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Caring for Ankle Sprains with Dr. Brad Castellano

Ankle sprains are the most common injury that keeps athletes from returning to the game. Non-athletes also suffer from sprains, most commonly from walking on uneven ground or even wearing improper footwear.

There are three different grades of ankle sprains according Dr. Brad Castellano, a podiatrist and foot and ankle surgeon at Gardner Orthopedics.

Grade one is a strain, grade two is a partial tear, and grade three is a full tear. What’s often surprising according to Dr. Castellano is, “With a grade three injury, when the ligament is torn completely, people often have less pain because there are no little fibers left to be pulled on. It’s the most severe injury but often the most undertreated because when patients aren’t in a lot of pain, they don’t seek help.”

These are the people that will have more frequent ankle injuries and sprains. Castellano explains, “Because they were never treated properly they often sprain the ankle again and again. It hurts, but many times it doesn’t even swell anymore.”

In the past MRI’s were not commonly preformed on ankle sprains, mainly because of the expense according to Dr. Castellano. But today he says, “The price of MRI’s have come down quite a bit, and we utilize them more frequently. A lot of associated injuries such as fractures and tendon tears are missed in lateral ankle sprains. An MRI helps us find those and that’s something that is especially important for a competitive athlete.”

For the most severe tears, surgery may be required to repair the ligaments. Dr. Castellano says there is hope for someone who has let their injury go for years or has injured their ankle so many times that there are little or no ligaments left to repair. “We now have a technique called an Internal Brace from Arthrex® that has been working really well. It’s very strong suture material that augments the patient’s own tissue. It’s a fairly simple procedure and most can return to their sport in 6 to 8 weeks.”

Treatment for an ankle sprain depends on the grade but can involve the use of a boot, crutches and/or a brace. Physical therapy is another important piece of the healing puzzle for strengthening muscles around the ankle.

Before resuming sports after an ankle sprain, Dr. Castellano puts his patients through a “hop test.” He has them hop forward, backward and sideways, first with both feet, to see if there is any pain.

Then it’s one foot at a time, starting with the uninjured to set the standard. If a patient can’t hop as far or fast on the injured foot, more healing time is needed.

If you are a non-athlete but have instability in the ankle, Dr. Castellano says it might be time for new shoes, especially if you are a man. He laughs, “Women have like 50 pair of shoes while most men have a black pair and a brown pair and will wear them until they are worn out.”

He advises, “Look at the heel. The lateral part (the pinky toe side) is the first to wear out. Then you’re walking on the side of the foot. If the shoe is worn it is letting you tip.”

Proper treatment early on is key to healing ankle sprains. If you suffer from ankle instability, you can still be helped. Call Dr. Castellano at Gardner Orthopedics for an evaluation.