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Sprained Ankle

Dr. Markle talks about sprained ankles, their classification, and treatment without surgery. Today, we’re talking about having a sprained ankle — what that means, some of the structures, the damages, as well as common questions we get from patients, such as “When do you need surgery for a sprained ankle?”

What Is a Sprained Ankle & What Causes it?

Your ankle is comprised of bones held together by a bunch of ligaments. These ligaments end up getting damaged when you sprain or roll your ankle.

Common causes are trauma or injury related, such as twisting your ankle.

We classify having a sprained ankle in several different ways. Depending on the ligament damage, you can have:

  • Grade 1, which is basically mild stretching of the ligament or some micro tears.
  • Grade 2, which is a large, yet incomplete tear of those ligaments.
  • Grade 3 which is completely torn. A Grade 3 you can further break down into a completely torn tendon or ligament that is
    • Retracted (meaning it’s been completely pulled apart and off the bone)
    • Non-retracted (meaning it’s still in good alignment)

How long does it take to recover from a sprained ankle?

If you have a Grade 1 or Grade 2 injury, typically this is anywhere from one to four weeks of recovery. If you have a more severe injury, such as a high Grade 2 or a Grade 3, this can take three to six months of recovery on its own.

What are the symptoms of having a sprained ankle?

Generally, there is immediate onset of swelling and pain around the ankle (typically located on the outside of the ankle). Once you recover, sometimes the ankle becomes unstable, meaning rolling, spraining, or repeat injury to the ankle becomes much more prevalent.

Ankle Pain After Walking

More than any other joint, our ankles bear the burden of all of our body weight. The ankles aren’t large weight-bearing joints, like our hips or knees; comparatively speaking, the ankles are rather small for the tasks they are assigned to do. If the ankles are normal and healthy and there isn’t a weight issue placing excess stress on the ankles, the ankles can typically bear the forces of walking, running, hiking, and so on quite well. However, when the ankles are weak or carrying too much weight, any additional forces placed upon them—even something as simple as walking—can create problems. Do your ankles get sore after walking? What about foot and ankle pain after hiking? If so, it’s a good idea to proactively address it now, before it gets worse, rather than resigning yourself to it and decreasing or stopping the activities you enjoy. We’ll explain more in a moment, but first let’s take a closer look at the structure of the ankle.

Read More About Ankle Pain After Walking

Ankle Pain When Running

There are multiple causes of ankle pain while running. The six major causes are: Stress Fracture A stress fracture is a small crack in the bone due to overuse and repeated impact. They are a common cause of pain in runners, accounting for up to 16% of injuries. The shin bone (tibia) is the most commonly affected bone accounting for approximately 40 % of stress fractures. Pain is the most common symptom. Plantar Fasciitis. The plantar fascia is the thick connective tissue that extends from your heel to your toes. Plantar fasciitis is the inflammation of the plantar fascia and is the most…

Read More About Ankle Pain When Running

Outside Ankle Pain

We often see patients with outside ankle pain who have no idea how it happened; they just know their ankle suddenly started hurting. One patient was a classic example of this. As an athletic hockey and Lacrosse player, however, it’s highly possible he experienced sprains and other ankle injuries, even minor ones, over the years, and these, rather than one big traumatic episode, could have been the catalyst to his sudden outside ankle pain. Outside ankle pain can be treated without surgery by an interventional orthopedics physician. Loose or torn ligaments usually can be treated nonsurgically with ultrasound-guided high-dose platelet-rich plasma (PRP) injections…

Read More About Outside Ankle Pain

Subtalar Joint Pain

Ankle pain can be debilitating making a simple step almost impossible, and a common source of ankle pain is the Subtalar joints. What are the Subtalar Joints? Why does my Subtalar Joint Hurt? What Movement Occurs at the Subtalar joint? What are the treatment options for Subtalar Joint Pain? Let’s dig in. The foot has 33 joints one of which is the subtalar joint. The joint is also known as the talocalcaneal joint and is where the ankle bone (talus) meets the heel bone (calcaneus) to form a joint. It is located near the heel and is immediately beneath the inside and outside ankle bones (malleoli).

Read More About Subtalar Joint Pain

What are the fastest ways to heal a ligament?

If you have a mild Grade 1 or Grade 2 injury, this can be accomplished two different ways:

1) A simple prolotherapy injection, which is a hypertonic dextrose injection utilizing ultrasound guidance to guide the needle directly into the ligament to inject it.

2) Using your own orthobiologic (such as platelet rich plasma, which is a concentration of your growth factors) that we inject into the ligament to encourage increased blood flow and stimulate your repair mechanisms to ideally get that Grade 1 or Grade 2 injury back towards normal tissue. If you have a more advanced injury, such as a Grade 2 or Grade 3 injury, utilizing stem cells or bone marrow concentrate typically is indicated. If it’s a high Grade 2, sometimes you can get away with utilizing PRP to facilitate your ankle pain recovery as well as improve the function of the ankle.

Patient Testimonial

Let’s take a brief minute to talk with a patient of ours about the experience he’s had with platelet rich plasma in his ankle:

Question: What Treatment was Suggested Prior to Visiting With Us?

“Surgery! I had three ankle surgeons say, “We’re going to have to, in order to get you to function, take part of your hamstring tendons or bicep tendons or cadaver tendons and put them from this ankle bone to that ankle bone, and you’re going to be off your feet for three months. Three surgeons want to do that. So I come to Dr. Markle, an injection once a year and 50 percent improvement, then 80, then 99. It’s pretty amazing.”

Question: What Kind of Results Have You Experienced Since Your PRP Injections?

“My name is Paul Berger, and I’m a medical doctor myself, but I’ve had multiple injuries to my ankle and to my wrist, so I’ve been coming to Dr. Markle for a few years now here for PRP injections, and when I first came about four years ago, I could no longer run, I tried to walk with a golf bag and every time I would twist, I would get sharp pains.

“He did an injection that improved it about 50 percent the first few months. He did another injection it the second year and it was up to about 75 or 80 percent improvement. Then we did one more, and now I’m running on single track over rocks in the mountains, steep ups steep downs, rock climbing, playing tennis again, which I just didn’t have the opportunity to play tennis before, but now I can  run back and forth and not have any limitations in my ankle.

“Once or twice a year, I’ll get a little tweak that, I think, oh did I cause some pain, I mean, did I cause some damage, but then I forget about it for months. So I’m still running on uneven ground and not always in the best shoes, so it’s pretty amazing that I can do a partial ankle twist and then and then have it resolved in seconds. It’s just amazing that I can do all these activities again and have maybe three seconds of pain twice a year.”

Do You Have a Sprained Ankle?

If you or anybody you know have been dealing with a sprained ankle that’s not recovering or have been told you need orthopedic surgery for that sprained ankle, feel free to give us a call. You can reach out to us on social media or give us a call directly. We are happy to set you up with either an in-person evaluation or a Telehealth evaluation to further discuss and evaluate your problem.

Related: Brostrom Ankle Surgery: Reasons to Avoid This Surgery

Our Doctors That Can Assist with Sprained Ankles

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Sprained Ankles

  • How Long Does a Sprained Ankle Stay Swollen?

    It happened several weeks ago as you stepped off the curb.  Your doctor told you that you sprained your ankle.   What is an ankle sprain? What are the different types of ankle sprains?  How can I tell if I have an ankle sprain?  How long does a sprained ankle stay swollen?  Let’s dig in. What … Continued


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