/ Turned ankle - trail race coming up

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Steff - on 31 Jul 2017
I turned an ankle on a night trail run 7 days ago and am trying to see an expert soon, but will have to wait a while for a traumatologist appointment. I was hoping for some advice on here meanwhile:

I felt my ankle turn outward as I landed on top of a rock. It hurt for a few minutes, but I was able to continue running home for another 5 km with no problem. It then started swelling and hurting on the upper outside of the foot (not the ankle).

This has not gone away completely and there is a small tender bulge. It generally hurts when I wake up in the morning and after sitting around for while, but feels fine once warmed up. Foot feels better barefoot or in strong shoe, but hurts in sandals and floppy trainers. Running feels okay until afterwards. Strangely, it actually feels better when running, so I have kept training. Apart from hanging the foot into some cold water, I have not applied any treatment or taken any medicine.

Has anyone experienced such an injury? I have a trail race coming up this Saturday and feel rather well prepared and would not like to miss it. Will taping help? Should I stop running until Saturday? Any taping that might help? Any advice appreciated.
wbo - on 31 Jul 2017
In reply to Steff: Yes, Ive done and experienced something very similar - in fact for a few days after walking was pretty tricky till I warmed up. How long is the race? If it were me, I'd keep on running a bit, but reduce volume as a taper, and twice a day, inc. after your run ice , and apply ibuprofen gel.

I have no idea on taping.

r0b on 31 Jul 2017
In reply to Steff:

Try to keep the ankle moving as much as possible without pain (without too much pain at least), by doing ankle circles, inversion and eversion, plantarflexion and dorsiflexion. It's important to keep the ankle's range of motion as it heals.
Steff - on 31 Jul 2017
In reply to wbo:

> How long is the race?

19 km with 1000m of ascend.
Irk the Purist - on 01 Aug 2017
In reply to Steff:

I sprained my ankle badly three weeks before my a-race for the year, if not my life. If you're running pain free you're about where I was the week before after 2 weeks rest. That's ok you should be able to get round. But...

There is a big risk of you doing it again, but worse, on the race. Your ankle ligaments are damaged and stretched aleady. Rather than a traumatologist (what's one of them?) I would seek a good sports physio the morning of the race and get it taped. Shave your legs and avoid the underlay so you can still get socks and shoes on comfortably.

In the meantime use ice and heat. Stand on the bad leg with your eyes shut to help relearn your balance. Do gentle running on road.

I got mine taped the morning of the race and got round 100miles of the Lakeland 100 later that day. And the next. And a bit of the next.

A doctor of any sort will advise you to rest. I had mine xrayed as a precaution and they wanted to put it in a cast ffs.
Niblet on 01 Aug 2017
In reply to Steff:

A physiotherapist, maybe even a sports one, will probably be of better use to you than a trauma specialist, who would most likely rather be patching up gunshot wounds than slightly sprained ankles.
Steff - on 01 Aug 2017
In reply to Niblet:

> A physiotherapist, maybe even a sports one, will probably be of better use to you than a trauma specialist, who would most likely rather be patching up gunshot wounds than slightly sprained ankles.

Gunshot wounds? Not around where I live, but I get your point.

Given that my physio can see me tomorrow I have made an appointment. I have only ever used him for sports massage so far, so I ma not sure how good he is at other stuff, but will give it a go.
Steff - on 01 Aug 2017
In reply to all:

Thanks for all the useful suggestions!
Diddy - on 01 Aug 2017
In reply to Steff:

I would tape it, Kinesio tape is good, if you know how to do it properly; see YouTube; or use an ankle support which can be better as you can take it off when it suits.
steveriley - on 01 Aug 2017
In reply to Steff:

I had a bad series of sprains a few years ago and found a modified version of basket weave taping and a mix of non-stretchy zinc oxide tape and stretchy cohesive tape gave me the support I was after without hindering movement.

You want to be able to flex normally but give a tug just when you're about to go over on it. That reminder is what you need to prevent doing it again (and again). The neural pathway telling your brain when you're about to go over has got a bit fuzzy once you've done it. Or something.

I found quite a good tutorial on the Rock and Run site I think but that seems long gone now.
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Murderous_Crow - on 01 Aug 2017
In reply to Steff:
Hi Steff,

You need an X-ray. Your description of the mechanism of injury, symptoms and signs could point to a fractured metatarsal. These are the long bones you can trace on the top of the foot. This type of fracture is fairly common on inversion injury (where the sole of the foot rotates inwardly under high load) and one of the ligaments connected to the metatarsal 'avulses', stripping from its attachment, often pulling a bony fragment away with it. Your signs are consistent with this picture.

Regardless, fracture must be excluded as a possibility before any kind of serious loading, let alone a race. It's not worth risking more serious disability. Your physio should, I would argue, refer you for X-ray.

ETA: you could also get an X-ray referral from your GP.

Luke
Post edited at 19:09
Steff - on 02 Aug 2017
In reply to Murderous_Crow:
Thanks for this! This had me worried for a minute, so I went to see the trauma specialist at the local A&E this morning (private hospital). I also had the physio appointment afterwards.

Both agree that there is some very light damage at the insertion of the lateral ligament.
But whereas, the trauma doc prescribes strong anti-inflammatory medication and complete rest, the physio tells me to take nothing and keep training. According to the trauma guy the race will cripple me, according the physio there is no reason to skip the race.

So, the expert advice covers an even wider spectrum than UKC. ;-)
At least any fracture has been discarded.

I will thus train and race according to what the foot feels like. Thanks again for all the suggestions.
Post edited at 12:29
Murderous_Crow - on 02 Aug 2017
In reply to Steff:

Wise to get fracture excluded.

For what it's worth I'd suggest the following:

Supportive strapping as suggested higher in the thread

Ice and compression for circa 20min three times daily

Non-steroidal anti-inflammatory as prescribed by the orthopod and if tolerated. Evidence against use of NSAIDs in acute musculoskeletal injury is weak and largely speculative, whereas such drugs if tolerated provably can and do improve pain and (obviously) reduce inflammation.

Plus paracetamol as required for break through pain

Elevation of the limb when not in use

Mobility *as tolerated* (also as suggested above) meaning no pushing through pain

There's nothing wrong with loading an injured limb if it does not produce pain; most of the literature nowadays indicates that early loading is associated with improved outcomes. It must not exacerbate pain however, so it's crucial that you start out fairly light and be prepared to stop training or indeed your race. Be aware that an inflammatory response to loading can develop over hours, so load yourself cautiously.

I think your approach is reasonable, to go on subjective feel now that fracture is ruled out. And I'd advise using an NSAID if you can: it won't mask an exacerbation of pain but will certainly improve your comfort, and make your movement more natural. This will reduce risk of an associated compensatory injury. If you're determined to race you should apply a fair degree of caution.

Luke

cb294 - on 03 Aug 2017
In reply to Steff:

+1for Diclofenac and tape, but proper inelastic tape rather than kinesiotape as recommended above (you want stabilization of a ligament injury, not muscle support).

CB
Steff - on 06 Aug 2017
In reply to Steff:

Just to let you know the outcome:

The race went very well indeed. The ankle held up fine. I still noticed it on a brief course inspection the day before, but it felt completely fine during the actual race. Maybe because I was distracted.
Came in 35th on technical course with a competitive field.

Thanks again for all the advice.
DancingOnRock - on 06 Aug 2017
In reply to Steff:

Well done.

The two bits of information that were missing were; how old are you and when is the race.

All academic now though.
Steff - on 06 Aug 2017
In reply to DancingOnRock:

Thanks!

Yes, my age was missing (40), but the day of race was in the OP. ;-)
BusyLizzie on 07 Aug 2017
In reply to Steff:

Brilliant, well done!
Irk the Purist - on 07 Aug 2017
In reply to Steff:

We'll done. Now get some rehab or you'll do it again and again and again until your ankles are nothing but floppy ears, flapping against frustrated legs.

Note I said rehab, not rest.

blackcat on 07 Aug 2017
In reply to Irk the Purist: agreed with the rehab, but dont overdo it,i rolled my ankle five weeks ago now and while i can walk,i still cant run on it yet still getting pain in the achilles area when pushing off the affected foot.
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DancingOnRock - on 07 Aug 2017
In reply to Steff:

Ah yes. "This Saturday", I read it three times and couldn't find it. Must be my age. ;)

I've found ever since turning 40, recovery times have got longer and longer. I should sleep more really.

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