Ankle

I just felt a pop in the back of my ankle while running–Did I tear my Achilles?

The most common presentation of an Achilles tendon rupture is a sensation of being kicked or shot in the back of the ankle while running or playing a sport.  Pain and limp occur immediately although the pain is typically not severe.  However, a tear of the calf muscle can feel quite similar and is a much milder injury.

How do I know what I damaged?

Diagnosing an Achilles tendon rupture and distinguishing it from a calf strain is a straightforward process in our office.  Through physical examination and immediate ultrasound in our office, we can make the diagnosis and develop a treatment plan.

What is the treatment for an Achilles rupture?

There are acceptable methods of treating these both surgically and nonsurgically.  Casting and bracing along with therapy can achieve very good results in most patients.  Traditional teaching of higher re-rupture rate and lower strength with nonsurgical treatment has been questioned recently; however a comprehensive rehab program is necessary and return to high-level athletics may be delayed.

Surgical treatment is favored for our high-level athletes.  This is an outpatient surgery in which a small incision is made on the back of the leg and the tendon is directly repaired.  At MCO, we use a high-strength Kevlar suture technique that generally allows patients to use a brace only rather than a cast and begin walking within several weeks.  Irritation of one of the nerves to the foot and wound healing problems are the most common problems seen with surgical repair; with our meticulous treatment of the tissues, in our experience this is rare.

When can I return to sports?

With surgical repair, a return to sports is generally feasible within 6-8 months although it may take up to a year to feel as though you are at your previous level of explosiveness and strength.

Drs. Frush, Bak and Silas are all highly experienced in both methods of Achilles treatment.

I twisted my ankle and cannot walk on it.  Is it broken?

Severe sprains and simple ankle fractures often occur the same way and feel similar.  A simple xray in our office can make the determination.  More severe ankle fractures resulting in a deformity are obvious and often require IV medication in the Emergency Department allowing us to “set” these fractures appropriately.

Will I need surgery?

There is a wide range of ankle fractures and severity.  In general, fractures which are nondisplaced (essentially a crack but no separation between the bones) are treated with a cast, crutches, followed by physical therapy with the expectation of full recovery.  Fractures where there is significant displacement between the bones generally require an outpatient procedure to position the bones anatomically and secure them with a plate and screws.  We are able to make that determination in the office via xray during your office visit.

What is the recovery like?

This depends on the severity of your fracture but in general, a 4-6 week period of cast immobilization and crutches is needed for most fractures followed by a 4-6 week period of therapy before returning to all activities without restrictions.  This is generally similar whether the fracture requires surgery or not.

All the physicians at MCO are well versed in ankle fracture treatment both surgical and nonsurgical.  We will get you in and xrayed quickly and formulate the appropriate treatment plan at your office visit.

What is the difference between a sprain and a torn ligament?

Ligaments are the rope-like structures in our body that stabilize joints.  A sprain refers to an injury to a ligament whether partial or complete.  These injuries are quite common in the ankle as twisting or turning of the ankle is very common in athletics.

The severity of the sprain is based on the degree of tearing of the ligaments.  In an ankle sprain, there are generally three ligaments that can be involved and the grading of these sprains depends on how many and to what degree these ligaments are injured.

Will I need an MRI?

Typically an MRI is not needed to diagnose or treat an ankle sprain.  An xray is obtained to rule out a fracture and then the injury is graded based on the clinical examination.  An MRI will show tearing of ligaments–this is what an ankle sprain is.  MRI is generally only ordered if the ankle is not healing as expected to see if there is additional injury to the cartilage or joint.

How is an ankle sprain treated?

Early weight-bearing and motion is encouraged for ankle sprains.  Other than uncommonly severe sprains, cast immobilization is counterproductive.  Early physical therapy is quite helpful in speeding the recovery and the time to return is directly related to the severity of the sprain, ranging from several days to 6 weeks.

What is a high ankle sprain?

A high ankle sprain refers to the syndesmotic ligament which is a thick ligament attaching the two bones of the lower leg together.  Most ankle sprains involve only the smaller ligaments attaching the lower leg to the foot; the syndesmotic ligament is actually located above these ligaments, hence the term “high ankle sprain.”

This is a more significant injury which may require use of a boot and does take longer to achieve full healing.  In some cases, if the ligament is completely torn, this may require a minor outpatient surgery to stabilize the ankle.  This is the “Tightrope” surgery which was highly publicized when Tua Tagovailoa of University of Alabama returned to play several weeks after his operation.  This technique has been used for several years by sports surgeons including Drs. Frush, Bak and Silas when necessary.

What is a 5th Metatarsal fracture?

This is a very common injury involving a break in the bony prominence on the outside of the foot about halfway between your heel and your pinky toe.  This frequently results from an acute “turning in” of the foot while stepping on uneven ground, similar to the mechanism of a simple ankle sprain.  However, these can also occur as chronic stress fractures which is a more serious type of injury.

How is this treated?

A simple or “avulsion” fracture of the 5th “Met” is treated with rest, comfortable shoes and maintenance of weight bearing and mobility–in our athletes, therapy may be required to maintain your strength to allow for a quicker return to sport once the fracture heals sufficiently which can take 4-6 weeks.  There is a variant of this fracture known as a Jones fracture which is more complicated.

What is a Jones fracture?

This is a fracture of the 5th Metatarsal occurring in an area of the bone that has poor blood supply.  As such, it can develop over time as a stress fracture and also takes a much longer time to heal.  As opposed to the simple avulsion fracture, the Jones fracture requires a cast for up to 3 months and at least 6 weeks of crutches.  In athletes, we frequently recommend a brief outpatient surgery to insert a screw in the bone to a) ensure the bone heals and b) speed the recovery and return to sport.

Drs. Frush, Bak and Silas treat both forms of this injury frequently and routinely perform this procedure on our athletes with excellent success in speeding their return to sports.