Now the problem is, how am I going to work tomorrow?
"Ligamentous injuries of the ankle are common among athletes. Inversion injuries of the ankle account for 40% of all athletic injuries. The anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) are sequentially injured when a plantar-flexed foot is forcefully inverted. The posterior talofibular ligament (PTFL) rarely is injured, except in association with a complete dislocation of the talus.
Ligamentous injuries of the ankle are classified into the following 3 categories, depending on the extent of damage to the ligaments:
- Grade I is an injury without macroscopic tears. No mechanical instability is noted. Pain and tenderness is minimal.
- Grade II is a partial tear. Moderate pain and tenderness is present. Mild-to-moderate joint instability may be present.
- Grade III is a complete tear. Severe pain and tenderness, inability to bear weight, and significant joint instability are noted.
Initial treatment of all grades of lateral ankle sprains consists of rest, ice, compression, and elevation (RICE) and nonsteroidal anti-inflammatory drugs (NSAIDs). Ice should be applied to the injured ankle for approximately 20 minutes, 3-4 times per day. Compressive dressings should be used to control swelling. Weight bearing should be encouraged as soon as it is tolerated. With grade III injuries, an ankle brace should be worn at all times for 6 weeks.
Studies have shown no difference in long-term outcome when comparing early mobilization to cast immobilization or early surgical repair. In the short-term, patients treated with early mobilization return to sports and work 2-4 times faster than those not treated with early mobilization. Also, no difference is found in long-term outcome when comparing early surgical repair with delayed surgical repair following failed conservative therapy. Therefore, there is no indication for routine early surgical repair.
The early phase of rehabilitation is begun approximately 48 hours postinjury. Icing is continued and range of motion (ROM) exercises are initiated. Writing the alphabet with the great toe moves the ankle through full ROM in all planes. Stationary biking and stretching of the Achilles tendon also are beneficial. As strength and mobility improve, isometric exercises for ankle dorsiflexion, plantar flexion, inversion, and eversion are initiated. The isometric exercises are followed by resistance exercises (initially using a Thera-Band strap) and then heel and toe raises. Agility training also aids in return to sports.
Primary repair of acute lateral ligament tears is rarely indicated. Open repair seems to offer no advantage over closed management at the time of initial injury. Delayed repair may be necessary in patients with chronic mechanical instability on clinical examination and functional instability; however, surgical intervention in these cases should only be considered after an aggressive rehabilitation program has failed.
- An emergent consultation is rarely required.
- Consultation with an orthopedist should be obtained for patients with unstable ankles, dislocations, or associated fractures."
You'd readily see that some people are not made to be doctors.
There are some that look, talk and act like they're congressmen. From a mile away.
You know - the yes-I'm-someone-important-so-do-this-errand-for-me-
I'm very heartened by my girlfriend's SMS to me. Yes, she's one of a handful of people who read this page.