DR PRADEEP MOONOT
While people assisting in following social distancing measures and maintaining the lockdown, some of them may have complications and may be hesitant to go to hospitals. Being at home, many may be new to household chores. There are two types of complications that people may face in the lockdown: one is common foot and ankle-related ailments, and the other is chronic morbidities and co-morbidities that may trigger these complications. Therefore, in order for everyone to know and identify the emergency trigger symptoms to consult assistance should be known amid the lockdown.
The common complaints
There are various types of foot and ankle problems that one may face during the lockdown, but when should one consider to consult a specialist? One of the most common ailments that almost every one of us undergoes is ankle sprain.
1. Ankle sprain – Compared to western countries where ankle sprain is attributed as a sports injury, it is quite common in India due to bad pavements, footwear and improper movements. In almost 95% of the cases this sprain is a lateral one where the ligaments are stretched towards outside. While these injuries are manageable without surgical intervention, but we have to be careful about the severity and identify the grades of it in order to seek timely medical attention.
Grade 1: If immediately after a sprain, if one is able to walk and there is no swelling until 24 hours, the sprain condition falls in the Grade 1 severity where only one ligament in the ankle is stretched. This is the most common grade and the most basic form of ankle sprain which can be treated with home remedial measures.
Grade 2: 2nd Grade severity causes more pain which is accompanied by limping, swelling and bruising. This can easily be identified if one needs immediate medical assistance through self examination. If the bony prominence in the ankle is painful upon touch then it is important to get X-ray done. But if the pain is scintillated around the bony prominence then it can be self managed at home itself.
Grade 3: This stage is accompanied by immediate and heavy swelling and excruciating pain. Due to the damage in 2 or more ligaments the patient may need support while walking due to imbalance and feels as if the ankle is going to give way. Thus for timely action, radiological diagnosis like X-ray must be done immediately and the specialist may put plaster or ankle braces for support.
Most of the time any ankle sprain occurring while at home or doing any household chores are of Grade 1 or 2 which can be easily managed at home and no need to visit the hospital. But this should seldom be taken lightly as the ankles if sprained once causes ligaments to stretch and chances of getting another sprain is high known as Recurrent Ankle sprain which has very high chances of ligament, joint and cartilage damage arthritis.
The simplest home remedy to treat ankle sprain is RICE technique.
Rest – Sufficient rest is required for quicker healing and depending upon the stages and severity of the sprain, duration of rest may vary. 5-6 days of rest may be sufficient in Grade 1, 1-2 weeks in grade 2 and around 3 weeks in grade 3. Rest here doesn’t signify to immobilize but walking on uneven surfaces should be prohibited.
Icing – Icing for 15-20 minutes three to four times a day may ease the pain and reduce swelling. This helps in reducing acute inflammation and swelling. This can be done in any comfortable way sought. Wrap ice in towel and apply for some time, but one must be careful as many people have complaints of skin burn due to excessive application of ice.
Compression – The affected area need to be compressed using a crepe band which can be put starting from toes and used while walking around and removed while resting. This will help in quicker healing, reduces swelling and bruises, and back to work will be faster.
Elevation – While lying down, keep your foot on two pillows and the swelling will go down. Do not worry if you see bruising as it will take 5 days to settle down.
2. Heel pain – it is the second most common type of foot and ankle ailments. There are two types of heel pain which people usually do not know to differentiate.
Plantar Fasciitis – 90% of us undergo heel pain at the bottom of the foot when the tissue from the heel bone joining with the toe is inflammated. This condition is known as Plantar Fasciitis.
This type of heel pain can be easily identified as the pain is at its peak when the patient gets up in the morning or gets up after rest and then subsides after walking and settles down. It is most commonly found in middle aged population who are overweight, or undergo intense & impact exercise or does a ot of walking without proper stretching, warm up or cooling down. Others having inflammatory disorders like Rheumatoid Arthritis, Psoriasis or Irritable Bowel Disease are also vulnerable.
Most of the time Plantar Fasciitis can be easily managed by routine exercises like stretching of calf muscles, plantar fascia, and toe stretching accompanied by icing the foot as soon as you get up in the morning. This also eliminates the amount spend on physiotherapy and relieves the symptoms within 5-6 weeks time.
Stress Fracture – While the remaining 10% of the heel pain cases do not have typical symptoms as in case of plantar fasciitis. In this case the pain aggravates only after starting to walk, and can be triggered even with normal activities, and the reasons attributed include low levels of Vitamin D, Calcium and poor Bone Mineral Density (BMD). Other rare reasons may include tumor in the heel bone, pain due to infection, and compression in the backster nerve.
—Dr Moonot is Orthopaedic Surgeon & Podiatrist, Mumbai Knee Foot and Ankle Clinic