Foot and Ankle Injury

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DEFINITION

• Injuries to a bone, muscle, joint or ligament of the ankle and foot

Types of Injuries

• Achillestendon rupture - There is pain in the Achilles tendon (area above heel and behind ankle). There is weakness or inability to extend the foot (e.g. can't stand on tiptoes).
• Contusion (bruise) - A direct blow or crushing injury results in bruising of the skin, muscle and underlying bone. 
• Cuts, abrasions
• Dislocations (bone out of joint)
• Fractures (broken bones)
• Sprains - Stretches and tears of ligaments
• Strains - Stretches and tears of muscles (e.g., pulled muscle)

See More Appropriate Topic (instead of this one) If

• ANIMAL BITE to foot or ankle
• BURN of foot or ankle
• PUNCTURE WOUND to foot or ankle
• SKIN INJURY is main concern
• TOE INJURY is main concern

FIRST AID Advice

FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Penetrating Object: If penetrating object still in place, don't remove it.

FIRST AID Advice for Shock: Lie down with feet elevated.

FIRST AID Advice for a Sprain or Twisting Injury of Ankle or Foot:

• Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes.
• Wrap area with an elastic bandage.

FIRST AID Advice for Suspected Fracture or Dislocation of Ankle or Foot:

• Do not remove the shoe.
• Immobilize the ankle and foot by wrapping them with a soft splint (e.g., a pillow, a rolled-up blanket, a towel).
• Use tape to keep this splint in place.

Transport of an Amputated Body Part:

• Briefly rinse amputated part with water (to remove any dirt).
• Place amputated part in plastic bag (to protect and keep clean).
• Place plastic bag containing part in a container of ice (to keep cool and preserve tissue).

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Major bleeding (actively bleeding or spurting) that can't be stopped.
• Limb has been partially or completely amputated
• Injury looks like a dislocated joint (crooked or deformed)
• Bone sticking through skin
• NOTE: For bleeding, see First Aid

Call Your Doctor Now (night or day) If

• You think you have a serious injury

• Severe pain

• You can't stand (bear weight) or walk

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think you need to be seen
• There is a large swelling or bruise (wider than 2 inches) at the site of the injury
• You are limping
• You are over age 54, have osteoporosis, or use steroid medications routinely

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Injury interferes with work or school
• Injury and pain have not improved after 3 days
• Injury is still painful and swollen after 2 weeks

Self Care at Home If

• Minor bruise
• Minor strained (pulled) muscle or sprained (stretched) ligament

HOME CARE ADVICE FOR MINOR BRUISE, SPRAIN OR STRAIN

1. Treatment of Minor Bruise (e.g. direct blow to ankle or foot):
   • Apply a cold pack or an ice bag (wrapped in a moist towel) for 20 minutes each hour for 4 consecutive hours. (20 minutes of cooling followed by 40 minutes of rest for 4 hours in a row).
   • 48 hours after the injury, use local heat for 10 minutes 3 times each day to help reabsorb the blood.
   • Rest the injured part as much as possible for 48 hours.
2. Treatment of Minor Sprains and Strains of Foot and Ankle:
   • FIRST AID - Wrap with a snug elastic bandage. Apply an ice pack (crushed ice in a plastic bag covered with a moist towel) to reduce bleeding, swelling, and pain.
   • Treat with R.I.C.E. (rest, ice, compression, and elevation) for the first 24 to 48 hours.
   • REST the injured leg for 24 hours. You may return to normal activity after 24 hours of rest if the activity does not cause pain.
   • Continue to apply crushed ICE packs for 10-20 minutes every hour for the first 4 hours. Then apply ice for 10-20 minutes 4 times a day for the first two days.
   • Apply COMPRESSION by wrapping the injured part with a snug, elastic bandage for 48 hours. If you experience numbness, tingling, or increased pain in the injured part, the bandage may be too tight. Loosen the bandage wrap.
   • Keep injured ankle or foot ELEVATED and at rest for 24 hours. Keep your foot up on a pillow and stay off your feet as much as possible.
3. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid  this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
4. Expected Course: Pain and swelling usually begin to improve 2 or 3 days after an injury. Swelling is usually gone in 7 days. Pain may take 2 weeks to completely resolve.
5. Call Your Doctor If:
   • Pain becomes severe
   • Pain does not improve after 3 days
   • Pain or swelling lasts more than 2 weeks
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.