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Patient Education

Ankle Sprains

Ankle sprains are among the most common injuries encountered by professional and recreational athletes alike and frequently contribute to missed playing time.

An ankle sprain is a tear in the ligaments that support either the inner or outer of the ankle joint. This usually occurs when the athlete rolls the ankle inward after stepping in a hole or onto another player's foot. As the foot rolls in (inverts) the ligaments connecting the outer bone of the ankle to the foot are stretched and torn to various degrees. A grade I injury is mild and will limit play for less than a week. Grade II injuries are moderate and last 1-3 weeks, while a grade III sprain is severe and may limit the player for 6 weeks or more. Often bruising of the bones within the ankle can occur simultaneously.

Signs of an ankle sprain include pain, swelling, bruising, inability to bear weight, and a feeling of instability. Initial management should be with the RICE protocol, which stands for rest, ice, compression, and elevation. For minor injuries, x-rays and evaluation by a physician may not be necessary, but for any significant problems consult your doctor.

Preventing sprains and returning to sports quickly are related issues. The muscles that control movements around your foot and ankle need to be kept strong to prevent injuries and to rehabilitate an injured ankle. Use of high top sneakers, ankle sneakers, ankle taping, and brace wear may be indicated in certain individuals.

Occasionally an athlete will develop chronic ankle instability, where long after healing of a sprain (or multiple sprains) the ankle still feels like it gives way or is loose. This is often caused by incomplete rehab of an injury or may be a sign of chronic stretching of the ligaments in the ankle. In some cases, the chronically stretched ligament has to be surgically shortened or substituted for.

Dr. Baltz is a fellowship trained Sports Medicine Orthopedist, former assistant team physician to the Boston Celtics and team physician to Massachusetts Maritime Academy.


Runners Injuries

This article deals with the most common injuries that avid runners face during training. Most are not serious and can be treated with rest, appropriate stretching, and possibly anti-inflammatory medications. Since running is an extremely leg dependent sport, the easiest way to classify injuries is by body part.

The foot and ankle is where the rubber meets the road, quite literally, and is the most common area of trouble. People who have excessively high arches (cavus feet) or people with low arches (flat feet) are more prone to develop problems. Running shoes and now made to accommodate for these extremes and can be a first line of defense. The foot is a complex interaction of ligament, bone, and tendon and shoe inserts or cushioning that can either pad areas that are overstressed or convert foot mechanics to a more normal range are very helpful.

Plantar fasciitis (heel and sole of foot), Achilles tendonitis, posterior tibial tendonitis (inner foot), and stress fractures top the list of maladies. Each of these is a form of overuse injury and is characterized by pain, swelling, and poor function. Early treatment may be as simple as altering your running style, resting briefly, or wearing the appropriate insert. More difficult cases may require medications, casting or bracing, cortisone injections, or rarely even surgery.

In the knee patellar tendonitis (front of knee), ileotibial band syndrome (outer side), or pes bursitis (inner side) are common overuse injuries. The key to treatment of these problems is early recognition and not ignoring symptoms. Again, rest and stretching tends to help quickly.

Sudden traumatic injuries can also be a problem with the knee. Tears of the shock absorbing cartilage (meniscus) can occur with the twisting injuries in the younger runners with even less force in older runners. These injuries are characterized by swelling not of the muscle and tendon around the joint, but by fluid that collects in the joint itself. This may be difficult to distinguish but is important in treatment because many meniscus tears need surgery.

Finally, there are a few less common problems with the hips. Hamstrings tendonitis (back of the thigh), trochanteric bursitis (outer hip), and groin pulls are usually a result of poor stretching and overuse.

It is important to remember that all of these parts are interconnected and that an injury or poor alignment in one area can affect others. This is one reason why it may not be smart to continue running with an altered form to protect one injury at the expense of causing another. This also highlights why it is important to stretch all muscle groups around the foot and ankle, knee, and hip before running.


Wareham Orthopedics
One Recovery Road
Wareham, MA 02571

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