Knee and Ankle Sprains: Your Shoes Might Be the Culprit

Most people have experienced sprain at one point in their lives, be it mild or severe . For some milder forms of sprain, it does not significantly affect day-to-day living. However, severe cases can cause severe pain and disability.

A sprain is an injury to a ligament - the connective tissue that joins two bones at a joint. Ligaments provide support to a joint. Sprain occurs when the ligaments are stretched or stressed beyond its normal limit. It may result from a fall, forceful wrenching or twisting of a joint, or a direct blow to the body that forces the joint out of its normal position. Structural joint abnormalities such as having knocked-knees(legs curve inward at the knees) or bowlegs (the leg or legs are bowed outward) also increase the risk of having knee and ankle sprain.

The ankle is the most common site of sprain. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), there are more than 25, 000 individuals who experience ankle sprain in the United States. Common causes include running, sudden turning, and falls while the foot is inverted (the foot is turned inward). Wearing of loosely fit shoes, worn out shoe heels, and high-heeled shoes contribute to the risk of having ankle sprain.

Another common site of sprain is the knee. Knee sprains may occur as a result of a direct blow to the knee joint or twisting the bended knee with the foot firmly planted on the floor. Knee sprains are more common in sports such as foot ball and basketball.

Depending on the severity, sprains may be mild, moderate or severe.

Mild Sprain is caused by over stretching or minimal tear to the ligament. There is little or no loss in joint function but the person may experience minimal pain and swelling. The person usually tolerates the pain upon putting weight on the affected joint.

In moderate sprain, there is further tearing of the ligament but an incomplete one. Signs and symptoms may include moderate pain, bruising, swelling and loss of joint function. The person usually experiences difficulty of bearing weight on the affected joint.

There is complete tearing of the ligament in people who sustain severe sprain. Severe sprain may be accompanied by damage to the bone, surrounding muscles, blood vessels, tendons, or nerves. The person experiences severe pain, swelling, bruising and cannot tolerate putting weight on the affected joint. Imaging techniques (X-rays and Magnetic Resonance Imaging (MRI)) may be required by your physician to rule out other injuries such as fracture or to see the extent of damage to the ligaments and surrounding structures.

The initial goal of treatment is to reduce pain and swelling in the site of injury. Sprain can be initially treated with PRICEM therapy.

PRICEM stands for:

P-Protection: Protect the injured area from further damage.

R-Rest: Rest the injured area. Try not to move the joint during the initial stages of recovery. Your health-care provider may advise you to use crutches or cane.

I-Ice Application: Apply ice pack wrapped in towel to the injured area for about 15 to 20 minutes, 4 to 8 times a day or as needed. Never directly apply ice packs or ice to the injured area for extended periods as this can cause frostbites.

C-Compression: Apply an elastic bandage, if possible, to compress the injured area and to reduce swelling. Ask your health-care provider to teach you how to properly apply an elastic bandage. Always remember to never wrap the elastic bandage too tightly as this will impede the blood flow to the distal part of the limb.

E-Elevation: Elevating the involved limb would help to decrease swelling.

M-Medication: Your health-care provider may also recommend over-the-counter pain relievers, or non-steroidal, anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen.

Resist the temptation of applying heat during the first 2-3 days after injury as this may worsen the swelling.

Mild and severe sprains may require casting to immobilize the involved limb after pain and swelling have subsided. In more severe cases, it may require surgical intervention to repair the torn ligaments.

After the pain and swelling have subsided, it is important to be active using an alternative fitness program that does not worsen the original injury. These activities should be determined with your physician or physical therapist.

Rehabilitation plays a crucial role in the recovery of the injured joint and patient as a whole. Goals in rehabilitation involve prevention of stiffness, improve range of motion, restore muscle strength, restore normal joint flexibility, and patient education.

Return to normal daily activities is the ultimate goal of rehabilitation for the patient.

We can prevent the occurrence or recurrence of sprains by being physically fit, maintaining a normal weight, wearing shoes that fit or changing worn out shoes, using low heeled-shoes, wearing protective gears, and avoid running on uneven surfaces.