Ankle pain - Walking the Walk

A hockey player with ankle pain limped in to the clinic after taking a slap shot off the outside of the ankle (lateral malleolus).  He said he was able to play the rest of the game and it did not really hurt until the next morning.  When he woke up, there was moderate swelling and a bit of bruising, but he found it actually hurt more on the medial side and on the bottom of his foot. 

SIGNS
-bruising and swelling
-decreased range of motion

SYMPTOMS
-pain (weight bearing and non weight bearing)

The most likely reason for the pain on the medial and plantar (bottom) aspects of the foot are from intra-articular swelling (swelling inside the joints).  It could also be from joint dysfunction or joints being jammed.  In terms of treatment, the best bet would be to bring the swelling down ASAP.  Rest, Ice, Compression and Elevation can help.  I find that a bucket of ice cold water works more effectively than gel packs.  Compression from a tensor or tape is effective.  I have also found laser therapy to be a benefit and seems to decrease recovery time.  If joints are restricted or jammed up, mobilizations and/or adjustments can be done.  The trick is to avoid the mobs or adjustments from being painful.

The question is can they continue to walk and perform daily activities (or even play another game?)  The answer depends on how bad the ankle pain actually is.  A good way of testing this is the use of the Ottawa Ankle Rules.  This can help determine whether the person needs to go for Xrays.  If they do not need Xrays, then you should find out how comfortable it is to walk.  If they want to play a sport, you could test them with some of the movements of that sport to see if they can move without hindrance or pain.  I would test them with a one leg squat, jumping on one and two feet, and running.  If there is pain with those movements, I would recommend resting until the pain and swelling go down, but depending on the athlete and the level of sport (and importance of the game), they may ignore the recommendations

Each ankle injury will present differently.  It is important to determine the nature and severity of the injury, the type and amount of treatment that it may require, and the functional capabilities of the injured person.