Ankle Injury Key West: How to Tell a Sprain From a Fracture

It was Fantasy Fest Saturday, the parade was inching up Duval, and you stepped back to make room for a float. Your heel caught the edge of the curb, your foot rolled underneath you, and the outside of your ankle suddenly gave way. By the time you walked home it had swollen up, and this morning it is purple, stiff and painful to stand on.

An ankle injury in Key West like this one is usually a sprained ankle, also called an ankle sprain. It means the tough bands that hold the ankle bones were stretched or partly torn. Most sprains heal well with careful home treatment, but some need an X-ray to rule out a fracture, meaning a broken bone.

"The first week is about protecting the ankle, not hiding it in bed," says Jason Pirozzolo, DO, a sports medicine physician. "People who start moving early usually recover faster," adds Dr. Pirozzolo of Key West Concierge Orthopedics.

To be seen sooner, contact Key West Concierge Orthopedics or call (305) 707-8484.

What Happened Inside Your Ankle

When your foot rolls inward, the outside ligaments, the tough bands connecting bone to bone, absorb the strain. A mild sprain stretches them, while a worse one tears one partly or completely.

The swelling, and the bruise that slides toward your toes, come from blood and fluid leaking from the torn tissue. "I pay less attention to the bruise than to how well you can stand on it," Dr. Pirozzolo says.

How to Tell a Sprain From a Fracture

Whether you can walk, and where the bone hurts when you press it, tells you more than the swelling. Physicians in Ottawa, Canada, published a checklist for this in JAMA in 1993, and doctors worldwide still rely on it.

It says you need an X-ray if you could not take four steps immediately after the fall and still cannot. You also need one if pressing the back edge of the bony knob on either side of the ankle hurts sharply. The same is true for the bump halfway down the outside of your foot.

A Stock Island line cook came in two weeks after last year's parade, sure it was only a sprain. The painful spot was the bump on the outside of his foot, and the X-ray revealed a small fracture there. "Being able to walk on it does not guarantee it is only a sprain," Dr. Pirozzolo explains.

This Week at Home

• Wear a lace-up brace or a snug elastic wrap whenever you are on your feet.
• Walk on it as much as the pain allows, in a shoe with a firm heel, not flip-flops or costume boots.
• Elevate your foot above your hips when you sit, so the swelling can drain.
• Twice a day, trace the alphabet in the air with your big toe to keep the joint flexible.
• Ice it for ten to fifteen minutes at a time, over a towel, when it aches.

A 2018 guideline in the British Journal of Sports Medicine favors a brace plus exercise over a cast for most sprains. It also warns that anti-inflammatory pills such as ibuprofen may slow natural healing, so use them with care.

Once walking feels easy, stand on the injured foot while you brush your teeth to rebuild the ankle's balance. The same guideline found a brace worn for sports or rough ground helps prevent another sprain.

When to Come In

Come in if the checklist above points toward an X-ray, or if you still limp at the end of the week. The same applies to an ankle that feels unstable on uneven sidewalks, or swelling that returns every evening.

Walk-in injury visits are Monday through Thursday, 8 AM to 5 PM, with digital X-ray on site. Dr. Pirozzolo presses the same spots and tests how well the ligaments hold. A fracture that the X-ray confirms moves on to fracture care in Key West.

"Most of the Fantasy Fest ankles I see are walking normally within a few weeks," Dr. Pirozzolo says. "The ones that give trouble later never regained their balance."

If you are still limping on the Wednesday after the parade, walk in and have it checked. Call Key West Concierge Orthopedics at (305) 707-8484, or read patient reviews of Dr. Pirozzolo.

Questions About Ankle Injuries in Key West

Should I wait until I fly home to have it checked?

Have the ankle examined before you board, because hours in an airplane seat with your foot down make the swelling worse.

Do I need a referral to have an ankle injury in Key West seen?

No referral is needed, so walk in during the hours above or call or text to book a time.

Sources

• Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation. JAMA. 1993;269(9):1127-1132.
• Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.