Uh oh. Misstep? Ankle gave out? Did you have a fall? Falling down and injuries are scary. A lot of times it is hard to recall what exactly just happened?! So then, what to do next? Full body survey. Is my head OK? How about my elbows, arms? I feel a little weak and shaky in my legs. I feel almost numbed in some ways. Can I stand on my foot? Is my foot turned differently than usual? Do I have swelling? Am I bleeding?
After the initial shock, I found myself continuing to search for what repercussions there were to my falling down. I remembered distinctly my foot turning in so far that I was amazed at the pain being so minimal. That isn’t the case for everyone. I continued to monitor. I know that adrenaline has some pretty intense effects on pain. So, I was able to get up. I was able to walk. I didn’t notice any swelling at first. I noticed I somehow scraped up my shin, which wasn’t even anything I felt when I did fall down. My ankle only hurt minimally and after a couple days felt normal. My opposite foot (which was only mildly painful after the injury) hurt more over the next few days.
So, understanding the value of knowledge and information, I had x-rays taken within a day of falling down. My ankle appeared completely normal. My foot also looked completely normal. What a relief! Given the fact that my foot and ankle still didn’t feel normal just yet, I was careful to provide plenty of support and shock absorption and wore my best running shoes for a week or so – really until I forgot why I was wearing them in the first place!
Although I never want to fall down or experience a particularly stubborn bout of plantar fasciitis, I do look for the positive in these experiences. I know how my patients feel who have had these types of conditions. I understand their frustration. I commiserate with their fears. I am sympathetic now more than before about the struggles and mental changes that happen after an injury or when experiencing chronic pain that limits your lifestyle. These are things that you can feel at times have changed you as a person. If your independence is no longer something you can rely on, I get it!
Let’s talk about how my experience (described above) can help YOU to know when it is time to call and what indications may be present to clue you in that you need help.
First, when you fall down, even with everything happening-sometimes you may hear or feel a pop or a snap or a crack. Any of these things should have you ready to dial us up for an evaluation. These types of sounds/feels very often correlate to tear or rupture of a ligament or a fracture of a bone.
Next, if you fall down and you literally cannot put weight onto the injured foot (or feet), there is a high likelihood that you have a fracture. Don’t try to push through this. A fracture is described with many different characteristics, one of which is whether the fracture is displaced – or not in proper alignment. Weightbearing on a fracture – exercising on a fracture – they both increase the likelihood that the fracture will displace. If this happens, the pieces can be shifted in a way that causes delayed healing or non-healing ultimately. In addition, if you push through the pain on a fracture, there is excess motion which makes healing suboptimal.
A third sign that you may have a fracture is relatively quick onset of swelling around the foot or ankle. A lot of swelling around an ankle can be associated with joint fluid seeping out into the subcutaneous tissues.
Another thing to look for is bruising. This does not usually come about immediately. However, over the course of hours or even the next day, deep purple bruising – especially if it is widespread should have you calling for an appointment. Bruising that is intense can be due to bleeding from the bone.
In reviewing the 4 above possibilities, remember that not ALL 4 must be present to merit evaluation. For instance, if you feel a pop, snap or crack but you can tolerate walking on your foot you should still have an evaluation. Any one of the above in and of itself can correlate to a fracture, so you should definitely have it evaluated. Some people bruise less than others and some more than others, some people are more sensitive after an injury and can’t walk where the same injury for another person may allow them to walk on it. The above description should serve as guidelines, but they are not rules and none of them can diagnose a fracture.
Now, if you have a misstep and quickly recover with mild discomfort, I would recommend monitoring over the course of the hours and day following the injury. Be on the lookout for swelling, bruising and the character and timing of pain. If you have concerns, even if the pain is minimal, your peace of mind can be what justifies an evaluation.
So now that I provided all this information and told you that none of what I’ve said so far diagnoses a fracture, you may be thinking – what does?! Well, as much as I wish I could tell through a simple evaluation or from your description, I cannot. The way to confirm a fracture is most often with an x-ray. X-rays are a quick simple and low risk way to look at the bones themselves. If there is a fracture, we will usually see a ‘crack’ or space between two pieces of a bone. We may also see that the bone is bent or curved in a way that appears different from the others. In rare cases, an MRI or CT scan may be needed to fully assess for and diagnose a fracture.
Treatment of a fracture or sprain is dependent on the severity of the injury. Some fractures are stable and can be treated with use of a walking boot. Others may be more unstable or may be present to a portion of the bone that does not heal reliably. In these cases, surgery and/or cast immobilization may be necessary in the earlier phases of healing. For an ankle sprain, as podiatrists we do not under-treat these. An untreated or under-treated sprain can lead to chronic instability and further ankle sprains and eventual fracture or arthritis in the joint.
So, if you find yourself wondering if you have a fracture or a sprain, review the above signs and please call our office. In cases where we find that you don’t require any advanced treatment, knowing what to do to ensure proper healing of your injury is vitally important.