This episode came from a real call with a real runner who thought he had an ankle sprain, but he actually had a real ankle fracture!
If you are trying to figure out what you are really dealing with, and what pieces might be missing in your return-to-running plan, you can block my calendar for a 10 minute strategy call.
Click here to block my calendar for a 10 minute strategy call.
He could still walk. He had sprained his ankle before. He even looked up the Ottawa Ankle Rules,
pushed on the areas he thought he was supposed to check, and concluded that he did not need an
X-ray.
But his ankle was broken.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains how a long-time
runner and multiple Ironman finisher injured his ankle while roller skating. His ankle violently
flipped one direction and then the other, creating both inversion and eversion forces.
He immediately developed pain and swelling, but because he could still bear weight and because the
injury felt familiar, he treated it like another ankle sprain.
Runners spend years learning to tolerate discomfort. That can be useful in training and racing, but
it can become a disadvantage when you are trying to decide whether an injured bone is actually tender
enough to be broken.
A systematic review and meta-analysis of 36 studies involving 2,492 participants found that athletes
demonstrated greater pain tolerance, reported lower pain intensity, and had somewhat higher pain
thresholds than non-athlete controls.
The Ottawa Ankle Rules are a validated clinical decision aid designed to help determine when
radiographs are appropriate after acute ankle and midfoot injuries. They are highly sensitive when
appropriately applied in clinical settings.
But a clinical decision rule and self-diagnosis are not the same thing.
This runner checked the navicular, the base of the fifth metatarsal, the tibia and fibula around the
ankle, and whether he could walk. He did not interpret any of those findings as significant enough to
suggest a fracture.
Almost a week later, however, the swelling was still substantial, the bruising was extensive,
walking was still difficult, and the injury was not following the trajectory of his previous ankle
sprains.
X-rays showed fractures involving both sides of the ankle.
Many fractures still permit weight bearing. Some runners can walk surprisingly well with a fracture,
and some can even run with one. The fact that you can tolerate the pain is not proof that the injury is
minor.
The mechanism of injury, swelling, bruising, examination findings, ability to function, and –
importantly – how the injury changes over time all matter.
If you are recovering from an ankle sprain or an ankle fracture, the goal is not simply to wait until the pain goes away.
The goal is to come up with a strategy that helps you protect the injured ankle while maintaining as much running fitness as possible during recovery.
On a 10 minute strategy call, we can talk about the pieces that may be missing in your return-to-running plan and the strategy you may need to keep your fitness while your ankle is healing.
Click here to block my calendar for a 10 minute strategy call.
Scientific References Supporting This Episode
Thornton C, Baird A, Sheffield D. Athletes and Experimental Pain: A systematic review and meta-analysis. The
Journal of Pain. DOI: 10.1016/j.jpain.2023.12.007. The review included 36 studies and 2,492 participants and
found greater pain tolerance and lower reported pain intensity in athletes, with a smaller increase in pain
threshold.
Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of
the ankle and mid-foot: systematic review. BMJ. 2003;326:417. DOI: 10.1136/bmj.326.7386.417. Twenty-seven
pooled studies included 15,581 patients; the review concluded that the rules are highly sensitive for excluding
ankle and midfoot fractures when appropriately applied.
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