By Brett D. Sachs, DPM
"Most of the time we order an MRI, especially after 6-8 weeks if they are still having pain for some unknown reason. MRIs, as far as I’m concerned, are much more predictable as far as telling me what you need to do if they’re still having pain after 6-8 weeks.
We kind of grade it on one, two and three. One, two, three basically means one’s not so bad, and three is the worst kind of ankle sprain you can have. Little swelling, much more swelling and bruising, and much more swelling and bruising. They basically are stretching of the ligament, stretching and partial tearing, and complete rupture of the ligament. With that, you’re only going to tell with a really good clinical exam and an MRI. As far as treatment goes, there’s basically two schools of thought. One is a functional rehabilitation and the other is more traditional. Functional is more like what physical therapists do. I believe more of a traditional approach. I tend to keep people in a walking boot for about 2 weeks followed by physical therapy and an ankle brace, but the other option is a functional rehabilitation where they get into physical therapy right away. I find that patients are just way too uncomfortable, way too swollen to do that. In my experience they don’t tolerate it very well.
The typical sprain can take about 2-3 months, and that’s a misconception - everybody tries to ‘walk it off’ or try to get back to activity too soon. That’s when it turns into 4-6 months, when the average sprain will just take about 2-3 months to heal.
Some basic things as far as treatment goes - typical R.I.C.E., anti-inflammatories, immobilization, ankle supports - this is the one that we typically use, a lace up brace with supporting straps. I had a patient in a cast who had his ankle fracture, and he took his x-ray and painted it right on his cast. I always thought that was a great one.
Physical therapy, as we talked about, there’s some very specific things that physical therapies do for ankle sprains. Range of motion exercises, strengthening exercises, functional rehab where you use a tilt board to try to stabilize the ankle, resistance bands and things like that. The goal is to regain full range of motion and strength so they can get back to normal activity."