Dear Ask The Doctor: Hello, In a soccer game after making a tackle another player's chest/abdominal area fell on my foot while I was on the ground causing the top of my foot to twist backwards and sideways. It hurt significantly, as though something in my foot was stretched. The injury occurred on the left side and top of my right foot just below and to the left of my big toe. It began to swell and bruise shortly after the injury and the day after it is still swollen and bruised and difficult to walk on. Do you have any ideas of what the injury may be?
Dear Jeff: From all the ankle injuries, the sprains are the most common. Ankle sprains are classified in 3 grades as follows: Grade I: mild degree of swelling and stretch has occurred to the ligaments. Weight bearing is possible. Grade II: moderate swelling and an incomplete tearing of ligaments, also mild instability may be present and also pain with weight bearing. Grade III: severe swelling and pain, complete rupture of at least 1 ligament, there is remarkable instability. First thing to do: apply ice and lift the affected limb for the first 24 hours, to control the pain and swelling. Physical therapy is recommended for sprains grade II and III. For less severe injuries, grade I, the strategy would be: immediate, protected ambulation, and physical therapy should emphasize exercises to get back the normal range of motion and strengthening of the ankle muscles and ligaments.
Treatment during this acute phase is aimed to minimize swelling and pain, allowing the patient to begin walking. The acute phase of treatment should last for 1-3 days after the injury. A combination of protection, relative rest, ice, compression, elevation, and support (PRICES) is used. Also the anti inflammatory drugs (as Ibuprofen) help in reducing swelling and pain. If it is an uncomplicated sprain you should improve with these conservative measures, but if on the contrary you do not see any improvement in pain/swelling in 48 hours, and have remarkable limitation to move the ankle, I strongly recommend that you go to the Hospital and get a clinical and radiologic (imaging) evaluation by an orthopedic surgeon.