Ankle injuries are the most common issues affecting the lower limb. It is a fact that 20% of all ankle injuries end up with some type of longer term problem.
Ankle injuries are so common… so how do you know whether it is serious or not?
I was reconstructing a severely injured ankle today and took some video of a very interesting case. My assistant, Dr. Peter Cole, a well known local sports doc, was remarking that he had seen some very serious injuries present to him of late; he was particularly observing that several of his patients had been to the Accident and Emergency centre after the injury, had been seen and then sent home. Two people in particular, had very serious injuries that had been completely under-diagnosed by the people in A and E and inappropriately treated.
Dr Cole made the important observation that both of these people had significant pain on the medial side of the ankle (that is the side of the ankle that is closer to the midline of your body). In the discussion that followed, whilst we were reconstructing the ankle, I made the observation that medial ligament tears of the ankle are far less common than lateral (outside) but that they are often very serious and sometimes associated with tears of the syndesmosis (the joint between the fibula and tibia) and also with serious injuries inside the ankle joint itself.
Of course, it is not just pain medially that matters: there are lots of things that can happen to an ankle and there may well be pain elsewhere.
So when do you know that something serious is going on and when should you see a sports doc or even an orthopaedic surgeon who has expertise in ankle injuries?
The initial treatment for ankle injuries should of course be:
It is very useful to obtain a “Cam” walking boot as it will help with rest and let you get on with your life. You are best to see a sports Doctor, like Dr Cole, Dr Lo or Dr Whiting because they have a good understanding of when to investigate with Xray and perhaps MRI and when to simply wait and see.
My own experience of ankle injuries is extensive. It has been my experience that the less than very serious ankle injuries should be on the road to recovery by 3 weeks. If not, then something may well be more significant; it is then that I would order and MRI and see whether a particular injury requires consideration for surgical reconstruction.
The video below is very interesting and gives a clear understanding of the seriousness of some ankle injuries. It is important to recall that it is doctors and especially sports doctors and Orthopaedic Surgeons who are trained to make these diagnoses. Other practitioners are not trained in the complex process of diagnosis which is, after all the most important part of the treatment process.
If you don’t know exactly what is wrong, you can’t formulate a treatment plan!