People tend to take their ankles for granted. They often do not stop to think that these joints support their body weight, allow them to walk, run, turn, stand on tiptoe, and do so much more. Dancers, figure skaters, and athletes depend on ankles to pivot, change direction, jump, and sprint. As long as these joints are healthy, athletes and regular folks do not give them much thought. Even ankle pain is of little concern to most people. It is only when a sprain occurs that individuals begin to consider ways to relieve the associated ankle pain, strengthen the joint, speed healing and, just as importantly, to prevent an ankle injury from recurring.
Why Ankle Sprains Happen
There are many factors that cause ligaments to stretch or tear, resulting in the sharp and almost unbearable ankle pain that accompanies an ankle sprain: walking on a broken sidewalk or other uneven surface; a jump that ends in a clumsy landing; a fall or other movement that causes the ankle to twist out of its normal position; inadequate warming up before exercise; and participating in a sport or physical activity for which one is not conditioned, especially if he or she is overweight. The possibility of an ankle sprain occurring intensifies if an individual has previously injured the joint.
In addition, current lifestyle trends contribute to ankle instability and resultant ankle pain. Closed and high-heeled shoes and urban walking surfaces reduce the ability of muscles to keep ankles stabilized and result in a loss of proprioception—an awareness of the position of the ankle as the foot comes in contact with the ground even when the person does not see the joint. All these factors combine to increase the likelihood of an ankle sprain and other ankle injury.
Keeping Ankles Strong
It is unnecessary and unwise to wait until an ankle injury occurs to take action to strengthen these vital joints. Especially if ankle pain is present, taking action is important to keep them healthy. Strength training to improve fibular and ligament vigor and keep ankle pain under control–and prevent an ankle sprain–need not involve visits to the gym or physical therapist. These simple exercises increase proprioception, muscle tone, joint stability, and the brain’s ability to anticipate body movement.
Ankle Writing. Write each letter of the alphabet with your big toe. Repeat once or twice.
Toe Raising. With your leg straight, raise your toes as far as possible without bending your knees. Hold for 15 seconds and repeat 10 times.
Heel raising. Keeping your legs straight, point your toes. Maintain this position for 15 seconds and do it 10 times.
Circles. The increased flexibility this exercise provides is an excellent way to prevent ankle injury. Move your ankle in a circular motion. Do 5 to 10 circles both inward and outward 3 or more times a day. Repeat with the other foot.
Steps. This exercise is excellent if you have ankle pain; it manages the discomfort that indicates a predisposition for an ankle injury. Put one foot on a bottom step. Slowly straighten that knee as your raise the other foot. Return to the starting position and repeat 3 to 5 times a minimum of 3 times daily with each foot.
Ankle flex. With your legs straight in front of you, turn one ankle inward as far as you can. Count to 15 and straighten your foot. Then turn your ankle outward as far as possible and count to 15. Do the same with the other foot. Repeat 10 times each way.
Resistance ankle flex. Tie the ends of an exercise band into a knot. Sit on a chair and wrap one end of the loop around a leg of the chair and the other around one foot. Do not let your heel leave the floor as you move your ankle outward. Count to 10, return to starting position, and move your ankle inward and hold for 10 seconds. At least twice a day, do 10 repetitions in and out.
Balancing act. Improving your balance is essential to avoiding ankle pain and ankle sprain. While standing with a chair next to one leg, stand on the opposite foot for a count of 30. Do this 3 or more times daily.. As you progress, build the time up to 3 minutes. Try closing your eyes while performing this exercise for an extra challenge.
Acting now to keep ankles healthy will guarantee freedom from painful and devastating injury for years to come. It only takes a few minutes a day.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris with large hematoma (blood)
Separation of muscle ends due to tear elicited on dynamic sonography examination
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