Ankle Pain

Real Patients. Real Stories – Kathleen Karr’s Total Ankle Replacement

total ankle replacement karrKathleen Karr thought her dancing days were over — until she underwent total ankle replacement surgery. 

Kathleen suffered an ankle injury during a car accident when she was 39 years-old. Unfortunately, the injury worsened over time. She began to lose more and more mobility in her ankle until, finally, she found herself barely able to walk.

Frustrated with her lack of mobility, Kathleen scheduled an appointment with an orthopaedist. After performing an initial exam and reviewing her X-rays, the doctor found that she had end-stage ankle arthritis and recommended an ankle fusion. While the procedure would give her back some mobility, the doctor warned that she would still not even be able to walk uphill or downhill following her surgery.

Kathleen had always been an active, vibrant woman. The thought of living out the rest of her life with such limited mobility just felt wrong to her. She had dreams of roaming the streets of Paris and dancing the night away. For her, barely being able to walk on flat ground was just not going to cut it.

Unsatisfied with what she was told, Kathleen decided to seek a second opinion. That’s when she found Dr. Jason Bariteau of Emory Orthopaedics & Spine Center in Atlanta, Georgia. “Kathleen was severely limited from her ankle injury,” recalls Dr. Bariteau. “She had already tried several conservative treatment options, but still couldn’t do the things she wanted to do.” Kathleen and Dr. Bariteau discussed possible treatment options and weighed the risks and benefits of each. They decided that a total ankle replacement would be the best fit for her.

Total Ankle Replacement Procedure

Traditionally, patients with end-stage ankle arthritis have been treated with an ankle fusion, which can lead to significant limitations after surgery and could cause further arthritis in the foot. Fortunately, total ankle replacement has evolved over the last few years. Not everyone is a candidate for total ankle replacement, but those who are, often find it offers them consistent pain relief and improved mobility.

Kathleen had a great experience with the procedure and is now pain-free and loving life. “I went dancing last night. I’ve always been a very active person, and it feels good to get back to the things I enjoy. Going from not being able to do anything, to getting onstage to dance and sing, feels amazing. I’m back to my crazy old self!”

With her trip to Europe booked, Kathleen feels grateful to Dr. Bariteau. “He’s such a great doctor—so thorough and personable. That’s what gave me the confidence to have the surgery. And that’s why I have my life back! Thank you, Dr. Bariteau!”

Emory Orthopaedics & Spine Center

Emory Orthopaedics & Spine Center offers the full-spectrum of orthopaedic care. If you have a foot or ankle injury, we can help. We want to get you back to living the life you love.

Learn more about total ankle replacement

About Dr. Bariteau

Dr. Bariteau grew up in a small town just outside of Albany, New York. After completing his undergraduate degree in Biology at College of Saint Rose, he then pursued his medical degree at Upstate Medical University in Syracuse, NY where he graduated Magna Cum Laude. Following completion of his medical training, he developed his surgical skills during his orthopedic surgery residency at Brown University. He then subsequently completed two advanced orthopedics fellowships; the first at Brown University in orthopedic trauma and the second at Baylor Medical Center in Dallas Texas under the tutelage internationally known Foot and Ankle Surgeon James W Brodsky MD. He currently resides in Atlanta, GA with his wife and three children. Learn more about Dr. Bariteau.

Preparing for Summer Road Races Live Chat Transcript

 

Road race runnersHave you been training hard getting ready for summer races or events like the AJC Peachtree Road Race? Emory sports medicine physician Amadeus Mason, MD and Emory sports cardiologist, and Peachtree Road Race Medical Director, Jonathan Kim, MD, answered questions around preventing injuries, when and how to stretch and discussed appropriate treatment options for select injuries.  The live chat had a good turnout and the transcript is now available below.

Live Chat Transcript

June 13, 2017, 12:01 PM

EmoryHealthcare: Welcome everyone! Thanks for joining us today for our Live Q&A on Preparing for Summer Road Races with Dr. Mason and Dr. Kim.

June 13, 2017, 12:02 PM

EmoryHealthcare: We’ll get started in just a minute. The doctors are here to answer all your questions!

June 13, 2017, 12:04 PM

EmoryHealthcare: Please note that all questions are moderated before appearing in the stream, so you may not see yours appear right away, but we will do our best to answer all your questions today.

June 13, 2017, 12:05 PM

EmoryHealthcare: We received some questions that were submitted in advance of the chat, so we’ll get started by answering a few of those first.

June 13, 2017, 12:06 PM

EmoryHealthcare: Q: What is the number one mistake you see runners make?

June 13, 2017, 12:09 PM

EmoryHealthcare: A: Doing much too soon, increasing the amount of running, or the pace of before they are ready and that leading to overuse/fatigue injury, etc.

June 13, 2017, 12:11 PM

EmoryHealthcare: Q: Does weightlifting make you a faster runner?

June 13, 2017, 12:13 PM

EmoryHealthcare: A: No, lifting is not can a make you faster only speed work and do that. Lifting can help to increase your overall stamina and in turn, allow you to do better quality speed training which will, in turn, make you faster.

June 13, 2017, 12:20 PM

Guest9090: I’ve heard of people going into cardiac arrest. How concerned should the average Joe be?

June 13, 2017, 12:23 PM

EmoryHealthcare: We published a paper on this exact question – Kim JH New England Journal of Medicine 2012. Cardiac arrests are rare during marathon events. However, as we age, it’s important to get a risk profile work up by your physician before starting training.

June 13, 2017, 12:23 PM

Guest5817: Does the pace of your easy run matter?

June 13, 2017, 12:25 PM

EmoryHealthcare: Yes, it does matter. Your easy run is part of the recovery portion of your workout. Therefore, if it’s too hard, this can negatively impact progress, rest and recovery are crucial.

June 13, 2017, 12:27 PM

Abe: Why do I get a stich in my side when I run?

June 13, 2017, 12:29 PM

EmoryHealthcare: There are a couple of theories, 1) the oxygenation of the tissues in the core of the body is diverted to the legs during exercise.

June 13, 2017, 12:30 PM

EmoryHealthcare: 2) Electrolyte imbalance when you’re running there’s a subtle change in electrolytes which can cause the stitch like pain.

June 13, 2017, 12:31 PM

Guest2147: Is post traumatic injury disorder a real thing?

June 13, 2017, 12:32 PM

EmoryHealthcare: Guest2147, can you provide more information?

June 13, 2017, 12:34 PM

Guest2147: The fear of an injury returning—or a new one developing.

June 13, 2017, 12:36 PM

EmoryHealthcare: It is a real psychological issue and should be addressed for the person to get back to his or her previous level of play. Apprehension is real.

June 13, 2017, 12:38 PM

Guest8697: Any pics on the best running shoes?

June 13, 2017, 12:39 PM

EmoryHealthcare: We can’t give a brand name, but when choosing a shoe to get an assessment from a professional and choose the shoe that is the most comfortable. A German study in the early 2000’s determined that the comfort of the shoe was the most important, not the brand.

June 13, 2017, 12:43 PM

Guest5057: What should I eat before the race?

June 13, 2017, 12:44 PM

EmoryHealthcare: Pre-race diet isn’t important as making sure your overall diet is good throughout your training. Carb loading before a big race has fallen out of favor, especially when not in the context of an overall dietary plan. Eating carbs, protein, and simple fats within 30 mins after the race has proven beneficial. The perfect combination is chocolate milk.

June 13, 2017, 12:45 PM

Guest9090: Will Emory be at the PRR this year?

June 13, 2017, 12:47 PM

EmoryHealthcare: Absolutely! Emory will be providing primary medical oversight during the race. We’ll we work in concert with Grady EMS, Atlanta Fire and Police to provide excellent medical care throughout the entire course.

June 13, 2017, 12:49 PM

Guest2147: My friend’s running form is terrible, should I say something?

June 13, 2017, 12:49 PM

EmoryHealthcare: It depends on how close of a friend you are.

June 13, 2017, 12:49 PM

Guest9186: I’m in my first trimester, is it safe to run the PRR?

June 13, 2017, 12:53 PM

EmoryHealthcare: Consulting with your OB-GYN should be on your list of to-dos. From an environmental standpoint, I would be very conservative with your intensity and pay close attention to the heat and humidity.

June 13, 2017, 12:54 PM

EmoryHealthcare: These questions have been great! We have time for just one more question today. Any remaining questions will be answered by in a post-chat Q&A blog on http://advancingyourhealth.org

June 13, 2017, 12:56 PM

Guest5057: I know we’re not supposed to, but any thoughts on running a 10k with headphones?

June 13, 2017, 12:58 PM

EmoryHealthcare: We don’t think headphones are prohibited from the Peachtree Road Race. However, running on your own vs. on a closed course brings its own dangers, and runners should always be aware of their surroundings.

June 13, 2017, 12:58 PM

EmoryHealthcare: That’s all the time we have for today. Thanks so much for joining us! As we mentioned, we’ll follow up with a blog post to answer any questions we didn’t get a chance to address today.

June 13, 2017, 12:59 PM

EmoryHealthcare: Thanks for your questions!


Want to Learn More?

At Emory Sports Medicine Center, you have access to a broad range of services to care for sports injuries that affect bones, muscles, and tendons. We provide evaluation and treatment of sports-related injuries for athletes of all ages, at all levels, in all sports.

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The Best Treatment for an Achilles Tendon Injury

Achilles Tendon InjuryAn Achilles tendon injury can affect your ability to perform the activities you enjoy and even your ability to walk. That’s why it’s important to talk to your doctor if you experience significant pain in your Achilles tendon, which connects the muscles on the back of your calf to your heel bone.

Types of Achilles Tendon Injuries

There are two common types of Achilles tendon injuries:

  • Achilles tendinitis: A gradual onset of pain, often from overuse. It can usually be treated with rest and rehabilitation.
  • Achilles tendon tear or rupture: A sudden injury that may feel as though you were hit or kicked in the back of the ankle. It usually affects your ability to walk properly and may require surgery to repair the rupture.

It’s crucial to know which type of Achilles tendon injury you have because treatment is very different for each form. If you suspect you have a torn Achilles tendon, seek treatment from a doctor specializing in sports medicine or orthopaedic surgery.

Achilles Tendon Injury Diagnosis

Your doctor will likely be able to tell if you have an Achilles tendon rupture from a physical exam by feeling the gap in your tendon. To know more about the severity of a tear, a magnetic resonance imaging (MRI) scan may be recommended.

Achilles Tendon Repair

If you have a torn Achilles tendon and are an active individual, surgery may be your best option. Sometimes a ruptured Achilles tendon can be treated with a brace, cast or splint that keeps your lower leg from moving. However, surgery decreases the chance of your tendon tearing again and requires a shorter recovery time. Your surgeon may wait a week after your injury to perform the surgery to allow swelling to decrease.

There are two forms of surgery to repair an Achilles tendon injury. Both involve your surgeon sewing your tendon back together through an incision.

  • Open surgery: The surgeon makes a single large incision in the back of the leg.
  • Percutaneous surgery: The surgeon makes several small incisions rather than one large incision.

Depending on the condition of the torn tissue, the repair may be reinforced with other tendons.

Rehabilitation for an Achilles Tendon Injury

Rehabilitation, especially physical therapy to strengthen your tendon and leg muscles, can also be helpful in treating an Achilles tendon injury, whether you require surgery or not. Most people can return to daily activities within four to six months, while high-impact athletes may need up to a year to heal before returning to play.

Total Ankle Replacement Surgery Explained

ankle replacement surgery smallAre you experiencing pain, bruising, swelling and inflammation in your ankle? Are these symptoms associated with a previous injury, osteoarthritis or rheumatoid arthritis? Have you tried physical therapy, bracing and medicine with no success? If so, you may be a strong candidate for total ankle replacement surgery. If not treated properly in a timely manner, the above conditions can cause the cartilage in your ankle to wear away, leading to joint damage, pain and disability. Total ankle replacement surgery is an option to treat severe ankle pain that doesn’t respond to more conservative treatments.

What Are the Benefits of This Surgery?

 

The American Academy of Orthopaedic Surgeons reports more than 90 percent of joint replacement patients have significantly less pain and see a dramatic improvement in their ability to complete daily tasks. We at Emory Healthcare recently presented research demonstrating significant improvements in both clinical and functional parameters after ankle replacement surgery. With your doctor’s sign-off, you can expect to return to walking, golfing, swimming or biking after your recovery.

Are You a Candidate for Total Ankle Replacement?

 

If you have chronic, daily ankle pain that worsens over time, make an appointment to see an Orthopedic Foot and Ankle Specialist who can evaluate your ankle and help you determine your best treatment plan. You may be a candidate for total ankle replacement surgery if:

  • You have ankle pain that interferes with your daily life
  • You stick to mostly low-impact activities like walking, daily chores, swimming, etc.
  • You have advanced arthritis in your ankle joint
  • The surfaces of your ankle joints are destroyed

What Happens During & After Total Ankle Replacement Surgery?

 

Your orthopaedic surgeon will remove your damaged ankle joint and replace it with an artificial one (ankle prosthesis). After you undergo the surgery, you can expect to stay in the hospital for one to three days. When you return home, you may need to use crutches, a walker or a scooter for six weeks followed by progressive weight bearing in a boot for another 4-6 weeks, depending on your doctor’s recommendations. You’ll likely be advised to:

  • Rest
  • Keep your foot elevated
  • Avoid putting weight on your foot
  • Take pain medicine as prescribed

When it’s safe to bear weight on your foot, your doctor may recommend physical therapy to restore strength and range of motion to your ankle.

Most people are ready for their normal activities after three to four months, though you may need to wear a special brace or shoes to aid recovery. Depending on how severe your ankle damage was prior to the surgery, full recovery may take six months to a year.

Overall, this option offers patients more movement and mobility, as well as less stress and risk of arthritis to nearby joints, if compared to other similar treatments. Want to learn more about total ankle replacement surgery at Emory?

About Dr. Bariteau

bariteau-jasonJason Bariteau, MD, grew up in a small town just outside of Albany, New York. After completing his undergraduate degree in Biology at College of Saint Rose, he then pursued his medical degree at Upstate Medical University in Syracuse, NY where he graduated Magna Cum Laude. Following completion of his medical training he developed his surgical skills during his orthopedic surgery residency at Brown University. He then subsequently completed two advanced orthopedics fellowships; the first at Brown University in orthopedic trauma and the second at Baylor Medical Center in Dallas Texas under the tutelage internationally known Foot and Ankle Surgeon James W Brodsky MD. He currently resides in Atlanta, GA with his wife and three children.

Best Ways To Recognize And Treat An Ankle Fracture

ankle-injury

What is an ankle fracture?

A fracture is a partial or complete break in a bone. An ankle fracture can range from a simple break in one bone, which may cause discomfort but not stop you from walking, to more serious fractures, which damage multiple bones that hold your ankle joint in place and may require surgery or immobilization for some time.

There are three bones that make up the ankle joint:

  • Tibia – shinbone
  • Fibula – smaller bone of the lower leg
  • Talus – a small bone that sits between the heel bone (calcaneus) and the tibia and fibula

Any one of the three bones could break as the result of a fall, twisting, rolling or rotating your ankle, a car accident or some other trauma to the ankle. The more bones that are broken, the more unstable the ankle becomes and the longer the recovery time.

What are the signs and symptoms of a fractured ankle?

Common symptoms of an ankle fracture include:

  • Immediate and severe pain, which can extend from the foot to the knee
  • Swelling
  • Bruising
  • Tender to touch
  • Decreased ability to walk or put any weight on the injured foot
  • Deformity or protruding bones

Because a broken ankle can frequently be confused with an ankle sprain, most severe injuries to the ankle should be examined by a musculoskeletal specialist.

What are the treatment options?

First, to prevent further complications, make sure to stay off the injured ankle until you receive medical evaluation from a physician. Other ankle fracture treatments include:

  • Elevate the ankle and apply ice to the injured area to decrease swelling and pain.
  • Rest and make sure to stay off the affected ankle.
  • Depending on the type of the fracture, a splint/cast/boot may be used to stabilize and realign the ankle joint.
  • Some patients may require surgery if the fracture is severe enough.

What is the best way to heal from a fractured ankle?

Healing of an ankle fracture depends on the severity of the injury. To optimize bone healing we advise patients eat a good diet, get enough calcium and vitamin D, and follow treatment instructions from their physician.

Will an ankle fracture heal by itself?

Some ankle fractures will heal without surgical intervention but most require some period of immobilization in boot or brace if treated without surgical intervention.

What should someone with a fractured ankle do to keep relatively fit during the period of immobility?

Patients often worry about their fitness when they are immobilized or unable to put weight on their extremity after an ankle fracture. I recommend my patient at Emory Orthopaedics & Spine Center begin upper body exercises as soon as they can resume activity. We also have patients frequently use rolling knee walkers, which allow them to be as mobile as possible while they are healing.

If you’ve suffered an ankle fracture, seek medical attention from an orthopaedic physician specializing in fractures. The physician will conduct a physical exam, perform appropriate imaging and recommend a treatment plan (non-surgical or surgical) to get your back to your pre-injury functional level safely and as soon as possible. If the injury is severe, please call 911 or visit the nearest hospital emergency room.

ortho-appt-bar

About Dr. Bariteau

bariteau-jasonJason Bariteau, MD, grew up in a small town just outside of Albany, New York. After completing his undergraduate degree in Biology at College of Saint Rose, he then pursued his medical degree at Upstate Medical University in Syracuse, NY where he graduated Magna Cum Laude. Following completion of his medical training he developed his surgical skills during his orthopedic surgery residency at Brown University. He then subsequently completed two advanced orthopedics fellowships; the first at Brown University in orthopedic trauma and the second at Baylor Medical Center in Dallas Texas under the tutelage internationally known Foot and Ankle Surgeon James W Brodsky MD. He currently resides in Atlanta, GA with his wife and three children.

Related Resources
Takeaways from Dr. Olufade’s Ankle Sprain Chat

Using Heat and Cold to Treat Injury

back-painIt’s hard to get through life without straining a muscle, spraining a ligament, or wrenching your back. When something hurts, ice and heat are often the go-to solutions, and using temperature therapy to complement medications and self-care can be very effective. But while both heat and cold can help reduce pain, it can be confusing to decide which is more appropriate depending on the injury. Our tips below give you the facts on when to use (and not use) heat and cold therapies.

When to Use Cold Therapy

Cold is best for acute pain caused by recent tissue damage is used when the injury is recent, red, inflamed, or sensitive. The inflammatory process is a healthy, normal, natural process that also can be incredibly painful. Here are some examples of common acute injuries:

  • Ankle sprain
  • Muscle or joint sprain
  • Red, hot or swollen body part
  • Acute pain after intense exercise
  • Inflammatory arthritis flare ups

When you sprain something, you damage blood vessels causing swelling to occur. Applying something cold causes the blood vessels to constrict, reducing the swelling and limiting bruising. Cold therapy can also help relieve any inflammation or pain that occurs after exercise, which is a form of acute inflammation. However, unlike heat, you should apply ice after going for a run to reduce post-exercise inflammation.

Tips for Applying Cold

  • Cold should only be applied locally and should never be used for more than 20 minutes at a time.
  • Apply cold immediately after injury or intense, high-impact exercise.
  • Always wrap ice packs in a towel before applying to an affected area.
  • Do not use ice in areas where you have circulation problems.

When to Use Heat Therapy

While ice is used to treat acute pain, heat therapy is typically used for chronic pain or conditions. Unlike cold therapy’s ability to constrict blood vessels, heat allows for our blood vessels to expand and our muscles to relax. That’s why overworked muscles respond best to heat. Heat stimulates blood flow, relaxes spasms, and soothes sore muscles. Some common chronic conditions that heat is used to treat are:

  • Muscle pain or soreness
  • Arthritis
  • Stiff joints

Tips for Applying Heat

  • Unlike cold therapy, heat should be applied before exercising. Applying heat after exercise can aggravate existing pain.
  • Protect yourself from direct contact with heating devices. Wrapping heat sources in a folded towel can help prevent burns.
  • Stay hydrated during heat therapy.
  • Avoid prolonged exposure to heating sources.

Low Level Heat

If you find that heat helps ease your pain, try a continuous low-level heat wrap, available at most drugstores. You can wear a heat wrap for up to 8 hours, even while you sleep.

What to Avoid

Heat can make inflammation worse, and ice can make muscle tension and spasms worse, so be careful. Just like anything else, don’t overdo it! It’s normal for your skin to be a little pink after using cold and heat therapies, but if you start to notice any major skin irritation like hives, blisters or swelling, you should call your doctor. Otherwise, use whatever works for you depending on your condition. Both ice and heat can be very effective if used correctly!

About Emory Sports Medicine Center

At the Emory Sports Medicine Center, our experts specialize in advanced procedures to treat and repair a wide range of sports related injuries. Recently recognized as one of the nation’s TOP 50 orthopaedics programs, Emory Orthopaedics, Sports and Spine has 6 convenient locations across metro Atlanta, as well as 6 physical therapy locations. Click to learn more >>

About Dr. Mines

mines-brandonDr. Brandon Mines is board certified in both family practice and sports medicine. He has focused his clinical interest on sports injuries and conditions of the shoulder, elbow, wrist/hand, knee, foot and ankle. He is head team physician for the Women’s National Basketball Association’s (WNBA) Atlanta Dream, Decatur High School and a team physician for NFL’s Atlanta Falcons. He is also a rotational physician for United States soccer teams.

Dr. Mines enjoys giving talks and lectures regarding the prevention of sports injuries. In fact, as an active member of the American Medical Society for Sports Medicine and the American Society for Sports Medicine, Dr. Mines has attended and presented at various national conferences. Through the years, he has helped all levels of athletes return to the top of their game.

What is a ruptured ligament?

sprained-ankleA sprained ankle is a very common injury in athletes, non-athletes and people of all ages. Approximately 25,000 people experience this injury each day. Ankle sprains are usually caused by an injury that places stress on a joint or ruptures the supporting ligaments. A ligament is an elastic structure that connects bones to other bones.

A ruptured ligament indicates a severe sprain. The ligaments in the ankle hold the ankle bones and joint in position, providing stabilization and support. Rupturing occurs when the ligaments tear completely or separate from the bone, impairing proper joint function.

Causes of ankle sprains

  • Sprains are common injuries caused by sports and physical fitness activities. These activities include: walking, basketball, volleyball, soccer and other jumping sports. Contact sports such as football, hockey and boxing put athletes at risk for ankle injury.
  • Falls, twists, or rolls of the foot that stretch beyond its normal motions are a result of ankle sprains.
  • Uneven surfaces or stepping down at an angle can cause sprains.

Treatment for ankle sprains

When treating a severe sprain with a ruptured ligament, surgery or immobilization may be needed. Most ankle sprains need a period of protection to heal that usually takes four to six weeks. A cast or a cast brace protects and supports the ankle during the recovery period. Rehabilitation is used to help decrease pain and swelling and ultimately prevents chronic ankle problems.

A sports medicine specialist should evaluate the injury and recommend a treatment plan. Meanwhile, using the RICE method is a simple and often the best treatment for injuries.

  • Rest
  • Ice
  • Compress
  • Elevate

Surgical treatments are rare in ankle sprains, but surgery may be needed in the event the injury fails to respond to nonsurgical treatment. Possible surgical options include:

  • Arthroscopy is a procedure done on the joint to see how extensive the damage is. Surgeons look for loose fragments of bone or cartilage or if a ligament is in caught in the joint.
  • Ligament reconstruction repairs the torn ligament with stitches or sutures.

How to prevent ankle sprains

Tips to prevent ankle sprains include:

  • Stretching and warming-up before physical activity
  • Wearing shoes that fit properly
  • Paying attention to walking, running or working surfaces

The highly-trained physicians and surgeons at the Emory Sports Medicine Center treat a wide variety of sports medicine conditions and athletic injuries, including sprains and strains from the foot and ankle to hand and elbow.

About Dr. Olufade

olufade-oluseunDr. Olufade is board certified in Physical Medicine & Rehabilitation and Interventional Pain Medicine. He completed fellowship training in both Interventional Pain Medicine and Sports Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team.

Dr. Olufade employs a comprehensive approach in the treatment of sports related injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in concussion, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration.

Dr. Olufade has held many leadership roles including Chief Resident, Vice-President of Resident Physician Council of AAPM&R, President of his medical school class and Editor of the PM&R Newsletter. He has authored multiple book chapters and presented at national conferences.

Related Resources
Is it a Sprain? Or a Fracture?
Find Out How to Prevent, Diagnose & Treat Ankle Sprains
What Should You Do When You Sprain Your Ankle?

Is it a Sprain? Or is it a Strain?

sprain vs strainA common question we field from patients with injuries is, “Is it a sprain? Or is it a strain?” While they both result in similar pain and symptoms, sprains and strains are actually different injuries that involve completely different parts of the body.

A sprain is an injury that affects the ligaments, which are a type of connective tissue that connects bones to other bones. When a sprain occurs, the ligaments are either stretched or torn and depending on the severity of the stretching and tearing, can be very painful. Sprains most commonly affect the ankles, in particular the lateral (outside) portion of the ankle, which can occur from a variety of activities.

Strains, on the other hand, affect the tendons, the fibrous connective tissue that connects muscles to bones, or the muscles themselves. Strains involve the stretching and/or tearing of these tendons or muscles.

Symptoms of Sprains and Strains

The hallmark symptoms associated with sprains and strains are similar

  • Pain
  • Redness and/or bruising
  • Swelling and inflammation at the site of the injury
  • Stiffness in the affected area

Causes of Sprains and Strains

Sprains typically happen suddenly and can occur in a variety of ways. When a person falls or twists in a way that puts their body in an unusual position or is hit with an impact that does the same, sprains can occur. On the contrary, strains can occur over time as a result of prolonged, repetitive movements, or occur suddenly.

One of the most common causes of sprains and strains is participation in athletic activities.

Treatment of Sprains and Strains

Most sprains and strains can typically be resolved with the RICE method – rest, ice, compression and elevation. Depending on the severity of the injury, future treatment and recovery efforts may involve a combination of physical therapy and various exercise techniques.

Seek help from a sports medicine physician if you experience any of the following:

  • Cannot put weight on the affected area without feeling significant pain
  • Cannot move affected joint
  • Have numbness around the injured area
  • Have significant swelling and/or changes in skin color

With proper care, most sprains and strains will heal without long-term side effects.

Prevention of Sprains and Strains

While there is no true way to prevent all sprain and strain injuries, proper stretching and strengthening regimens can help keep your body strong and more resistant to many injuries, including sprains and strains.

The highly-trained physicians and surgeons at the Emory Orthopaedics & Spine Center treat a wide variety of orthopaedic, spine and sports medicine conditions, including sprains and strains from the foot and ankle to hand and elbow.

About Dr. Olufade

Dr. Oluseun OlufadeOluseun Olufade MD, is board certified in Physical Medicine & Rehabilitation and Interventional Pain Medicine. He completed fellowship training in both Interventional Pain Medicine and Sports Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team.

Dr. Olufade employs a comprehensive approach in the treatment of sports related injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in concussion, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration.

Dr. Olufade has held many leadership roles including Chief Resident, Vice-President of Resident Physician Council of AAPM&R, President of his medical school class and Editor of the PM&R Newsletter. He has authored multiple book chapters and presented at national conferences.

Understanding Talar Fractures

talus fractureThe talus is a small bone that sits between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). Where the talus meets the bones of the foot, it forms the subtalar joint, which plays an important role in walking and stabilization. The talus is an important connector between the foot and the leg and body, helping to transfer weight and pressure forces across the ankle joint. The talus has no muscular attachments and is mostly covered with cartilage, which makes injuries difficult to heal.

What causes a talus fracture?

Talus fractures are often the result of high-energy injuries. Most injuries to the talus result from motor vehicle accidents, although falls from heights also can injure the talus. These fractures also may occur from twisting the ankle, particularly when significant weight bearing forces are involved, which can result in small chips or fragments that are broken off the edges of the talus. Talus fractures may occur in running and jumping sports involving change of direction such as soccer, football, basketball, etc.

Signs and symptoms of a talus fracture

Many patients with a talus fracture will experience a sudden onset of intense pain and swelling about the ankle following the injury. The pain will usually be felt at the front of the ankle—although it may be felt on the sides or back of the ankle—and may lead to an inability to walk due to bruising and swelling, often to protect the talus. In severe cases, particularly involving a displaced fracture of the talus, the patient will be unable to bear any weight on the area. One common sign of a talus fracture is pain that increases during certain movements of the foot or ankle or when standing or walking up hills or uneven surfaces.

How are talus fractures diagnosed?

In many cases the diagnosis can be made by your physician on physical examination alone. He or she will examine your foot, and an X-ray is usually required to confirm diagnosis and assess the severity of the injury.

Treatment for a talus fracture

Depending on the severity of the injury, a talus fracture may be treated with either a cast or possibly surgery. Your orthopedic specialist will advise the patient which management is most appropriate based on a number of factors, including the location, severity and type of the fracture. It’s important to note that a talar fracture that is left untreated or that doesn’t heal properly will most likely create problems for you later. Your foot function will be impaired, you may develop arthritis and chronic pain, and the bone may collapse.

Non-surgical treatment

In rare cases, a talus fracture can be treated without surgery if X-rays show that the bones have not moved out of alignment. You will have to wear a cast for at least six to eight weeks and will not be able to put any weight on the foot during that time.

Surgical treatment

Most fractures of the talus require surgery to minimize later complications. Your orthopaedic surgeon will realign the bones and use metal screws to hold the pieces in place. If there are small fragments of bone, they may be removed and bone grafts may be used to restore the integrity of the joint.

Recovery

Recovery can be prolonged, with no weight or walking on the leg being allowed for eight to 12 weeks.
Patients with a fractured talus should perform flexibility, strengthening and balance exercises as part of their rehabilitation to ensure proper healing. This aspect of rehab is important, as balance, soft tissue flexibility and strength can be quickly lost with inactivity. Most people, depending on the type and severity of the fracture, are able to return to most work and recreational activities.

About Dr. William Reisman

William Reisman, MDWilliam Reisman, MD, specializes in Orthopedic Trauma and has been practicing at Emory since 2010. He is the Chief of Orthopedics at Grady Memorial hospital and is the Director of Orthopedic Trauma. His interests include general fracture care, pelvic and acetabular fractures, periarticular fractures and multi-extremity injuries. He has active research focusing on areas of fracture care, acute compartment syndrome and cost savings analysis at Level I trauma centers.

Related Resources

Takeaways from Dr. Olufade’s Ankle Sprain Chat

Ankle SprainThanks to everyone who joined us Tuesday, May 27, for our live online chat on “Symptoms, diagnosis and treating an ankle sprain,” hosted by Emory Orthopaedics, Sports & Spine physician Oluseun Olufade, MD.

With summer coming into full swing, a lot of us are out, about and getting more active. Some of our activities can lead to ankle sprains. Dr. Olufade discussed some common misconceptions about treating sprained ankles and exercises you can do to strengthen your ankles to help prevent sprains.

See all of Dr. Olufade’s answers by checking out the chat transcript! Here are just a few highlights from the chat:

Question: My son rolled his ankle this weekend at the beach. What do I need to do?

Oluseun Olufade, MDDr. Olufade: Great question! We use something called the RICE principle. Start with “R”est by staying off the foot, “I”ce the ankle for 20 minutes at a time every hour or two, use “C”ompression, like an Ace bandage, and “E”levate the foot as much as possible.

 

Question: What are some common mistakes that people make when they think they have an ankle sprain? In other words, what do people do to “treat” ankle sprains that can actually make them worse?

Oluseun Olufade, MDDr. Olufade: Ankle sprains can be associated with fractures. Some people try to “walk it off” if they think they have an ankle sprain, and without a proper diagnosis, you could actually be doing more damage to your ankle without knowing it.

If you do have an ankle sprain (not a fracture) I would recommend resting the injured ankle for 3-5 days. Some people worry and stay off of the foot for too long. Prolonged immobilization will make for a longer recovery. People often also make the mistake of using heat on the acute ankle sprain. Heat can actually worsen swelling, so ice packs are recommended instead of heat.

Question: How can you tell if you have a fracture and not just a sprain? Are there any additional symptoms other than increased pain?

Oluseun Olufade, MDDr. Olufade: Fractures are usually diagnosed by x-rays. You should see a doctor to confirm whether you have a fracture or not.
 
 
 
 
 
If you missed out on this live chat, be sure to check out the full list of questions and answers on the web transcript. You can also visit emoryhealthcare.org/ortho for a full list sports medicine treatments offered.

If you have additional questions for Dr. Olufade, fee free to leave a comment in our comments area below.