sprained ankle ... how to get back to racing asap?

[flash]

Well, I did it. A "RNS" ... really nasty sprain ... to my ankle, but thank goodness the x-rays say not broken.

I'm doing the obvious ... icing inside (ben and jerry's) and outside, rest, splint & crutches, vitamin I, and elevation. But, I would really appreciate any advice on how to return to full function (and, of course, to 'cross racing!) as quickly as possible ... without sacrificing long term health, of course!

I'll be under the care of a great physical therapist, but I wanted to post here to get ideas from other people who have "been there".

[OakLeaf]

Electro-stim, lots of papaya enzyme and Ester-C, a little extra protein, gentle self-massage (strokes, really), comfrey root poultices.

And when you're ready to start ankle-stressing activities again, this is a really, really terrific brace: ASO brace from See The Trainer. Rock-hard support against lateral movement, nearly full flexion and extension, comfortable, fits easily inside an athletic shoe (though not necessarily a motorcycle or ski boot).

Hope you feel better soon.

[HillSlugger]

Flash, how's the rehab going?

[flash]

thanks for asking! j-u-s-t came back from my 2 week follow up visit to the dr. After a brief moment of panic (the dr's, not mine), another round of x-rays was ordered to make sure my foot/ankle wasn't broken in a place that didn't show up during the 1st x-rays (apparently it should look and feel much better than it does). Those x-rays were clear too, so more waiting, icing, and resting were ordered with a plan to start PT in a couple of weeks.

Not ideal, but it could still be worse. At least using crutches is helping me build some serious upper body strength, AND the whole adventure has made me go back to swim trianing (sans kicking, of course)

[HillSlugger]

I sprained my ankle in a race back in June. I never needed crutches and was not sent for PT. I was able to restart swimming and biking about 10 days later. I went 3-4 weeks without running and hadn't really regained my running speed or form for my triathlons in July and August. I ended up taking off another 8 weeks due to knee issues that were probably initiated by the ankle sprain. I'm happy to say that I've now been running again for 2 weeks and it's all feeling good again and my times are looking good.

Please come back and give us periodic updates.

Nicole

[flash]

Hi! Quick update & wondering if this type of situation is "normal", and what I can do about it.

I'm now 2 months out from my "oops" decision that resulted in a sprained ankle. I'm definitely no where ready to race, and haven't even been able to ride my bike trainer for 10 minutes in a super easy 32--27 without having a serious setback. I spent 1 month on crutches, and have been super-compliant with PT exerices, in clinic and at home. Treatment has been physical manipulations by PT/PTAs, ROM, some strength work, lots of balance work, some unweighted walking. Most inflammation is gone, and I could walk (without being unweighted) without limping up to about a week ago, the ankle joint/ligaments have been labelled as healed, strong, and stable, BUT ... there is a new diagnosis of peroneal tendonitis. The pain from the tendonitis largely prevents me from walking without a limp, is intensified by most weight bearing exercise (standing, especially barefoot; walking, cycling; elliptical if tape isn't applied across the lower outer leg). A massage therapist (who I trust) indicates this is b/c residual inflammation is keeping the bones from sitting and interacting properly, and as a result the tendons are not sitting down in their grooves properly. He can tweak the tendons to sit down, which feels wonderful, but after 1 day or so, they're back where they were before massage & incredibly painful again. PT and Dr. say "rest and wait" until the residual inflammation goes down, then go back to the strength phase of the original ankle sprain PT rehab plan.

Unfortunately, Santa didn't bring that extra dose of patience that I was hoping for, and I'm obviously not going to be racing or taking bike vacations anytime soon!

So....is this type of secondary tendonitis common for an ankle sprain?
Is it a result of something I did? Walking too soon, or too much too soon? (It seemed to appear after we added calf raises to the PT program ... calf raises were quickly halted, but...)

And...what do I do about it? After 2 months of resting my ankle/leg, I'm really not keen on adding 2 or more more months to just wait for the inflamed tendon(s) to settle down. Will a steroid shot or ionto help speed healing?

Thanks, in advance, & looking forward to a more positive update soon. The swimming is going well...still can't kick hard or push off the wall, but I'm getting pretty good at one legged pushoffs and swimming. I used to train with a phenomenal swimmer, Darta, who was an amputee with a single leg. Thinking about Darta's achievements is helping me keep things in perspective...and is inspiring me to try some masters swim meets in the next couple of months, 1 legged swimming and all!

[flash]

p.s. The ASO brace that you recommended WAS awesome for stabilizing the ankle's side to side movement, and it's very comfy too. It isn't helping with the tendonitis, though...

[KnottedYet]

You said they xrayed you twice, and found no broken or cracked bones? Whew! Sounds like one doozy of a sprain!

What are the PT/PTA mobilizing? (why do you need mobs?)

Sounds kind of like something in your hindfoot is still pretty unstable. Do you already have custom orthotics or insoles the PT had you get? If not, and you're willing to spend $35, I'd suggest you get Superfeet Green insoles or some other very firm support insole with a deep heel cup. The deep snug heel cup will help to stabilize the hindfoot (and so also the ankle) and maybe help cut down on inflammation from excess movement.

Cutting down the irritation/inflammation and the excess stress might let the sprain finish healing. Keeping things stable might let the sprained and loosened ligaments tighten up a bit.

Ask your PT to watch you walk barefoot down the hall. Ask them where they see the instability as you weightbear and progress over the boo-boo foot (is it hindfoot or forefoot) and ask if they can recommend an over-the-counter insole to correct the instability. (if it turns out to be a forefoot problem, they'll still want you to have some OTC insoles so they can put wedges on the underside to stabilize the forefoot. But if it's forefoot a deep heel cup won't be so crucial.)

Your best bet is to have an eyewitness check out the behaviour of the foot/ankle while walking. I can throw ideas out there, but I wish I could see it myself! Take everything i say with a grain of salt.

Edit to add: oops, I forgot to mention that peroneal tendonitis is often related to hindfoot instability because the peroneals are part of the "stirrup" muscles that support the arch of the foot and act at the ankle sort of like the brace you were wearing. They may be getting overworked trying to stabilize you or you might be pronating from the sprain and yanking on those muscles a lot.

[flash]

thank you!!! We've done lots of barefoot walking inspection, but I didn't know why or what was being analyzed. Your explanation certainly helps me understand what they were looking for & what questions to ask. Thanks! One more question? Just came back from MT & am frightened! Do you really get put in a cast for 6 months if the tendonitis doesn't resolve itself with rest? Ai yi.

[KnottedYet]

Do you really get put in a cast for 6 months if the tendonitis doesn't resolve itself with rest? Ai yi.

Ummm, not that I know of.

Rest, wait, find a way to give your foot a mechanical advantage (brace or insoles or good shoes).

Ionto or steroids can work at inflammation, but won't eliminate the cause of the inflammation. Sometimes they weaken tissues. I'd go after mechanical assistance before chemical assistance.

And if things just don't seem right, hunt down a specialist. (I like specialists. I can pick up on obvious stuff, but when I'm really stumped I love specialists, cuz they pick up on the subtle stuff!)