Q) Two years ago I twisted my ankle in the garden of our house in Spain. At first the pain was manageable, but over time it got worse.
Our GP diagnosed me with arthritis and recommended physiotherapy and electrotherapy. My understanding of my condition is limited because of the language barrier. I want to be able to get back to the life we planned when we moved out here, which involves being active and farming our land.
Walking on rough ground is particularly painful for me, so for the past year I've been very limited in what I can do. I take NSAIDs, paracetamol and tramadol for the pain.
What advice can you offer to give me back my mobility please?
Rachel (submitted by email, Winter 2016)
A) Nasty ankle sprains can lead to significant problems down the line. The phrase "just a sprain" is a big understatement for many people.
You can’t change the injury, so your focus is now about protecting the joint from further injury and managing any symptoms as they arise. I’d recommend a multi-pronged approach:
Physiotherapy is a good idea to work on the range of movement in the joint and help with guided exercises to strengthen the tendons and muscles that support the joint. You'll need to continue these exercises at home for the foreseeable future to keep the ankle strong and flexible.
2. Wearing a brace
Consider using an ankle brace to provide extra support for the ankle especially when working and walking on uneven surfaces. They need to have a stirrup splint which passes under the foot and provides stability to both sides of the ankle.
You’ll see Andy Murray wears these when playing tennis as he has a history of ankle injuries.
3. Appropriate footwear
You should consider wearing ankle height boots for working on your land to provide additional support and prevent injury
4. Develop joint position sense
You need to do a lot of work on developing your joint position sense (this is called proprioception). When you twist your ankle you damage not only the ligaments around the ankle but the nerves that give the brain detailed information of what the joint is doing.
This needs retraining to prevent you continuously reinjuring the ankle. Look at our ankle sprain information (PDF 810 KB) for more details on this.
5. Apply ice
If the joint swells or is painful then try applying ice. You may also find topical non-steroidal anti-inflammatory drugs (NSAIDs) are helpful to relieve pain
6. Steroid injections
If the pain in the joint continues despite the treatments outlined above, then sometimes an injection of steroid and local anaesthetic can help to relieve symptoms in the short to medium term.
I wish you all the best with your rehabilitation.
This answer was provided by Dr Tom Margham for the Winter 2016 edition of our magazine, Arthritis Today, and was correct at the time of publication.
Send your questions for Dr Tom Margham to firstname.lastname@example.org
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