I think I broke my ankle while out running - Part II

Well, I am back to careful jogging after having cracked the medial malleolus of my right ankle. I am even playing soccer with my son. Here are a couple of photos of my ankles 13 days post injury:

If you look closely, you will see that the ankle bone on the inner side of right ankle is noticeably thicker than the left hand side. This bone was fractured when I went over on the outside of my ankle while running off road (Refer earlier report here and compare photos). Some people think I have the boniest ankles in the business!

What is really important is the fact there has been no muscle wasting, there is no loss of ankle mobility and the ankle reflexes have been restored to pre-injury working order. If the ankle had been immobilised for this period of initial healing, there would have been a period of several weeks rehabilitation to restore normal strength and function.

Now, I am not suggesting for a moment that a person with a fractured ankle forgo with immobilisation and commence exercising, including soccer as part of their rehabilitation. However; I am using my case as an example of how a carefully managed "sports medicine" approach to injury management can bring about wonderful results. The fracture was not unstable and did not directly involve weight-bearing bones.

First of all, I ensured there was minimal swelling despite having to continue walking and jogging for an hour after the injury just to get home. I then determined what I could and could not do without stirring up the injury - how to remain active while the scarring and callousing knitted the damage securely enough to take the strain of this or that activity. I had the injury site massaged daily after about the first 36 hours. I took no pain medication, including anti-inflammatories which might interfere with the healing processes. The closest was some flax oil, bone broth and joint food to assist the joint and bone with healing. Long, hot Epsom Salt baths with a cool bottle of beer on the side were my pain management. I walked daily up and down steep hills for as long as the pain was bearable, steadily increasing the distances as the days passed. I practiced balancing exercises to strengthen the ankle muscles and to retrain the reflexes.

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I think I broke my ankle while out running!

I went for a long run in the hills with my brother-in-law 10 days ago. It was very wet, windy and cold. I went over on my ankle. There I lay in the mud, clutching my ankle, screaming every four letter word in the vocab (good pain management technique).

Choosing pain over death from cold, I hobbled my way towards home, even managing to break into a laboured one-legged trot now and then.

The actual damage to the outside of the ankle that was sprained did not seem that serious despite the bleeding and swelling (I have such skinny ankles that swelling never looks that bad). What really hurt the most was the inside of the ankle affecting the base of the tibia bone.

Treatment
Well, first priority was to warm up, so it was straight into a big hot bath of Epsom Salts (And a beer!) for an hour or so as soon as I got home with my ankle propped up (elevation). I did not bother with ice or compression, much prefering elevation as the best means of preventing further bleeding while not compromising circulation and metabolism (Bear in mind that well over an hour had already passsed since the sprain so the initial clotting was complete).

You can see in the photos the damage to both sides of the ankle and the associated bleeding and swelling (Photos taken 12 hrs post injury).

Within 12 hours I was walking carefully trying to maintain proper foot mechanics and not allowing the foot to turn outwards. Proper foot posture and normal movement during healing ensures scar tissue is laid down in the right places and in the right direction.

I did not compress or ice the injury at all, prefering to continue the elevation and relying on normal movement to manage any swelling.

At 24 hours I had my partner, Alofa, commence gentle massage on the area to promote circulation and reduce the swelling. This massage became progressively more vigorous as each day passed with the emphasis more on softening up the injured areas.

There has been no change in diet other than to take some Joint Factors which contains the right combinations of glucosamine, chondroitin and MSM to help recover from the destructive wrench to the joint and damage to the surrounding tendons and ligaments.

A quite large lump of hard gristle was found behind the achilles tendon. This was an area that had given some pain over previous years when doing extremes of exercise, so the opportunity has been taken to do deep tissue massage to soften and free this up.

As swelling diminished and pain disappeared it became apparent that I might have fractured the medial maleolus of the ankle. When I went over I think I compression-chipped the margin of the ankle joint and possibly caused a hairline fracture a few mm further up. Still, no worries: 10 days have passed and I am walking without a limp and kind of jogging. My goal was to be running within a week; but that might have to be put back a few weeks.

While I wait for the bone to settle, I can do some house-keeping like dealing with that troublesome lump of gristle.

Questions:
Why didn't I go to the hospital?

• The thought of a hot bath was much more inviting than hanging about for hours in the A&E. If I thought it was more serious than it first appeared I would have been off to the Doc the next day.
  

If you think you fractured your ankle shouldn't it be in plaster?

• Probably, but it is not an unstable fracture as far as I can tell and so long as I am careful it should heal quickly. Besides, I am able to maintain muscle strength and balance thus avoiding the problems of rehab once plaster is removed.

Why did you sprain your ankle?

• Other than the fact I was running down a very muddy, slippery trail, I think it has a lot to do with my shoes. I switched from wearing Asics trail shoes to a similar pair of Nike. I mildly sprained my ankle the first run in the Nike and a further time not long ago. This is despite them being designed for off-road stability. I think I am being sent a message: go back to the Asics!!
  

(Gary Moller is available for individual consultations about training and injury issues)

For the latest article about this injury go here.

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