difference if your foot ends up lodged at an awkward angle.
Dancing is rigorous exercise, and ballet in particular puts the ankles under intense strain. As you learn new routines, it’s vital to gradually strengthen and work up to moves that force your feet into more difficult contortions. It is also important to strike a balance between mastering a move and overworking the muscles of the foot.
In what is already a standard practice, wrapping satin shoe ribbons around the ankle while dancing en pointe will help keep the foot stable in this elongated, high-pressure position. Although less research has been done on other forms of dance, proper warm-up, strengthening, and stretching have all proven helpful for injury prevention among ballet dancers.
Beyond buying sturdy shoes, choosing the right surface is key to safe running. By sticking to flat surfaces, you can decrease the risk of rolling your ankle. If you prefer running trails, then make sure not to lose sight of the changes in terrain. While some ankle injuries come from missteps and twists, others can stem from repetitive pounding. When you start to feel consistent pain, it’s time to take a break. Stretching before and after running sessions is also useful.
If you’re suffering from an ankle injury, consult an orthopedic specialist to learn about your treatment options. At Comprehensive Orthopaedics, our team of ankle specialists —Dr. Engel, Dr. Nute and Dr. Lasee — have helped countless patients get back on their feet and return to the activities they enjoy. Contact us today to take your first step on the road to recovery.
Tendonitis can affect anybody, from office workers to athletes. Here’s how to keep your symptoms under control.
Tendonitis is a common problem, affecting athletes, office workers, and musicians alike. Indeed, it can affect almost any part of the body, though it’s most common in the tendons of the shoulders, elbows, wrists, and knees. Some of the most frequent types include patellar tendinitis (or “jumper’s knee”), lateral epicondylitis in the elbow (or “tennis elbow”), and Achilles tendinitis.
As common as it is, however, tendonitis can be a debilitating condition, creating chronic pain and greatly restricting the patient’s range of motion. Fortunately, some basic knowledge of its common causes and symptoms can help you seek relief from this condition.
CAUSES AND SYMPTOMS OF TENDONITIS
Tendons are strands of elastic fibrous tissue that connect muscles to bones, providing stability to the joints and enabling a free range of motion. Any tendon in the body can become inflamed or irritated, causing pain, tenderness, and swelling in the affected tissue.
The most common cause of tendonitis is prolonged stress or gradual wear caused by repetitive movements, though it can also be caused by sudden trauma. As a result, most people develop tendonitis while performing their jobs, enjoying hobbies that rely on a specific joint, or playing sports A typist, for example, is most likely to have tendonitis in the wrist, while weightlifters may suffer from biceps tendinitis. Aging also increases the likelihood of developing tendonitis, since tendons become less flexible with age.
TREATMENT FOR TENDONITIS
The severity of tendonitis can vary greatly depending on the specific cause of the inflammation and the particular tendon affected. Most cases of tendonitis, however, can be successfully treated without surgery. Some of the most common courses of treatment include:
Resting the affected area
Avoiding activities that cause flare-ups or increased pain
Taking over the counter anti-inflammatories like Advil or Aleve
If your tendonitis does not respond to these conservative treatments, the inflamed tendon may need to be repaired with a minimally invasive surgery. During the procedure, your surgeon will mend any tears in the tendon and remove any permanently damaged tissue.
Since tendonitis is an injury that often results from overuse, the best treatment in many cases is simply to refrain from using the joint in question. Some effective preventative measures include stretching before exercise, wearing protective braces, using proper technique when lifting, and always maintaining correct posture.
Whether you suffer from tennis elbow or jumper’s knee, our team at New York Bone and Joint can help. With decades of combined experience in treating injured tendons, our specialists are able to provide comprehensive assistance at every stage of the process, from identifying the source of the problem to crafting a personalized treatment plan. If you worry that you may have tendonitis, contact us today to schedule a consultation.
Injuries of the ankle are common among athletes and amateurs in many different sports and exercises. Working out at the gym, enjoying summer jogs, or playing any type of sport are typical ways to injure your ankle. Unfortunately, spraining, rolling, or fracturing your ankle is easy to do and will often occur again without the proper rehabilitation and strengthening of your ankle joint. Strengthening your ankles is also a great way to do thing outside of sports – such as wear high heeled shoes without wobbling!
There are many exercises and stretches you can do to strengthen your ankles, which can help to prevent future injury or help to recover from a previous ankle injury.
Working on your balance strengthens your ankles, as they are the joints that hold your weight steady on your feet. Try holding your weight on one foot, grabbing your opposite ankle behind your back. Work toward increasing the amount of time you balance on each foot. Eventually, work up to catching and throwing a ball while standing on one foot, or doing one-legged squats.
You can purchase the resistance bands you would find at your physical therapy gym for very little cost. Wrap them around the top of one foot and curl your toes to stretch your foot and ankle. Make sure to match the number of repetitions on the other foot. These bands can be used to stretch the foot and ankle is a variety of ways and directions – consult your physical therapist for proper form and technique.
Jumps and Skips
Another way to strengthen your ankles is to do exercises that require jumping or skipping. These work the muscles in your foot and your ankle. They get your ankles used to landing and absorbing that impact, as well as aiding your balance.
You can do jumping squats, scissors kicks, or do skips or bounds if you are exercising in a large area.