Of the PT Persuasion: Ankle Sprains
Have you ever wished for a resource that helped writers cut back on hours and hours of researching how to accurately portray injuries and medical conditions? Look no further. In this blog series, I’ll be discussing just that. What makes me qualified to do so? Well, I’m a Physical Therapist! Or, rather, I’m a writer…Of the PT Persuasion.
Maybe you’ve done it, too: you’re running through the woods, and suddenly you’re not running anymore—you’re flat on your face because some tree pulled a classic prank and decided to grow a root underfoot. This ankle-vs-root scenario is exactly what happens in Rachel Griffin’s The Nature of Witches while Clara Densmore is sprinting through the forest on her way to rescue her adorable witch’s familiar (and stumble into her meet-cute).
Ah, the twisted ankle. A mainstay for character injuries in literature and media.
I get it—ankle sprains are a quick, easy, and common injury that can take a character out of a fight or make them a burden. And they’ll be up and walking around on it in a day or so, right? As Clara correctly demonstrates, that’s not always the case…
The ankle joint, or the “talocrural joint” in technical jargon, is composed of three bones: the tibia and fibula of the leg and the talus of the foot. The bottom of the tibia and fibula form a dome-like structure into which the rounded talus fits, making a hinged joint—in fact, we term this specific type of joint a “hinge joint.” The knee is also a hinge joint, and just like the knee, the ankle is very good at doing two things and two things only: going up and going down. We call the action of flexing your ankle up so that your toes point to the sky dorsiflexion. Contrastingly, pointing your toes down is plantarflexion.
Because of the way the ankle is shaped, in dorsiflexion, the bones align more congruently, increasing stability. But when the ankle is in plantarflexion, the area of contact between the bones decreases, making for less stability. You’ve probably felt it if you’ve ever worn high heels; you’re so much more wobbly in those five-inch stilettos when your ankle is forced into plantarflexion!
So, we have our lovely Clara on her rescue mission, and the only thing between her and that gnarled root booby-trap waiting to take her down is ligaments, my friends. Yes, ligaments. They strap bones together, forming the joint. There are three main ligaments on the outside of the ankle that keep the foot from rolling in, and there are four main ligaments on the inside of the ankle that keep the foot from rolling out.
Now, due to the structure of the bones and ligaments of this joint, the ankle is most likely to be injured when the ankle rolls inward and the ligaments on the outside of the ankle give way. This is called an “inversion sprain,” where the act of the foot turning in is termed “inversion” and a “sprain” is damage to ligaments. (Fun fact! By far, the most commonly injured ligament is the anterior talofibular ligament, which straps the talus bone to the fibula.)
So our heroine has sustained an inversion sprain, saving her cat and fighting weather phenomena with her eco-magic. Now what?
It depends on the degree of her sprain. Sprains are categorized into three tiers:
Grade I: the ligament is stretched or slightly frayed. This is accompanied by mild swelling and tenderness, but no bruising. The patient will be able to walk with some discomfort.
Grade II: the ligament is partially torn. This is accompanied by swelling, pain, and bruising. The patient is able to walk, but not without pain and a feeling of some instability.
Grade III: the ligament is ruptured or completely torn. This is accompanied by high swelling, pain, and bruising. The patient is not able to walk due to instability at the ankle, as well as pain. (With a complete rupture, it is possible for the patient to feel no increase in pain afterward while walking, due to the fact that the damage has been done, in full, and there’s nothing left of the ligament to tear.)
What does this look like in a patient? In all cases, the injured person (as with Clara) is going to feel a sharp, localized pain over the outside of the ankle when the injury happens. Dull, achy, throbbing pain usually follows with the sharp pain returning when walking or standing on that side. Swelling begins to develop immediately and peaks within a couple of days. Bruising also begins immediately, but it starts with a reddish color, the hallmark black and blue coming within a couple of days. One to two weeks later, the color will fade to yellowish. In the clinic, I’ve seen swelling and bruising go away within a few weeks, but it can last for a few months!
So, in your writing, what can you do? If you’re looking to completely take your character out of the action and force the rest of the gang to help her along, Grades II-III are your best best. If you want her to be able to maybe walk again in a week or so, Grade II is a possibility, though she’d still be in a bit of pain. A Grade III, on the other hand, can require immobilization: a cast, boot, or brace to allow the ankle to heal without movement disrupting the process. Surgery is sometimes required for Grade IIIs.
Where I see ankle sprains being portrayed inaccurately is mostly in the time following the injury rather than the moment of injury, itself. A sprained ankle needs time to heal. Full recovery for a mild sprain can be a few weeks. Full recovery for a more severe sprain can be a couple of months or much longer if surgery is involved. Furthermore, once an ankle has sustained a sprain—even if it heals—it is more likely to be sprained again. What Rachel Griffin really nails in portraying Clara’s injury is that she has to offload it with crutches, and it takes her a month to heal enough so she can get back to training!
As a PT, how do we treat and prevent further ankle injures? Acutely (within the first week), treatment is aimed at reducing pain and swelling with rest, ice and elevation, medication, and not walking on that foot if necessary (e.g. Clara’s crutches). Gently moving and stretching the ankle within a comfortable range helps prevent the joint from freezing up and losing range of motion or flexibility. Balance and strengthening exercises aimed at the foot, ankle, calf, knee, and hip are integral to creating muscular support where structural (i.e. ligamentous) support may be lacking. Lastly, making sure the patient walks normally is a main goal, though Clara might choose not to wear stilettos for any upcoming solstice parties.
That’s a wrap on ankle sprains! Remember, an injury isn’t just a one-day thing!
Thank you for reading! I hope you enjoyed this installment to Of the PT Persuasion.
Disclaimer:
If you’re seeking medical advice for yourself or someone you know, you should speak to a medical professional. This blog is not intended for diagnosing or treating real-life medical conditions, only fictional ones.
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