Rehabbing from an Ankle Sprain

Rehabbing from an Ankle Sprain

Rehabbing from an Ankle Sprain

One of the most common injuries we see at New Mexico Foot & Ankle Institute is a sprained ankle.  These injuries range all the way from a simple twinge to a set of crutches and a cast.  The most common sprain is when the foot comes down on an uneven surface and the leg wants to keep going thus “rolling” the ankle.  The pain is usually on the outside of the ankle bone and results in immediate pain and swelling.  The biggest myth we hear on a regular basis is that you can “walk it off.”  After practicing sports medicine for 20 years I have yet to see an injury that was best served by walking it off.  All sprains are considered an injury.  Most of these injuries involve the ligaments that connect the leg to the foot and they are injured by pulling them further than they are designed to go.  This goes from a minor inflammatory response to a complete tear of the ligament.  No matter how badly you sprain your ankle there is a very specific way the treatment should go.

Most people have heard the mnemonic RICE.  Rest, Ice, Compression, and elevation.  The first thing to do with every ankle sprain is to immediately get off the ankle that hurts to stand or walk on.  Stop whatever activity you are doing and get off the ankle.  If it feels like it doesn’t want to be walked on, then don’t walk on it.  The second thing to do with any pain that lasts longer than a few minutes is to apply ice.  If there is any swelling this becomes even more important.  Heat is not helpful at this stage in the game and will make the swelling even worse.  You can safely ice an ankle 20-30 minutes an hour (30 minutes on followed by 30 minutes off).  The third thing to think about is getting some compression on the ankle.  Using an ace wrap works great.  Wrapping the ankle will help with keeping the swelling under control.  This is going to be really important when you want to go back to normal shoes and normal activities.  The 4th thing to consider is elevation.  If it is swollen, put it up.

The first type of sprain is called a grade 1 ankle sprain.  These sprains are mild injuries without swelling it’s just a matter of a few hours and the ice and rest do the trick and the next day it is feeling pretty normal.  If you had one of these count yourself lucky and make sure you don’t do any side-to-side type movements for the next few weeks while these ligaments heal.  Normal walking rarely requires the use of these ligaments that were sprained so people feel pretty good as long as they don’t try and walk on uneven surfaces or turn too quickly.

The second type of sprain is a grade 2 ankle sprain.  If the ankle is still sore the day after the injury but you can walk on it and it is only minimally swollen then an over-the-counter ankle brace can be used for the 3-4 weeks it takes for these ligaments to heal.  The ankle brace will help compress the area and it fits much better in a shoe than an ace wrap and is much easier to walk on.  These types of braces are available at all the local pharmacies and the big box athletic stores.  Remember to not push these sprains too hard.  Do what is comfortable and don’t return to normal activity until the ankle is fully pain-free.   Pushing through the pain or trying to run or exercise on an injured ankle always makes it worse.  Knowing the injury can last up to a month for recovery usually helps to keep us patient with the injury.

The third and fourth types of sprain are grade 3 and 4 sprains.  These sprains involve partial or full tearing of the ligaments.  These are considered moderate to severe sprains and require evaluation by a professional.  We don’t necessarily recommend urgent care or emergency rooms since they are good at giving you ice and crutches and can take x-rays if there is a concern for a broken ankle but most of the time they will still refer you to a specialist the next day.  Many private podiatry offices like New Mexico Foot and Ankle Institute will get you in for urgent injuries within a day and can also take x-rays and will be able to get you into a walking boot rather than a cast.

The best way to tell between a minor sprain that you can treat at home and a moderate or severe sprain that should be seen is the swelling.  If the day after a sprain the ankle is still swollen and looks like a softball or grapefruit on the side of your ankle you need to be seen.  The last thing anyone wants is chronic recurrent sprains on that ankle or a sprain that takes 6 months to heal.  Moderate and severe sprains can take up to 3 months for a full recovery.  Many people have heard that a bad sprain can be as bad as a broken ankle and that can be true.  Severe sprains are best served with a cast or boot for a few weeks followed by a medical grade brace for 1-2 months.  Many patients need formal physical therapy to quickly return to 100%.  Therapy also helps to regain your balance which can be lost when the ligaments are torn.  Many injuries heal well enough to not hurt but people are not aware that their balance is gone until they find themselves with another sprain down the road.

There are also a number of other injuries that can occur with a sprain.  If you notice that a mild sprain still hurts after a few weeks or you have a moderate sprain that doesn’t want to progress with treatment after 3-4 weeks in a boot and brace then often an MRI is needed to evaluate the extent of the soft tissue damage that an x-ray can’t pick up.  There can be damage to the cartilage in the ankle joint itself, the tendons can be inflamed or torn, and other injuries can occur that may need a different treatment plan.

An ankle sprain can definitely be a bad injury but if treated appropriately they rarely cause long term issues.  The vast majority of sprains return to normal function and never result in chronic pain or instability.  There are many home treatments for minor sprains and when in doubt it is never a bad idea to get some help from a professional.  Never live life in pain.  If an ankle sprain is slowing you down come see us at New Mexico Foot and Ankle Institute and we’ll work on a plan to get you back to normal activity as quickly as possible.

 

What’s with the MLS laser?

What’s with the MLS laser?

What’s with the MLS laser?

MLS Laser Therapy

MLS Laser

Here at New Mexico Foot & Ankle Institute we continuously deal with painful conditions.  We see arthritis, tendonitis, nerve pain, sprained ankles, broken bones and lots and lots of deformities that limit activity levels for various reasons, but the #1 reason is pain.  With the 100’s of different problems we see there are still only a limited number of solutions.

Personally, I struggle occasionally with a pinched nerve in my left foot.  Despite my good orthotics and great collection of good shoes sometimes it still bothers me.  It came down to getting a steroid injection or using the MLS Laser on it.  I chose the MLS laser and it worked great for me.  So why chose the MLS laser over a steroid injection?  For me, the answer was as simple as the shot hurts and the laser doesn’t.

Low level lasers have been around for many years and studied extensively and shown to be effective in increasing blood flow to an injured area which in turned helped the healing.  Our MLS laser is short for a class IV multiwave locked system laser.  Additonally, te new MLS laser that we are now using is a high energy laser and overcomes the limitations that the older lasers had of not being able to treat conditions that were deeper down from the skin.  High energy lasers like the MLS laser have been shown to have analgesic, anti-inflammatory, and anti-edema effects.  There is a lot of science behind how this works which is well beyond the scope of this discussion today.

The take home message is that the laser can be used to treat almost all of the painful conditions I see in clinic.  Similarly, it opens another door for us to offer more treatment options to patients who are looking for immediate relief of their pain and for safe and pain free ways to achieve that goal.  The laser worked well for my inflamed nerve and we’ve seen tremendous results with the laser on postoperative patients, slow healing wounds, tendonitis, plantar fasciitis, sprained ankles and many other conditions.  In brief, we are always striving to enhance our services to our patients by offering the best available treatments on the market and this is just another way we do this.

Don’t live life in pain, we now have another fantastic option for returning you to enjoy a pain free active lifestyle.

Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Nathan Ivey, DPM

#topdoctors   #bestABQfootdoctors   #nmfai   #wesavesoles #footdoctors   #podiatrist

 

Total Ankle Replacement: Who’s a Candidate?

Total Ankle Replacement: Who’s a Candidate?

Total Ankle Replacement: Who’s a Candidate?

I see a lot of new patients that struggle with arthritis.  One of the most common places is the ankle joint.  We usually start simple with x-rays, bracing, anti-inflammatories, injection therapy, and minimally invasive procedures like an ankle scope.  What happens if all of those things fail?  In the past, the ankle fusion was the only viable alternative.  That may sound aggressive and limiting but, truth be told, most people do very well with the procedure.  I admit that it does sound scary to no longer be able to move the ankle joint.  Many patients then ask, “Are there any other options?  Surgeons can replace hips and knees.  Can they replace ankles?”  The answer is YES.

The first total ankle replacements came out decades ago with more complications than success.  Over the years, things have slowly improved.  Companies are now on 3rd generation implants which have been very successful.  In the past year, I have started doing them at Presbyterian and they are now approved at Lovelace.  Patients have been very happy with these implants and do quite well with them.  The replacements are followed by 2-3 days in the hospital but most patients get to go home.  Most patients are walking 4-6 weeks after surgery as opposed to 8-12 weeks with an ankle fusion.

The most important thing to recognize is that not everyone is a good candidate.  I look at age, severity, deformity, activity level, weight, and of course, medical history before I perform these surgeries.  So, if you’ve been suffering with ankle pain and avoiding surgery because of limited options, I would be happy to meet with you and see if you are a candidate for a total joint implant.

Don’t  Live Life In Pain!  Call us at 505.880.1000 today to make an appointment.

Jonathan Williamson, DPM

Achilles Tendon Injuries

Achilles Tendon Injuries

Achilles Tendon Injuries

If you watch basketball you probably saw or heard about DeMarcus Cousins recent injury to his achilles tendon.  He was diagnosed after the game with an MRI confirming a complete rupture of his achilles tendon which means he will not be returning to play this season.  In my practice we see a lot of achilles injuries ranging from minor tendonitis problems to partial and complete tears.  The interesting thing about DeMarcus Cousins injury is that it was not an obvious traumatic injury.  He was just playing the game like usual, got in a small scuffle and then couldn’t walk on his leg anymore.  It is not unusual for me to see patients who are wondering how they have such a horrible problem with no good story of an injury to tell.  It would be great if we could all talk about how we injured our leg or foot after falling from the back of a car racing down the freeway or sprained our ankle while lifting a car off a fallen friend but unfortunately sometimes we are just going about our normal activities and suffer an injury that takes us out of our normal ability to get around.  Many people feel that since there wasn’t a good cause to the pain that they should just ignore it or hope that it goes away with a little home remedy.  Don’t let the injury get worse by ignoring it.  Most injuries will heal much faster with aggressive treatment.  If you are limping even a little bit you need to be seen and evaluated.  Despite the fact, that you didn’t fall off the roof, you may still have a serious injury that will do better with appropriate treatment by a podiatrist.  Unfortunately, sometimes as in the case of DeMarcus Cousins it may even require surgery to correct appropriately.  Fortunately though, almost all injuries get back to normal function and hopefully if all goes well we’ll see DeMarcus Cousins back on the court next season.

Don’t Live Life in Pain! Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Nathan Ivey, DPM

#topdoctors #bestABQfootdoctors #nmfai #wesavesoles

Childhood Development: What’s normal and what’s not

Childhood Development: What’s normal and what’s not

Childhood Development: What’s normal and what’s not

Ever wonder why your child looks like they are flatfooted or pigeon-toed?  It all could be part of normal development.  I have a 5 year old and an infant so I have been watching feet grow and can sympathize with the concerned parent.  Most have heard that flat feet are bad and can cause problems in the future.  We all want what’s best for our children and many of us make huge sacrifices to achieve those goals.

Normal development:

Bowed legs are normal through the toddler years (2-4) and sometimes it is very pronounced earlier in that time frame and will slowly improve. Flat feet are common in early walkers and can stay flat through 6-8 years of age.  At this time the knee/leg relationship becomes more like an adult and children usually don’t grow out of a foot condition after about 8 years old.

When to see a podiatrist?

Total Ankle Replacement: Who’s a Candidate?

Ankle Replacement Surgery: How long will recovery take?

Ankle Replacement Surgery: How long will recovery take?

I’ve been doing total ankle replacements for a couple of years now.  My implant of choice is the Wright Medical Ankle Implant because of its full, staged, revision system should revision ever be necessary.  One of the most commonly asked questions is concerning the length of recovery after the replacement.  There is a lot of different information out there regarding this subject.   Some information suggests up to a year for recovery.  I think that some of the information is implant specific so keep that in mind.  So what has my experience been?

The surgery generally takes a couple of hours.  After the surgery, most patients spend 2-3 days in the hospital.  While in the hospital, they work with the physical therapy team to ensure that they can remain non weight-bearing on the surgical extremity.  Assuming they have a good support system, they get to go home.  For people who live alone or who need further therapy, they sometimes need to go to a rehab facility prior to going home.

My patients are generally non weight-bearing on the affected ankle for 2 weeks.  After that, I let them start putting some weight on the ankle.  That does not mean that they are walking.  They are in a hard cast from week 3-4 so walking is not really possible.  However, they can put weight on the extremity to stand and to transfer.  Once the cast comes off at 4 weeks, the patient is placed in a surgical boot.  At that point, they can start walking but this is most likely going to be a transition.  Most patients start with the boot and crutches and slowly wean off of the crutches.  That can take a couple of weeks.  Most patients are returning to a regular shoe, sometimes with an ankle brace, somewhere between 6-8 weeks.

So, when are you “back to normal?”  My response is…that depends on what “normal” is for you!  Even after walking in a regular shoe, your ankle and leg can be weak and stiff.  Sometimes, further physical therapy is required.  If you had a fairly modest activity level prior to surgery, you’re going to be back to normal faster.  If you had a higher level of activity prior to the surgery, it is going to take a little longer.  And remember, low impact activity is the way to go with these implants as they will last longer.

I follow my total ankle patients very close for the first 3 months.  I then see them back at 6, 9, and 12 months.   By 6 months, most of my patients are pretty much back to what they would consider to be normal.  And while there are exceptions, this seems to be the trend.

Don’t Live Life in Pain! Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Jonathan Williamson, DPM

#topdoctors #bestABQfootdoctors #nmfai #wesavesoles

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