When should a runner who rolled an ankle be concerned that there might be a fracture like a lateral process fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just saw a runner who sprained her ankle and it’s been about a month and she’s still having pain. She’s actually still having swelling too and obviously pain and swelling that are persisting a month later, are not good, but it is common and there are a couple of reasons that that can happen. Sometimes it can happen with a soft tissue injury, but anytime we see persistent swelling and pain, we become concerned there might be a fracture.
One of the ways that you can get injured and actually have a fracture is a thing called a lateral process fracture and I will explain to you what the one thing was with her that may be worried about that and what these things are.
So, in short, a lateral process fracture is an ankle fracture that happens, I actually did the largest research study ever on lateral process fractures and won an award for it from the American College of Foot and Ankle Surgeons when I was in residency. We were taught that they’re actually very rare injuries but in the research that we did at the University of Utah, I discovered that it’s not really that rare. In fact, they are 10 times more common than previously thought.
This is your ankle, you’ve got several things. You have the fibula bone sitting on the outside of the ankle. You have the talus bone underneath the tibia. So, this is your tibia, or shinbone, you have the fibula, then you have the talus, and then you have the heel.
When you roll your ankle, one thing that can happen is that you can actually get a fracture or a crack in this little bone right here. And that piece that little, little pointy part there, that is this thing that we call the lateral process of the talus. So, the lateral just means outside, so it’s on the outside of your ankle.
If we’re looking at you and you’re standing and these are your feet and you have your heel bones here and the talus sits on top of the heel bone like that. These are your shin bones and fibula bones are on the outside. So, the pain is always on the outside. It’s lateral, right under the fibula bone. That’s where the lateral process fracture happens. So, if you have pain over here on this spot, well that’s the point piece we call the lateral process.
In her case, she had pain in a couple of areas. The ligament that’s most often sprained when you get an ankle sprain is up here. It’s called the ATFL or anterior talofibular ligament and that one goes basically from the fibula to the front of the talus. And so, you can have pain there, you can have pain in lots of places, but in her case, she had pain specifically when I pushed on that one spot.
If I manipulated her ankle and sort of compressed it and pushed against the fibula bone, no pain. If I stretched her and tested her perineal tendons that can also get injured when you sprained your ankle, no pain. But when I only pushed on that one spot, she had a lot of pain and that made me concerned that she might have actually had one of these lateral process fractures.
Another word of caution. These things are very, very frequently missed, really frequently missed and so I actually go to medical conferences and teach physicians how to not miss these fractures when they see people with ankle sprains. But about 10% of people, well, specifically, about 9% of people who have an ankle sprain will actually have a lateral process fracture. At least that’s what we found in the study that we presented at the scientific conference of the American College of Foot and Ankle Surgeons many years ago. And so, if you have pain that persists, if you have had bruising, if you’ve had swelling and the swelling hasn’t gone away, and the pain is still persisting, this could be a thing that’s bugging you.
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