HEALTH TOPICS 
It takes less force to sprain an ankle as we age. A few precautions can help to reduce the severity of these injuries or avoid them altogether.
Few of us have gone through life without spraining an ankle. Sprains are among the most common musculoskeletal injuries in people of all ages, and ankles are particularly vulnerable because of the small size of the joint and the forces exerted on it when the body is in motion. While younger people usually sustain sprains while running or jumping, for older people just stepping off a curb awkwardly or walking on an uneven ground can do it. "As you age, your balance and strength can diminish, especially if you've been immobile, increasing your risk for sprains," says Dr. Holly Johnson, a foot and ankle orthopedic surgeon at Harvard-affiliated Massachusetts General Hospital.
How sprains occur
The injury occurs when one or more of the ligaments — elastic bands of tissue that keep the ankle bones in place — are stretched or torn. The most common type of ankle sprain is an inversion injury, or lateral ankle sprain. The foot rolls inward, damaging the ligaments of the outer ankle. Less common are sprains affecting the ligaments of the inner ankle and sprains that injure the ligaments that join the two leg bones (the tibia and the fibula) just above the ankle.
What to do if you have a sprain
The first treatment for an ankle sprain is the classic RICE regimen — rest, ice, compression, and elevation. Rest the ankle as much as possible for the first day or two. Ice the ankle for 20- to 30-minute periods every three or four hours until swelling starts to subside. Compress the injury with an elastic wrap, but not so tightly that you block circulation and lose feeling in your toes. Elevate the injured ankle to hip height when you're sitting.
For severe sprains, you may need to wear a brace for protection and stability for a few weeks. In some cases, you may need crutches until you can walk without pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to control pain and swelling.
When to seek treatment
It's not always easy to distinguish a sprain from a fracture. "What might have been a sprain in a younger person can be a fracture in someone older because the bones are weaker," Dr. Johnson says. If you have lots of swelling, bruising, or numbness, or if you can't put your foot down or walk on it, you may have a fracture. If you have any questions about whether your ankle is sprained or broken, you should get it evaluated in an urgent care facility or your primary care office.
Preventing ankle injuries
Strong, flexible ankles are key to avoiding injury. Simple exercises like writing the alphabet in the air with your foot are easy to do while you watch television. Any activity that keeps you on your feet — like walking or dancing — is likely to help, too. You may also want to give tai chi a try to improve your balance.
And, as always, wearing supportive shoes will help to ensure that you're on stable footing.
Image: © Judith Glick/Thinkstock
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