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A new twist in ankle injuries

Whether you patrol in a car, a different type of vehicle, or on foot, walking and running are important components of a LEO’s crime-fighting arsenal. So an injury to the foot or ankle can spell disaster -- or at least a sentence to limited duty. Having a strong ankle joint and maintaining foot and ankle health are important in order to continue being able to perform many police functions. Because the ankle is a suspension system that carries the rest of the body, it is vital to treat any foot or ankle injuries promptly and appropriately to prevent future recurrences and complications.

Every day, over 25,000 people sprain their ankles in the United States. Every year, more than 2 million people experience permanent disability as a result of an ankle sprain. The most common reason for an ankle sprain is having had one already, and the best prevention of a second sprain is appropriate treatment of the first one. Repeated sprains are particularly dangerous because they can lead to arthritis in the ankle, a loose ankle, or a tendon injury. There is a high frequency of associated injuries that occur in patients with chronic ankle sprains, including tears and inflammation of the peronal tendons, synovitis of the ankle joint, impingement liaisons, as well as loose bodies and fractures.

Generally, a sprained ankle indicates that one or more ligaments on the outside of the ankle are stretched or torn. Ankle sprains are most likely to occur when the toes are on the ground and the heel is up (called “plantar flexion”). This position puts the ankle’s ligaments under tension, making them vulnerable. A sudden force, like landing on an uneven surface, may turn the ankle inward (“inversion”). Sometimes, a sprain is just an awkward moment with a loss of balance and pain that quickly fades away. But sprains can be more severe; the ankle might swell and cause too much pain to be able to tolerate standing on it. Severe sprains might be accompanied by a “popping” feeling when the injury occurs.

Over 4 million visits to doctors’ offices are paid annually because of foot and ankle problems. Of these, almost 2 million visits are for ankle sprains and fractures. These figures are not too surprising when some foot facts are taken into consideration: Walking puts up to 1.5 times your body weight on your foot; your feet log approximately 1,000 miles per year; and feet are the ultimate shock absorbers, cushioning up to a million pounds of pressure during one hour of strenuous exercise.

Each foot has 26 bones. The ankle bone (talus) and the ends of the two lower leg bones (tibia and fibula) form the ankle joint, which is stabilized and supported by three groups of ligaments. Muscles and tendons move the foot and ankle. Sprained ankles are one of the most common injuries. Because the inner ankle is more stable than the outer ankle, the foot is likely to turn inward (“ankle inversion”) from a fall, tackle, or jump. Inversion stretches or tears ligaments; resulting in an ankle sprain. The lateral ligament on the outer ankle is most prone to injury.

Achilles tendon injuries are also commonplace. The strongest and largest tendon, the Achilles tendon connects muscles in the lower leg with the heel bone. Sports that tighten the calf muscles, such as basketball, running and high-jumping can overstress this tendon and cause a strain (Achilles tendinitis), or a rupture. A direct blow to the foot, ankle, or calf can also cause it.

Another common problem is pain in front of the shin bone (tibia). This pain is usually caused by a stress fracture (called “shin splints”). Overtraining, poorly fitting athletic shoes, and a change in running surface from soft to hard are risk factors for this injury.

Other activities that most often lead to ankle sprains include those that many LEOs engage in during the course of a typical shift. Extensive running, exercise, or training also can overstress the ligaments and lead to injury, including stress fractures and muscle/tendon strains. Jumping also creates a risk of an ankle sprain because it is easy to land on the side of the foot accidentally. It takes only one chase after a bad guy to cause a serious ankle injury.

In addition, improper footwear can play a part in causing foot and ankle injuries. Shoes should fit properly and be appropriate to the type of activity for which they are worn. Not only should uniform shoes be selected carefully, but care should be taken that footwear for any kind of training or sports activity is also appropriate. Improper training can also be a contributing factor to injury, and of course, proper warm-up and conditioning go a long way toward preventing injuries.

The good news is that there are some things that can be put into place in order to prevent or reduce the likelihood of such injuries. And if the foot or ankle does get hurt, new treatments are much more likely to be helpful than ever before.

According to the American Academy of Orthopaedic Surgeons, following these guidelines can go a long way toward reducing the risk of injury to the ankle:

-- Warm up before any sports activity, including practice.
-- Participate in a conditioning program to build muscle strength.
-- Do stretching exercises daily.
-- Listen to your body: Never run if you experience pain in the foot or ankle.
-- Wear protective equipment appropriate for a given sport.
-- Replace athletic shoes as soon as the tread or heel wears out.
-- Wear properly fitting athletic, dress, and casual shoes.

Exercises can be done at home to treat and rehabilitate sprained ankles, as well as to help prevent recurrent sprains and permanent injury. Contrary to what many amateur sports coaches recommend, the standard method of ankle support -- taping the ankle -- may not provide sufficient support to the injured joint. A simple ankle brace can be employed, along with commonly available items, such as ice packs, elastic ankle wraps and elastic bands to help strengthen the ankle.

If a sprain occurs, a medical professional should be consulted for treatment immediately and an X-ray taken to ensure that no bones are broken. It is important to tell the doctor, nurse or therapist exactly what you were doing when the ankle was sprained.

Depending on whether one, two or three ligaments are injured, the sprain is classified as Grade I, II or III. Treatment for a Grade I sprain should encompass R.I.C.E. (Rest, Ice, Compression, Elevation) therapy. If these guidelines are followed, the swelling should be reduced within a few days:

-- Rest the ankle. Do not walk on it.
-- Ice the ankle to minimize any swelling.
-- Compressive bandages immobilize and support the injured ankle.
-- Elevate the ankle. Keep it above heart level for 48 hours.

For a Grade II sprain, the R.I.C.E. guidelines also should be followed. In addition, more time for healing will be necessary. The doctor may choose to immobilize or splint the ankle.

A Grade III sprain is very severe. Sufferers are at risk for permanent ankle instability. For sprains of this magnitude, an orthopedic specialist may treat the sprain with a short leg cast or a cast-brace that is worn for 2 or 3 weeks. Surgery is sometimes -- although rarely -- needed to repair the damage; however, those who suffer repeated ankle sprains may need surgical repair to tighten the ligaments.

Regardless of the severity of the ankle sprain, there are three phases of recovery necessary for proper rehabilitation of the joint. Absent taking the necessary steps to ensure proper healing, a recurrence is very likely, possibly with more severe consequences.

Phase I of recovery includes resting, protecting and reducing swelling of the injured ankle.

Phase II includes restoring the ankle’s flexibility, range of motion and strength.

Phase III includes gradually returning to regular activity while doing maintenance exercises. Once the ability to stand comfortably on the ankle is restored, exercise routines to strengthen the muscles and ligaments and increase flexibility, balance and coordination may be incorporated into the fitness routine.

Following a prescribed rehabilitation program is important as doing so lessens the chances of re-injuring the ankle. If the program is not completed, chronic pain, instability and arthritis can occur in the ankle. Pain is a good indicator of the progress the ankle is making toward a full recovery. Some pain could indicate that the ligaments have not healed properly or that another, different injury has occurred.

To prevent ankle sprains, pay attention to the signals that your body sends. If you feel pain or fatigue, slow down.

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