Lateral ankle sprains are the most common type of ankle sprains. These sprains happen after an inversion injury or inward rolling of your foot on your ankle and affect the ligaments on the outside of your ankle. They most commonly occur in sports, especially seen in basketball and football, but also can occur in everyday activity. The lateral ankle is composed of three major ligaments, the anterior talofibular ligament (ATFL), the calcaneal fibular ligament (CFL), and the posterior talofibular ligament (PTFL). There are varying degrees of severity of ankle sprains, but the most commonly injured ligament is the ATFL.
Certain people are more prone to ankle sprains than others, especially those with a higher arch foot or those who have had a severe or multiple sprains in the past. It is normal after suffering from a sprain to have varying levels of swelling and bruising. The most important thing following a sprain is over the first 24-72 hours to practice the pneumonic RICE. RICE stands for rest, ice, compression, and elevation. Studies also show that initiation of early range of motion is key in the recovery process. Once the swelling goes down, then strengthening of the muscles around the ankle joint should be initiated to help prevent chronic ankle instability. Taping, bracing, and balancing exercises also can help in preventing re-injury. Most people start to feel better after a sprain over a couple of days, but in the case of severe sprains this could take several weeks to recover. If you develop a sprain that is not improving over a couple days, especially if you have followed the pneumonic RICE, then make sure you schedule an appointment with your doctor.
-Dr. Colleen Law
Here is the latest copy of the APMA Newsletter “Footprints”. Focus on Foot Injury: Identification, management and protection tips from future injury.
Microlight ML830 Cold Laser
Cold laser therapy is a relatively new technology (30 years old) when compared to acupuncture which has been used since 8000-3500 B.C. Just like the abacus evolved into the computer, slowly needles are evolving into light. Recent innovations in low-level lasers now make it possible for the average physician or consumer to own cold laser equipment. Cold lasers are sometimes called Low Level Lasers (LLL) or soft lasers.
In general, cold lasers can be used in 2 distinct ways:
- Targeting acupuncture trigger points (similar to acupuncture but without the needles)
- Broad coverage of deep tissue with laser photons to stimulate changes in the tissue
Cold Laser therapy offers a non-intrusive option to acupuncture and surgery. It also provides a non-addicting treatment that eliminates the complications of long-term drug treatment programs. Cold laser are widely use for treatment of:
- Acute and chronic pain
- Ligament sprains
- Muscle strain
- Soft tissue injuries
- Tennis elbow
- Back pain
- Carpal Tunnel Syndrome
The cold laser produces an impulse of light at a wavelength (approximate 900nm) that maximized the energy (in photons) at a desire depth, usually 10-13cm (4-5 inches) deep. This may be combined with other laser diode with a shorter wavelength (875nm) to add photons to the shallower levels of tissue. In addition, red light diode with a wavelength of 660nm may be used to add energy to even shallower levels of tissues.
The goal of laser therapy is to deliver light energy units from infrared laser radiation, called photons, to damaged cells. It is the consensus of experts is that photons absorbed by the cells through laser therapy stimulate the mitochondria to accelerate production of ATP. This biochemical increase in cell energy is used to transform live cells from a state of illness to a stable, healthy state.
Over 4000 studies have been conducted in recent years to validate the effectiveness of cold laser therapy. Cold lasers treatment systems may be cleared by the FDA.
Benefit of Cold Lasers
- Easy to apply
- Extremely safe
- No side effects or pain
- Cost effective for both the practitioner and patient
- Highly effective in treating ailments (more than 90% efficacy)
- Superior alternative to analgesics, NSAID’s and other medications
- Reduces the need for surgery
General Therapeutic Laser Biological Effects
- Increased Cell Growth: Laser photons accelerates cellular reproduction and growth.
- Increased Metabolic Activity: Photons initiate a higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells and thus greater production of the basic food source for cells, Adenosine Tri-Phosphate (ATP).
- Faster Wound Healing: Cold laser photons stimulates fibroblast development and accelerates collagen synthesis in damaged tissue
- Anti-Inflammatory Action: Laser photons reduce swelling caused by bruising or inflammation of joints resulting in enhanced joint mobility.
- Increased Vascular Activity: Laser photons induce temporary vasodilation that increases blood flow to effected areas.
- Reduced Fibrous Tissue Formation: Laser photons reduce the formation of scar tissue following tissue damage from: cuts, scratches, burns or post surgery.
- Stimulated Nerve Function: Laser photon exposure speeds the process of nerve cell reconnection to bring the numb areas back to life.
Types of Cold Lasers
The fixed level of power is too low to deliver photons beyond the surface of the skin, making them ineffective in delivering photons to deep tissues. This includes laser pointers and other low cost laser diodes.
Class IV Continuous Lasers
The increase in the power of class IV continuous wave lasers increases the photon delivery to deep tissues. Unfortunately, it also increases the amount of the heat generated. This heat increases the potential risk of destructive thermal effects. Class IV laser may result in damage to the retina requiring clinicians to exercise additional FDA implemented controls to ensure patient and practitioner safety. This can include a safely lock on the device to prevent accidental exposure.
Modulated Lasers (Class II to IV) Modulating or super-pulsing the laser output power (turning it on and off in less than 1 billionth of a second) provides a unique combination of benefits. It allows the use of very high power levels (up to 50 watts) while insuring that there is no heat or damage. The ratio between the on and off times is call the duty cycle. In general a super pulsed laser class II laser can provide more power to the treatment area than a class IV continuous lasers without a risk of damage. Modulated lasers provide a good combination of safety and power.
Today, lasers are used extensively in the medical industry for everything from cosmetic surgery, eye surgery and heart surgery. The ability to put just the right amount of energy into a critical area of the human body has been a huge advancement in the medical field. Cold lasers are an important addition to these other established medical laser treatments and the recent development of low-cost professional cold lasers means that cold laser therapy will be a rapidly growing medical treatment option.
Ligaments in the ankle bind bones and the ankle joint together, providing it with stability and limiting its lateral movement. Unlike strains, which are damage to the muscles, ankle sprains are injuries to the ankle’s ligaments, usually on the outside of the ankle. Damage to these ligaments is usually caused by a traumatic event – a fall, twist or impact – and can range in severity depending on whether the damaged ligament(s) is stretched, partially torn or completely torn.
You may be able to identify an ankle sprain because of a combination of symptoms, usually after a traumatic event. These include pain and soreness, swelling, bruising, difficulty or unsteadiness walking and stiffness in the joint. If you have had previous ankle injuries or weak ankles, it may not be surprising that you would sprain your ankle.
The bottom line with ankle sprains is that they must be treated in a proper manner. Without treatment, an ankle that was sprained can become weak and lead to chronic ankle instability. While these soft tissue injuries are often short of a tear, they still need to be immobilized for a number of weeks, depending on how bad of a sprain it is. Without visiting your podiatrist for a diagnosis, other related injuries or underlying conditions may go undetected leading to complications and further or prolonged injuries – like repeatedly spraining the same ankle.
Your podiatrist will most likely give you a walking boot in order to immobilize your ankle. A variety of treatment options are recommended for ankle sprains, including RICE and NSAIDs. Early physical therapy that works on your ankle’s range of motion will promote healing and increase the injured ankle’s rehabilitation. Surgery may be required in severe cases in which a ligament, or multiple ligaments, has been damaged. It is essential for the long-term health of your ankle that you find the proper treatment regimen for you injury.
On Saturday (bright & early in the morning!) Dr. Chang spoke to Charlottesville Women’s 4 Miler Training Program participants about how to maintain healthy feet & ankles while training for the race coming up this Fall. His main piece of advice for them was to be sure they rest. Their training schedule gives them a ‘day off’ on Fridays and he asked that they stick to that so their body can recover and remain injury free. After their training run, many of the ladies came to Dr. Chang for advice on foot and ankle issues that they are already experiencing. We had a great time meeting so many women who are dedicated to getting fit while helping their community at the same time! If you are planning to run the Charlottesville Women’s 4 Miler next year or just want to get started with running, this training program is a great way to do it!
We gave training program participants a flyer with instructions on how to download our free book- A Runner’s Guide To Maintaining Healthy Feet & Ankles. If you would like a copy, you can download it here: www.brfootandankle.com/book
Women athletes, especially those who run and do triathlons, are often told that they are more susceptible to certain lower extremity pain. But what are the unique qualities of the female physique and subsequent common injuries? This post will discuss lower extremity pain common among women due to musculo-skeletal characteristics, hormonal changes and even cultural factors. Below you will also find a few simple suggestions for reducing the risk of foot and ankle injuries. However, Ladies, injuries are cause by a variety of factors and treated in a variety of ways depending on your individual body type and list of activities. If you are experiencing foot and ankle pain, never hesitate to consult your local Charlottesville podiatrist for more information.
Female Musculo-Skeletal Factors in Injuries
There are a few factors that doctors consider when discussing female-specific injuries. Foremost, the angle that represents the relationship between the pelvis, leg and foot, referred to as the Q angle, is more dramatic in females because of women’s wider hips. Knowing this angle is important for athletes because repetitive and continual stress throughout the lower back, pelvis, hip, knee and ankle will often produce injuries in the lower part of the body, especially among women with wider Q angles. Determining whether your Q angle falls outside of the normal range may help in considering the causes of foot and ankle pain, not to mention pain in the lower back, pelvis and even the neck. If you are concerned that your Q angle is affecting your running or causing foot and ankle pain, visit Dr. Murray and Dr. Chang for a professional assessment. They will be able to provide various suggestions, including fitting you with over the counter and custom orthotics.
Common running injuries due to a wide Q angle include patellofemoral pain syndrome or runner’s knee, iliotibial (IT) band syndrome, and shin splints. Women commonly feel pain from patellofemoral pain syndrome, otherwise known as runner’s knee, behind or around the kneecap. Runner’s knee has a range of causes – from over use, direct trauma or misalignment to flat feet. Women commonly are afflicted by runners knee due to a weak VMO muscle (vastus medialis oblique <<image>>), a muscle in the interior thigh. The good news is that it is easy to strengthen the VMO through knee extension and hip abduction exercises. Contact your Charlottesville or Waynesboro podiatrist to find the right exercise plan for you.
Iliotibial band syndrome is also a common injury found among female runners and triathletes. The IT band is made up of tissue that runs on the outside of the thigh, from the pelvis to just below the knee. While crucial to stability during activity, its continual abrasion against the top of the femur and the knee can make it inflamed, causing pain in the hip, thigh and/or knee. Often, using a foam roller can help runners prevent and heal sore IT bands. Stretching is a great preventative measure for IT band pain. Try standing straight up, and bending to the side as far down as is comfortable. Two sets of 15 repetitions on each side should work wonders. Hip flexor exercises can do the trick as well. Kneel on one knee and turn the torso until you feel a stretch on the IT band. Hold this for 5-10 seconds, and repeat 3 times on each side. Again, consult Dr. Murray and Dr. Chang or another licensed professional to design the appropriate workout for you.
Shin splints, known to doctors as medial tibial stress syndrome (MTSS), result from too much force on the shinbone and the connective tissue attaching muscles to it. If you run, chances are that you’ve had the ‘splints. Studies show that up to 15% of running injuries are shin splints, and the advertisements in the back of running magazines are certainly a good testament to that fact. Shin splints are common among runners who have flat feet or over-pronate. In other cases they are caused by tightness in other various muscles and tendons (another good incentive to warming up and stretch!) and by increasing mileage too quickly. Try your best not to increase mileage more than 10% per week; especially with the female disposition to have diminished bone density, female runners are up to 3.5 times more likely than men to contract stress fractures from shin splints.
By far, the single most important to preventing shin splints, along with all of the Q-angle injuries mentioned above, is wearing properly fitted shoes and being attentive to when your shoes are worn out. Your local shoe dealers, Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes, can all provide foot assessments and expert advice about properly fitting shoes.
Age and Hormone-Related Causes of Injuries
The female Q angle can take tolls on knees, ankles and feet of all ages. High school athletes have a high incidence of injuries to the ligaments in the knees, primarily the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), because they tend to lack the lateral stability and endurance necessary for optimal performance and injury prevention. Some experts write that 30% of all ACL tears occur among high school females due to the Q-Angle of the female hip. Some helpful tips for ACL/MCL injury prevention among teens include not neglecting a 5-10 minute warm up, followed by stretching, planning for rest, and staying hydrated. High school athletes can also benefit from light to moderate lateral plyometrics such as lunges and squats, and even light weight lifting.
Female-specific hormones may have great effect on female runners throughout their lives. Hormones, such as relaxin, that women release during pregnancy lead to the relaxation of ligaments. Biologically, this allows for smoother births, but these hormones can affect ligaments in the feet, leading to arch pain, collapsed arches, plantar fasciitis and over pronation. While the jury is still out on the benefits of running during pregnancy, most experts agree that easy running in moderation can be helpful for second trimester moms who are runners, as long as it is balanced with enough time resting the feet and attentiveness to overheating and hear rate levels. Consult your obstetrician to determine a proper exercise routine during your pregnancy.
Not surprisingly, pregnancy may necessitate larger shoe sizes due to swelling. Ligament laxity may permanently increase shoe sizes or altered foot shape. Cramming a new foot size into old shoes too often results in foot and ankle pain. Contact your local shoe experts to determine whether your shoe size has changed, and what the best new fit might be – your feet are worth it!
And what about running injuries during menopause? The experts are still out on whether running correlates to an easier ride through menopause. However, the precaution about menopause often is that diminishing bone density resulting from hormonal changes can often lead to osteoporosis. Boosting the amount of calcium in your diet to between 1000-1500 mg before menopause is a good preventative measure to ward off post-menopausal osteoporosis, especially for female runners. Keeping running and strength training up can keep your bones strong, help prevent bone fractures and healthy circulation, not to mention running’s other physical and emotional benefits!
Other Causes of Female Injuries
In addition to biology, nurture, or cultural influences, may be factors in female injuries as well. High heels often lead to bunions, hammertoe, ingrown toenails, sesamoid injuries, Morton’s Neuroma, back pain and other problems. Remember that good-looking shoes are not exclusive of comfort. Consider buying shoes with arch support and room in the toe box from stores like Richey and Co. Shoes.
But high heels are not the only culprits of foot and ankle pain! If your running or athletic shoes do not fit or are worn out, you can likely injure your legs, ankles or feet. Be attentive to the wear in your shoes, and buy new athletic shoes frequently – according to your podiatric experts, Dr. Murray and Dr. Chang, the appropriate shoes will prevent a host of injuries!
Unfortunately, female athletes are particularly susceptible to eating disorders, and what doctors have come to know as the “Female Athlete Triad.” The triad is made up of an eating disorder and weight loss, amenorrhea (missed periods), and osteoporosis. Poor nutrition can lead to bone loss, decreased serum estrogen levels, psychological abnormalities, and, in extreme cases, death. Those who suffer from the Female Athlete Triad may experience fatigue, anemia, depression, decreased concentration, constipation, cold intolerance, and parotid gland enlargement seen in the cheeks. If this isn’t bad enough, the boneless can cause stress fractures that will not heal without proper nutrition and self-care.
Nurture your body! Healthy eating leads to strong bones and can keep you strong, fit and running your best. Balanced and healthy diets improve athletic performance, prevent osteoporosis, and aid in the healing of injuries. Consuming a target of 1000 mg of calcium per day, with sufficient Vitamin D for calcium absorption (which can either be derived from sunlight or regulated supplements), will help prevent stress fractures. Visit our page on bone healing for more information.
So, to all the female runners out there, stay strong and inspired, and remember that consulting your doctor, fully understanding the various causes of injuries and taking care of yourself will aid in injury prevention and healing.
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.