May 11, 2012

Ice or Heat – Which Path to Help a Sprained Ankle?

Quick Rules For Faster Recovery From Foot Injuries

Most of us who are old enough to get into a “PG-Rated” movie have experienced the pain and indignity of a sprained ankle or foot. It often happens when we are rushing about or engaging in sports, and it’s usually a simple matter of your body going east while your foot goes west. Ouch!

As podiatrists, sprains and pulled muscles are our most popular injury. It hurts and comes with a considerable amount of pain, so people are quicker to reach out for help. However, with a sprain or pulled muscle in the foot, by the time a patient gets to a doctor’s office or Emergency Room, the opportunity to quickly lessen the pain and promote healing has passed.

What to do?
Ice and heat therapies are the two most effective resources you have for a sprained ankle or foot. However, ice and heat are not “synonymous.” You use each separately at different times and for different reasons. Using the wrong therapy can actually aggravate the situation.

Here is a simple rule of thumb for sudden injuries: Ice first, heat later. The greatest amount of swelling occurs in the first minutes after a foot or ankle injury. Cold reduces swelling, so by quickly applying ice, you can significantly cut down on the recovery time.

If you or someone near you hurts their foot or ankle, here is what you need to do immediately to help:

1. Get to a safe place. If you went down while scurrying across a busy intersection on a yellow light, do what you must to get to the curb quickly. Likewise, if you came down “wrong” while snatching a rebound under the boards, pass the ball to a teammate and get out of traffic. You want your hurt ankle to be your ONLY injury of the day.

2. Determine if you are injured. Particularly with athletes who are in exceptional condition, muscles can stretch and recover quickly, thus the term “walk it off.” For most people, this might not be true. The best way to determine if you are injured is to sit on a chair or bench with your feet flat on the floor. This should immediately take the pressure off your hurt foot or ankle and ease the pain a bit. Take a moment to collect yourself. Then see if it hurts to stand, walk or stretch your foot in several directions. The hallmark of a broken bone is strong and relentless pain. If the pain is more of a throbbing that increases and lessens depending on your movement, then likely you have a sprain.

3. Wiggle your toes. The quickest way to determine if you have broken one of the 26 bones in your foot or your ankle is this: Wiggle your toes. If you can’t move all of them, and your pain is constant, then you need to proceed to the Emergency Room for professional medical treatment.

4. Ice the foot or ankle immediately. The quicker you get ice or something cold on the injury, the less swelling will occur and thus there will be a shorter recovery period. If you believe you have a sprain or twisted foot and are away from home, stop at the 7-Eleven for a bag of ice. Minutes count, so don’t wait until you get home. If nothing else is available, grab a couple of cold sodas out of the machine and wrap them in a towel. In a pinch, paper towels wrung out in cold water work.

5. Elevate the foot. Whether you’re sitting or lying down, prop your injured foot up so that it is above your heart. This decreases the amount of blood rushing to the injury and therefore reduces the swelling.

“Icing” therapy should be done only within the first 48 hours of being injured. Whether a plastic bag with ice cubes or – my favorite – a bag of frozen peas, carefully apply the cold to the injured foot. Start with 15 minutes on, then 15 off. (You don’t want to add frostbite to your troubles!) After doing this every so often over the course of two days, both the pain and the swelling should lessen considerably. If they haven’t, then you need to see us.

Heat therapy should start on the third day of the recovery process. It is now helpful because – to put it in childlike terms – gentle heat sends the signal that “the emergency is over.” The extra blood that rushed to the rescue can go home, and the muscles and ligaments that tightened to protect you foot can now relax. It’s a process.

As with ice, heat therapy should be done for short, on-off periods of 15 minutes at a time. An electric heating pad is best, but a hot water bottle wrapped in a towel also works. Don’t use heat while you are sleeping, and continue to keep the leg elevated whenever possible.

Crutches are helpful for two reasons: Most important, they take the pressure off your injured foot while walking. Second, when you are out, they signal to those around you to stand clear and not bump you. (Best not to go down a second time.) For under $40, you can order crutches through your pharmacist (many Schnuck’s pharmacists will do this), or most Walmart’s now carry them.

Finally, gently wrapping the injured ankle or foot in an ACE bandage is a good thing. The compression from the ACE bandage protects your foot from re-injury. However, when home, take the bandage off so blood can circulate freely.

Let me emphasize that this “ice first, heat later” recipe is only for sudden sprained ankles or a pulled muscle or ligament in the foot. Other body injuries, like a pulled back muscle, have a different protocol. Chronic conditions, like shin splints, also have a different use for ice and heat. We’ll address those challenges in another blog.

If your seemingly simple sprain continues to seriously hurt after 48 hours, please call us at the Snyder-Stuart Podiatry Center nearest you and we’ll set up an appointment quickly.

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