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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine.

January 1998

Ankle Injuries

By Rick Allen, DC

"Better health leads to better dancing."

This month I'm starting a series of articles elaborating injuries of the ankle, knee and shoulder joints. I'll start from the ground up, so this month let's examine two chronic and acute ankle injuries. Chronic injuries result from low-grade overuse and poor biomechanics over long periods of time, such as dancing for hours on end in poor shoes. Acute injuries are the result of sudden trauma, such as falling while doing a lift.

The most common site of chronic, overuse ankle injury is the Achilles tendon. These injuries can range from simple tendinitis to severe rupture. This large tendon is comprised of two tendons of the soleus and gastrocnemius muscles of the calf that come together to insert on the calcaneus or heel bone. Usually, the first set of symptoms involves inflammation of the vascular sheath surrounding the tendon. This pain is described as a mild burning or prickly heat sensation about 1 to 3 inches above the calcaneus. This area of the tendon has the poorest blood supply and is susceptible to injury even from rubbing of the back of the shoe.

The second stage of injury causes inflammation and degeneration of the actual tendon fibers: a tendinosis. Second stage pain is described as a shooting, stabbing sensation during physical activity, especially after a sudden change in direction or while running uphill. You may actually feel a crackling sensation while rubbing a hand over the tendon: this is due to inflammatory fluid collecting under the tendon sheath.

Stage three involves extensive weakening of the collagen protein fibers, leading to a partial or complete rupture. You may feel a sudden snap or a pop when the tendon ruptures. It may not even be painful; however, a great deal of swelling develops. Your physician can do a simple test squeezing the calf to test for a ruptured Achilles tendon.

As always, prevention is the best course of action. A solid preconditioning program consisting of both stretching and strengthening exercises will help prevent inflammation and possible rupture. If symptoms do appear, simple self-treatment includes stretching, icing the tendon after dancing, and avoidance of irritating shoes. Your physician may prescribe a heel lift or orthotics to support the foot and give the Achilles tendon a rest.

[ Diagram of heel and tendons ]

Ankle sprains are one of the most common acute athletic injuries. Ankle sprains can affect either side of the ankle, but most frequently damage the lateral (outside) ligaments. This occurs when the foot turns under the leg, stretching the ligaments to the point where they may tear or rupture.

Sprains are graded as mild, moderate, or severe. A mild sprain usually affects only the anterior talofibular ligament, causing a partial rupture. A moderate sprain involves the anterior talofibular and calcaneofibular ligaments, resulting in increased damage to the structure of the ligaments. A severe sprain affects these two ligaments as well as the posterior talofibular ligament and may result in their complete rupture or, occasionally, a fracture of adjacent bones.

Although some mild sprains may allow a return to activity in 2 or 3 days, the seriousness of a moderate or severe ankle sprain should not be underestimated. Improper treatment may result in a chronically unstable ankle that is prone to repeated injury, forces limitation in sports activities, and eventually results in the need for surgery.

Mild ankle sprains cause some initial discomfort, mild swelling, and little or no bruising. Treatment should include immediate discontinuation of physical activity, icing the ankle for 20 to 30 minutes, and applying an elastic wrap. The affected foot should be kept elevated as much as possible. If swelling persists, icing should be repeated several times a day. This initial treatment is referred to as RICE - rest, ice, compression, and elevation. With mild ankle sprains, RICE usually needs to be continued for only 2 to 3 days, followed by a gradual return to activity.

Moderate ankle sprains cause a greater amount of pain around the outside of the ankle, plus increased swelling and bruising within 12 to 24 hours. Initial treatment is the same as for mild sprains: RICE. In addition, moderate sprains require increased protection, such as a soft cast, to allow proper healing of the ligaments. If you suspect that you have sustained a moderate to severe sprain, you should seek professional help, because of possible ligament damage. X-rays should be taken to rule out any bony damage. A moderate ankle sprain may have to be immobilized for 2 or 3 weeks. After the ligaments have healed, exercise involving the ankle can gradually be resumed.

A severe ankle sprain is a serious injury. A tearing or popping may be heard or felt. There is immediate pain, with swelling within 5 minutes of the injury. Although it may be possible to walk on the ankle immediately afterward, pain and swelling increase over the next 30 minutes, until it becomes difficult to walk. There may be extensive bruising over the outside of the ankle, foot, and leg. Initial first aid is again RICE. A professional examination and x-rays should be obtained as quickly as possible. If there is a complete rupture of the ankle ligaments, surgical repair may be required. If the ligaments have been damaged but the ankle is still stable, a cast may be necessary for 4 to 6 weeks. After recovery from a severe ankle sprain, extensive rehabilitation is needed. All told, recovery may take 6 months.

An ankle rehabilitation program should be started after the ankle ligaments have had adequate time to heal. The rehabilitation program prescribed by your physician will generally include the following steps:

  1. Range of motion exercises without resistance.
  2. Inversion-eversion exercises while standing.
  3. Peroneal muscle strengthening.
  4. Toe walking with shoes.
  5. Heel walking with shoes.
  6. Gradual return to activity.

The specific steps and the length of time spent at each step must be determined on an individual basis.

With care and preventative exercises, hopefully you will keep on dancing and not experience either of these debilitating injuries.

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