Could Old Ankle Sprains Hamper Fitness Efforts?
Have you been seeing an increase in lateral ankle pain among baby boomers who have recently resumed regular exercising or sports activities? Sports medicine experts say the pain may be the result of old ankle sprains that haven’t healed properly and recommend checking the ankles of these patients for chronic instability. An estimated 25 percent of sports injuries involve the foot or ankle, according to the American College of Foot and Ankle Surgeons (ACFAS), and a majority of these result from incomplete rehabilitation of earlier injuries. Robert Duggan, DPM, says rigorous physical activity for these patients may cause persistent pain and swelling, and increase the risk for further damage to improperly healed ligaments. When it comes to diagnosis, Mark Dollard, DPM, says it is easy to identify the major classic injuries of torn ligaments and bone fracture with stress testing. However, he cautions that initial diagnostic tests may miss the hidden tears in the peroneal tendons, osteochondral joint cartilage defects in the ankle, joint capsule defects, associated sinus tarsi syndromes or nerve damage. One may not see these developing problems until “months later” via sophisticated MRI or CT scans, according to Dr. Dollard, the Scientific Chairman of the upcoming 2003 National Scientific Conference of the American Podiatric Medical Association. Amol Saxena, DPM, concurs, noting that “peroneal tendon tears are an overlooked cause of lateral ankle pain.” He says there are warning signs you can look for during the clinical exam. Dr. Saxena says you should be especially suspicious of a split or tear of a peroneal tendon if your patient has persistent pain and tenderness after a sprain, feels a “pop” on the outside of his or her ankle, and cannot stand on the tips of the toes. He says sometimes the injury is so severe that the tendon will produce a snapping over the lateral malleolus, which usually needs to be repaired surgically. One should obtain a MRI to confirm clinical suspicion of the injury, advises Dr. Saxena, who practices within the Department of Sports Medicine at the Palo Alto Medical Foundation in Palo Alto, Calif. Key Treatment Considerations Recent research from the ACFAS annual meeting revealed that more than 85 percent of athletes who had surgery to repair a torn peroneal tendon were able to return to full sporting activity within three months after the procedure. Dr. Saxena, a Fellow of the American Academy of Podiatric Sports Medicine, adds that these patients usually do spend six to eight weeks in a cast postoperatively and then undergo physical therapy. Generally, when it comes to treating ankle sprains, Dr. Dollard says the severity of the sprain determines the duration of immobilization needed for proper healing. He says patients with grade 1 sprains (which involve stretched ligaments) or grade 2 sprains (consisting of partially torn ligaments) should resume “functional weightbearing with stabilizing devices as soon as possible to prevent diminished recovery of the lateral ankle reflexes.” In order to attain the necessary stability of the ankle, Dr. Dollard says one can utilize a variety of recent bracing devices, including custom dynamic hinged ankle foot orthosis or static AFO braces. These devices help patients make the transition from non-weightbearing casts or boot devices to weightbearing rehabilitation options, emphasizes Dr. Dollard, the Founding AMPA Liaison to the President’s Council on Physical Fitness and Sports. What Preventive Action Can Athletes Take? Dr. Dollard says baby boomers also tend to forget that their musculoskeletal reflexes that protect posture and balance do become slower as they age. (He notes lateral ankle reflexes are the most vulnerable.) This tendency makes sprains an “inevitable consequence” of a hasty return to exercise or the playing field, according to Dr. Dollard. Before baby boomers begin any exercise program, Dr. Dollard recommends testing them for any ankle instability or lower extremity balance problems with the functional Trendelenberg Test. He says you should have the individual stand on one foot only with his or her arms outstretched to the side. Proceed to have the middle-aged athlete gently raise up onto his or her tiptoes and hold that position for 30 seconds. “Any gross failure to hold this position or to tilt the torso in compensation over the supporting limb heralds impending balance disaster,” says Dr. Dollard. If that happens, Dr.