How to get back to Sports after an Ankle Injury?

Dr. Abhishek Arun Nerurkar, Orthopedic SurgeonDr. Abhishek is an M.S. Orthopaedics., D.N.B. Orthopaedics, and is associated with Hinduja Healthcare Surgical, Khar, Holy Family Hospital, Bandra and SL Raheja Fortis, Mahim. He is a Consultant Orthopaedic Surgeon, and Specialist in Shoulder and Knee Surgeries (Arthroscopy and Arthroplasty).

I believe few decades back, sports was considered to be an accessory. However, now there is increased awareness for sports as a profession. As the competitiveness increases, sports are played with passion as also there is more chances of injuries. All contact sports need high energy activities and are prone to injuries. There is increased forces across the weight bearing joints like knee and ankle and also the muscles and tendons passing around the joints.

Ankle injuries over the years have been considered as sprains and treated with immobilization. Patients had to adapt their lifestyle and often go back to desk job if the ankle didn’t heal completely. However, with the advent of technology to diagnose the exact problems and invention of newer implants, there is hope to all the sportsmen to recover faster and often get back to their previous fitness levels.

The most common ankle injuries that we commonly encounter are ligament sprain. The treatment and outcomes are not as simple as it appears. You should show your doctor to classify the extent of the injury. The sprain may consist of mild injury to few fibres of the ligament or it may be complete rupture of the ligament. The treatment and recovery may be completely different in both the sprains.

The most common investigation advised by your doctor will be the X-rays as per the probable diagnosis suspected by the clinician. The X-rays are often taken to rule out concomitant bony injuries. Sometimes a CT scan may be performed to get additional information on the bony architecture. Usually your doctor will put you in some kind of immobilization for certain period of time to get your pain and swelling
down. Once the swelling is down, the ankle is examined again and need of further investigations is determined. The magnetic resonance imaging (MRI Scan) is the most common advanced investigation performed to diagnosed soft tissue injuries. It gives thorough diagnosis for tendon injuries, integrity of the ligaments and also the joint cartilage. In patients with high BMI and with high levels of activities, the forces around the joint may be more and may lead to delayed healing or re-tears.

The other common injuries giving niggles to sportsmen are tendon injuries. As you know, the function of human activity is done by muscle tendon units. All the force generated by muscles is transmitted to the bone by the tendons. As such in sports and violent activities, these forces may be more than what the tendons can sustain leading to injuries. Repetitive stresses on tendons in contact activities like football, basketball and others cause inflammation in the tendons, known as tendinitis. You may feel the pain in certain activities and hence affects the performance. Sometimes there may be pain on rest and sportsmen may have to skip a season. It is often prudent to start treatment in early stage so that you can go back to sporting activity early. It is often possible that there may be partial to complete tears of the tendons and such injuries may need surgical treatments.

The sprain may consist of mild injury to few fibres of the ligament or it may be complete rupture of the ligament

Constitutional problems like generalized hyper elasticity of ligaments and pes planus (flat foot) are often coexistent and should be taken into consideration. Individuals with hyper elasticity are good at gymnastics due to better flexibility, but are at increased risk of injuries in high energy sports. Individuals with flat foot often need footwear modification and/or arch supports to improve mechanics and prevent fatigue and chronic pain.

I believe that the treatment of all sports injuries begins on the field with cold fomentation by ice application and cold fomentation. If the injury is deemed to be critical, the person should leave the field for assessment to prevent further damage. Rest and elevation are one of the most important aspects of initial treatment to reduce tissue trauma and also reduce pain and swelling. You should get yourself assessed by a sports medicine consultant to decide when you can continue with sports. Most of the injuries do heal with conservative management and immobilization, but it depends on the nature and extent of the injuries.

As you know, prevention is better than cure, and hence sportsmen should take proper precautions to avoid injuries. The most important precaution to be taken before every game and practice session if to have a proper warm up protocol. In Sports where you need a protective gear, a player should always use a proper gear as per the demand of the activities needed. To prevent foot and ankle injuries, appropriate shoes go a long way to prevent injuries. Regular exercise to maintain the tone of muscles is very important. There should be dedicated time set to build up muscle tone. Overexertion is a strict ‘NO’. Always do training under proper guidance and you should be able to draw line to prevent over exertion and prevent chronic aches. And lastly, don’t do self-medications. Always consult your doctor in cases of niggles and take the proper treatment after the diagnosis is established, so that you can go back to pre-injury sporting levels early.