Should you spend $300 to X-Ray your ankle?

Alright, we know that X-rays can be really useful for seeing fractures, but are they worth the cost? A typical X-ray can range anywhere from $63 to extortionist prices of over $1000. With sports ramping up this spring, I am seeing our young athletes for the routine injuries. The X-Ray question keeps coming up.

To X-Ray or NOT to X-Ray

The first joint that I am going to focus on is the ankle. We have all rolled our ankles at least once, and a number of us have broken our foot or ankle. Always the question that we ask first is – Do I need an Xray?

Ottawa Ankle Rules:

The best way to evaluate the need for Xrays involve the Ottawa Ankle Rules.
If any of the following questions are yes, then an X-ray is recommended.
1) Could you bear weight (4 steps) immediately or at presentation?
2) Is there tenderness at the posterior 6cm of the lateral mallelolus?
3) Is there tenderness on the posterior 6cm of the medial mallelolus?
4) Is there tenderness at the base of the 5th metatarsal?
5) Is there pain at the navicular bone?

If the answer is NO to all of the above questions, then treating as a sprain is the best initial approach. If the pain is not improving over the next 1-2 weeks, X-rays may still be indicated.

How do we treat a sprained ankle right after it occurs?

First line therapy is RICE therapy.
R) Resting your ankle briefly may help with pain control, but it is important to get back on your feet
I) Ice is good for the initial injury to decrease the swelling
C) Compression is good to help support your ankle. The best technique for this is an ASO or lace up brace that will provide support and compression to your ankle. The ASO brace will provide lateral support as well mild compression. This is also valuable as you move into the rehab phase as well to decrease repeat injuries.
E) Elevation is the next step to help decrease the swelling.

In addition, to help with the pain, I recommend NSAIDS (ibuprofen or naproxen) to help return to function sooner, but it is important not to suppress all of the pain on an unstable ankle.

How do we rehab a sprained ankle?

Studies have shown formal physical therapy versus home exercises do not have a drastic difference in outcomes in pain. That being said, after any severe sprain, your proprioception (sensation of where your foot is located) is often disturbed. Physical therapy allows you to reestablish your proprioception and decrease risk of reinjury as you return to function.
Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103112/

Home Exercise Regimen:

If you injure your ankle and you are not sure if it needs X-rays or it is not recovering, please contact us at the clinic to get in to see Dr. Silakoski or myself to get you back to being as active as possible.
Stay active out there,
M. Ryan Odom, MD
North Idaho Direct Primary Care

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