Working primarily with athletic populations, we evaluate and treat a plethora of ankle injuries, especially during peak volleyball and basketball seasons. Our role as medical oversight at sporting events is to be there and assess athletes following acute injuries. In sports, it's common for athletes to step on their teammate's feet and roll their ankles.
After limping over to the medical tent, the first questions are "do you think it's broken?" and "do we need to go get an X-Ray?"
Well, you could technically X-ray every ankle injury, but that doesn't mean it's necessary. As clinicians there has to be evidence that we cannot rule out fractures without imaging. This means we have a certain set of guidelines and rules that we apply to the presenting history, complaint, and examination to make the best clinical decision for the patient.
Let's discuss further how we determine whether or not you should get an X-ray if you just rolled your ankle.
First and foremost, fracturing and breaking a bone are synonymous terms. We hear that ALL the time. "Is it fractured or is it broken?" They layman term is broken and the clinical term is fractured.
Second, there is usually a traumatic component to the history of fractured ankles. For example, if you were just walking in high heels and rolled your ankle, rarely does that result in a fracture. However, if you were walking in high heels and someone ran into you quite hard and you rolled your ankle, there is now a traumatic component.
In sports, this looks like landing on your teammate's foot, sliding into 2nd base and your foot gets caught, an opposing player following on your ankle, or even getting hit by the ball in the ankle. Without this occurring, it is much less likely that the ankle has been fractured.
Finally, the most important part is the examination of the ankle. When we examine things there are multiple things we must consider, however, we formulate our decisions by assessing, the location of pain, intensity of pain, edema (swelling), bruising, range of motion, function, and orthopedic examination.
This step is crucial in determining the next steps following an acute ankle injury as it can make or break the treatment of the ankle (pun intended). For example, just because the ankle is swollen and bruised, does not mean it is fractured and vice versa. We had a patient in our office that had one of the puffiest ankles we've ever seen with severe pain and minimal range of motion, but not the slightest bit of bruising. We've also seen horribly bruised ankles with minimal pain and great function that weren't broken.
In addition, when determining if radiographs are needed for an acute ankle injury, the Ottawa Ankle Rules are commonly followed.
The Ottawa Ankle Rules consist of the 5 major things (as discussed in the video):
- Bony tenderness along distal 6 cm of the posterior edge of fibula or tip of lateral malleolus
- Bony tenderness along distal 6 cm of the posterior edge of tibia/tip of medial malleolus
- Bony tenderness at the base of the 5th metatarsal
- Bony tenderness at the navicular
- Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
If any one of these are present, we cannot rule out ankle fracture and it is clinically advised to seek radiographs of the ankle following trauma.
For us, this is quick and easy. But we also use things like a tuning fork to help determine if you should get an X-ray. Because bone is very sensitive to vibration when fractured, a vibrating tuning fork is placed on an area of potential fracture and there would be a moderate to intense amount of pain. This is helpful for areas like fingers and feet, but not arms or spine.
Following an X-ray, the next steps are critical. If fractured, seek an orthopedic specialist. If no fractures are detected, it's crucial to see a practitioner who will help start the rehabilitation process as soon as possible. You can wait weeks to see an ortho, or you can schedule with doctors like us who will get straight to helping the healing process through a combination of our hands and world-class modalities as well as start the mobilization and strengthening process ASAP! And of course, if we don't feel comfortable we would refer for an MRI or send you out to ortho.
If you or your youth athlete at home has recently suffered a traumatic ankle injury and you're concerned on what the next steps should be, schedule your free discovery visit today at strengthchiro.com or call 727-228-3030 to learn more about how we can simplify the process and help you get back to the game as fast as possible!
