Ankle Injuries, Rehabilitation

Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.

Unlike Achilles or ACL injuries, which are often related to sports injuries, ankle injuries can happen to anyone, at any age and at any time. Thus, it’s no wonder that more than 1 million individuals visit emergency rooms each year due to an ankle injury. While the most common types of ankle injuries are sprains and fractures involving ligaments and bones, one can also tear or strain a tendon in the ankle. Even so, medical professionals classify ankle injuries according to the tissue (bone, ligament or tendon) that’s damaged.

To better understand, consider the joining of the bones and tissues of the ankle. The bones of the lower leg (tibia and fibula) meet with the bones of the foot (talus). They are secured by connective tissues, or ligaments. Attaching muscles to the bones, the tendons further stabilize the ankle joint while allowing for the foot and ankle to move.

When one or more of the bones break, there is a fracture injury of the ankle. In turn, when ligaments are extended outside of their normal range of motion, they become sprained. A sprain may be a tiny tear within ligament fibers, or it may be a complete tear or even a rupture. The peroneal tendons in the ankle are most commonly sprained. If the sprain is the result of a sudden injury (acute), inflammation is sure to set in, causing pain from tendonitis. Yet, in ankle injuries that have formed over time such as the gradual tearing of the ligament tissue, repeated tissue damage or a previous injury that hasn’t been treated properly, individuals may experience tendinosis. It’s important to understand that when injuries have not been treated successfully, the compromised connective tissues of the ankle make it possible for the tendon to snap out of position and become dislocated. This is called subluxation, and its primary cause is an ankle sprain. As an example, imagine that your foot rolls inward when walking on a curb and becomes sprained. The stretching of the peroneal tendon may rip the retinaculum. The retinaculum helps maintain the proper position of the peroneal tendons on each side of the ankle. This may cause the peroneal tendon to dislocate. There may be a “popping sound,” as the tendon moves, and pain and sensitivity will follow.

Treatment and Rehabilitation for Ankle Injuries

Initial treatment of an ankle injury depends on the classification of the injury. For instance, if the injury is acute, reducing pain and stabilizing the ankle is a priority. Thus, anti-inflammatory medication along with a short-leg cast helps provide ample time for the retinaculum to heal. Even so, effective rehabilitation of ankle injuries, particularly in regard to the retinaculum, is vital to a patient’s functioning and for the prevention of subluxation injury in the future.

With a multidisciplinary approach, physiatrists are in the best position to identify and manage treatment and rehabilitation for patients with ankle injuries. Physiatrists understand a wide range of conditions that affect the nerves, bones, joints, ligaments, muscles and tendons. They have the ability to personalize rehabilitation and optimize patient care. As a team leader, they often consult medical professionals from many disciplines. Some include physical therapists, occupational therapists, clinicians and interventionists. In addition, patient education and counseling in body mechanics and performance enhancement are often part of rehabilitation as well.

When pain and inflammation from an ankle injury is managed, patients can better tolerate therapy and rehabilitation. Manual therapy such as active release techniques, the Graston technique and massage therapy are often applied to restore the relationship between the retinaculum and ankle tendons. In addition, exercise is important, with a specific regimen aimed at building strength and flexibility. Even so, effective rehabilitation must consider neurological components. For instance, when the ankle is damaged, whether from a sprain or fracture, receptors become altered. In other words, the body begins to adjust positions and movements to compensate for the injured area, and this may lead to more injuries. Thus, physiatrists often propose specific exercises to retrain muscle groups and improve balance and coordination.

At the Howard Liss, M.D. Rehabilitation Institute in Englewood, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.

To schedule your appointment, contact the Howard Liss, M.D. Rehabilitation Institute today.

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