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ORTHOPA EDIC S Sprained Ankle : When Is It Time to See a Doctor? Ankle sprain is one of the most common sports injuries — approximately 2-million people sprain their ankle each year. When is it cause for a visit to the doctor? The majority of people who suffer ankle sprains don’t seek treatment, and in many cases that is appropriate, say two UCLA orthopaedic surgeons who specialize in foot-and-ankle injuries. But some sprains warrant professional attention, including physical therapy. In the most severe cases with persistent symptoms, surgery may be necessary. In those cases, ignoring the problem or trying to fight through the pain can aggravate the injury and prolong the recovery period. “This is a very common injury, with a wide range in the severity of symptoms,” says Joan R. Williams, MD, a UCLA orthopaedic surgeon, who sees patients in Santa Monica and Torrance. “Some sprains just feel twisted or tweaked, and while they are a little swollen and tender, you can still walk. But ankle sprains can also be fairly severe, with lots of swelling and bruising, along with severe pain when any weight is placed on them.” Too often, Dr. Williams notes, people shrug off their ankle sprain and resume normal activities without allowing the body to heal. Depending on the severity of the injury, she advises patients to avoid any impact on the injured ankle, including running and other athletic pursuits, for four-to-six weeks before gradually working up to previous levels. “If you take a few weeks off and then try to run three-to-five miles your first day back, it’s going to place too much stress on the injured ankle and prolong the symptoms,” she cautions. Most ankle sprains heal with basic care that people can administer on their own, says Nelson SooHoo, MD, director of foot and ankle surgery for UCLA Orthopaedic Surgery. In the immediate aftermath of minor or moderate sprains, he advises patients to follow the guidelines that spell out the acronym RICE: rest by avoiding putting weight on the ankle (using crutches if necessary); ice to control swelling; compression to reduce swelling and immobilize the injury; and elevation that props the ankle above the waist. “If you do these things and you begin to feel better, you probably don’t need additional treatment,” Dr. SooHoo says. People with a more severe ankle sprain — characterized by extreme bruising or swelling and an inability to bear weight on the foot without significant pain, or when there doesn’t seem to be any improvement over the first several days after the injury — should seek medical attention, Drs. SooHoo and Williams say. In some cases, patients need only a walking boot or an ankle brace to stabilize the area during healing. When the ankle continues to feel weak or unstable after rest, physical therapy can be helpful. “The majority of people will do well with nonoperative management, including physical therapy and rehabilitation, but for patients who still aren’t better at that point, we can offer the likelihood of a successful result with surgery,” Dr. SooHoo says. “So if there is still a problem, you don’t have to just live with ongoing functional limitations, as we have effective surgical reconstruction techniques.” To view a video about addressing ankle sprains, go to: Vital Signs Summer 2017 Vol. 75 11