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Foot and Ankle Injury
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Ankle Fracture (Open)

X-Ray - Ankle Fracture

Ankle Sprain

First Aid - Splint for Ankle Injury

First Aid - Bleeding Leg

First Aid - R.I.C.E.

Definition

Injuries to a bone, muscle, joint or ligament of the ankle and foot

Types of Injuries

Achilles tendon rupture - There is pain in the Achilles tendon (area above heel and behind ankle). There is weakness or inability to extend the foot (e.g., can't stand on tiptoes).
Contusion - A direct blow or crushing injury results in bruising of the skin, muscle and underlying bone.
Cuts, abrasions
Dislocations (bone out of joint)
Fractures (broken bones)
Sprains - Stretches and tears of ligaments
Strains - Stretches and tears of muscles (e.g., pulled muscle)

If not, see these topics

ANIMAL BITE to foot or ankle
BURN of foot or ankle
PUNCTURE WOUND to foot or ankle
SKIN INJURY is main concern
TOE INJURY is main concern

First Aid:

FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Penetrating Object: If penetrating object still in place, don't remove it.

FIRST AID Advice for Shock: Lie down with feet elevated.

FIRST AID Advice for a Sprain or Twisting Injury of Ankle or Foot:

Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes.
Wrap area with an elastic bandage.

FIRST AID Advice for Suspected Fracture or Dislocation of Ankle or Foot:

Do not remove the shoe.
Immobilize the ankle and foot by wrapping them with a soft splint (e.g., a pillow, a rolled-up blanket, a towel).
Use tape to keep this splint in place.

Transport of an Amputated Body Part:

Briefly rinse amputated part with water (to remove any dirt).
Place amputated part in plastic bag (to protect and keep clean).
Place plastic bag containing part in a container of ice (to keep cool and preserve tissue).

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Care at
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When to Call Your Doctor

	Call 911 Now (you may need an ambulance) If
	Major bleeding (actively bleeding or spurting) that can't be stopped Limb has been partially or completely amputated Injury looks like a dislocated joint (crooked or deformed) Bone sticking through skin NOTE: For bleeding, see First Aid
	Call Your Doctor Now (night or day) If
	You think you have a serious injury Severe pain You can't stand (bear weight) or walk
	Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
	You think you need to be seen There is a large swelling or bruise (wider than 2 inches) at the site of the injury You are limping You are over age 54, have osteoporosis, or use steroid medications routinely
	Call Your Doctor During Weekday Office Hours If
	You have other questions or concerns Injury interferes with work or school Injury and pain have not improved after 3 days Injury is still painful and swollen after 2 weeks
	Self Care at Home If
	Minor bruise Minor strained (pulled) muscle or sprained (stretched) ligament

Symptom
Description

Care at
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HOME CARE ADVICE FOR MINOR BRUISE, SPRAIN OR STRAIN

Treatment of Minor Bruise (e.g., direct blow to ankle or foot):
- Apply a cold pack or an ice bag (wrapped in a moist towel) for 20 minutes each hour for 4 consecutive hours. (20 minutes of cooling followed by 40 minutes of rest for 4 hours in a row).
- 48 hours after the injury, use local heat for 10 minutes 3 times each day to help reabsorb the blood.
- Rest the injured part as much as possible for 48 hours.
Treatment of Minor Sprains and Strains of Foot and Ankle:
- FIRST AID - Wrap with a snug elastic bandage. Apply an ice pack (crushed ice in a plastic bag covered with a moist towel) to reduce bleeding, swelling, and pain.
- Treat with R.I.C.E. (rest, ice, compression, and elevation) for the first 24 to 48 hours.
  - REST the injured leg for 24 hours. You may return to normal activity after 24 hours of rest if the activity does not cause pain.
  - Continue to apply crushed ICE packs for 10-20 minutes every hour for the first 4 hours. Then apply ice for 10-20 minutes 4 times a day for the first two days.
  - Apply COMPRESSION by wrapping the injured part with a snug, elastic bandage for 48 hours. If you experience numbness, tingling, or increased pain in the injured part, the bandage may be too tight. Loosen the bandage wrap.
  - Keep injured ankle or foot ELEVATED and at rest for 24 hours. Keep your foot up on a pillow and stay off your feet as much as possible.
Pain Medication:
- For pain relief, take acetaminophen or ibuprofen.
- Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
- Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
- People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
- CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
- CAUTION: Do not take acetaminophen if you have liver disease.
- Read the package instructions thoroughly on all medications that you take.
Expected Course: Pain and swelling usually begin to improve 2 or 3 days after an injury. Swelling is usually gone in 7 days. Pain may take 2 weeks to completely resolve.
Call Your Doctor If:
- Pain becomes severe
- Pain does not improve after 3 days
- Pain or swelling lasts more than 2 weeks
- You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/5/2008

Content Set: Adult HouseCalls Online