Ankle sprains and injuries of the ankle are some of the most common musculoskeletal injuries physicians treat. Most ankle sprains will resolve, and patients will improve without the need for further intervention. After recurrent ankle sprains, or after a severe ankle sprain, long-standing pain or instability in the ankle may develop. After a period of 3 to 6 months following a standard ankle sprain, continued pain or instability of the ankle is unusual, particularly after undergoing an appropriate course of physical therapy and other conservative interventions. In this scenario, treatment with an orthopaedic foot and ankle specialist is indicated.
Instability is the continued lack of confidence, recurrent sprains, or feeling of giving way of the ankle that becomes a long-standing problem. This may occur during sporting activities but may also occur — and is particularly concerning — if it occurs during everyday activities such as walking on uneven surfaces or without any specific trauma. For those who have failed conservative treatment, a reconstructive procedure may be necessary to reconstruct the ankle ligaments by tightening back to the bone. Some of the surrounding tissues are often used to reinforce the repair strongly. The majority of patients simply need this type of procedure to improve their symptoms. In some patients with poor or severely stretched-out ligaments that are not repairable, other tissue is necessary to reconstruct the ligaments of the ankle. Sometimes, additional bone correction is necessary for patients with abnormal bone alignment of the heel.
Another problem that can occur is continued pain in the ankle or surrounding tissues after recurrent ankle sprains or instability. For such patients, additional evaluation of the ankle for problems involving tendons around the ankle (peroneal tendons), ankle joint lining (soft tissue scar impingement of the ankle), cartilage lining of the ankle joint for possible chip fracture (osteochondral lesion), or other problems is required. Many of these problems require surgical intervention to improve symptoms and to prevent the progression of pain.
Dr. Vora specializes in the treatment of sports-related injuries of the foot and ankle and utilizes arthroscopic or minimally invasive techniques for such conditions to minimize recoveries and maximize outcomes whenever possible. Dr. Vora has published and lectured on these conditions both locally and nationally and instructs other orthopaedic surgeons in the treatment of these conditions. Dr. Vora has also been instrumental in developing a new orthopaedic device that allows quicker recovery after ankle ligament injuries with near-immediate weight bearing and strengthening with quicker return to activity and sports. That device is now being utilized nationally and internationally.
What is the P.O.L.I.C.E. method?
As explained by Dr. Anand Vora.
The P.O.L.I.C.E. stuff is really just a further extrapolation of the RICE method of recovery. The RICE method is an acronym that stands for rest, ice, compression, and elevation, but really the next level of the thought process behind this is to get patients better quicker. The way to think about this is that when we have an acute injury, we acutely want to protect the ankle. We want the ankle or the soft tissues around the area of the injury to allow for some rest to try to prevent over-damage when the acute injury occurs. As soon as that occurs, what we’ve learned is that we do not want to keep patients off their extremity. If the ankle and the bones and soft tissues are stable, regardless of the acute injury, we want to try to load the joint. That’s called optimal loading.
Is P.O.L.I.C.E. better than the RICE method?
The advantage of that has been shown that rather than just the traditional RICE method, combining some optimal loading in the early phases of healing when the acute injury occurs, but the ankle is still stable, allows for a much quicker recovery. What happens is that the ligaments don’t atrophy or become weak during that non weight-bearing time frame. By providing weightbearing, it actually surprisingly provides all the nutrients through the ankle joint, synovial fluid, and the lining of the joint to let the cartilage try to heal quickly, and also provides appropriate blood flow to let the ligaments and soft tissues heal quicker. Then we use the same principles of compression, elevation, and all the other things that are traditional.