What is the best way to manage a sprained foot joint after a long run?

Management of a Sprained Foot Joint After a Long Run

For a sprained foot joint after a long run, immediate treatment should follow the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) with cold application for 20-30 minutes several times daily, followed by early functional rehabilitation with supervised exercises focusing on proprioception, strength, and coordination. 1

Immediate Management (First 24-72 Hours)

PRICE Protocol

• Protection: Avoid activities that cause pain and protect the injured area from further damage 1
• Rest: Limit use of the injured extremity for 3-5 days, but complete immobilization is not recommended 1
• Ice: Apply cold therapy (ice and water in a bag surrounded by a damp cloth) for 20-30 minutes, 3-4 times daily 1
  • Do not place ice directly on skin to prevent cold injury
  • Cold therapy reduces pain and swelling in the acute phase 1, 2
• Compression: Apply a compression wrap to promote comfort 1
  • A semi-rigid brace is more effective than elastic bandages or tape 1
  • Ensure compression doesn't compromise circulation 1
• Elevation: Keep the foot elevated to reduce swelling 1

Pain Management

• NSAIDs (e.g., naproxen, celecoxib) can help reduce swelling and pain 1
• These medications may decrease recovery time and improve function 1
• Acetaminophen may be preferred over aspirin due to the latter's effect on blood coagulation 3

Rehabilitation Phase (After 48-72 Hours)

Early Functional Treatment

• Begin functional rehabilitation within 48-72 hours after injury 1
• Supervised exercises are superior to non-supervised training 1
• Focus on:
  • Proprioception exercises
  • Strength training
  • Coordination activities
  • Range of motion exercises 1

Progressive Loading

• Gradually increase weight-bearing activities as tolerated
• Pain-free walking should be achieved before returning to running 1
  • Aim for 30 minutes of pain-free walking 1
• Functional movements should be assessed before returning to running:
  • Single leg squat
  • Hop tests 1

Support Devices

• A semi-rigid brace is the most cost-effective option compared to taping 1
• Continue using support during initial return to activities 1

Return to Running Criteria

Before returning to running, ensure:

• Resolution of local tenderness for at least 1 week 1
• Pain-free with activities of daily living for 3-14 days 1
• Ability to walk pain-free for at least 30 minutes 1
• Functional movements can be performed without pain 1
• Lower extremity strength is at least 75-85% compared to the uninjured side 1

Common Pitfalls and Caveats

1. Avoiding Proper Assessment: Ensure it's a sprain and not a fracture. If severe pain, inability to bear weight, or visible deformity is present, seek medical attention 1

2. Prolonged Immobilization: Complete immobilization is not recommended as it delays recovery. Functional treatment leads to faster return to activities 1

3. Returning to Running Too Soon: This can lead to re-injury or chronic instability. Follow a gradual progression based on pain and function 1

4. Neglecting Rehabilitation: Supervised exercises addressing proprioception, strength, and coordination are crucial for full recovery and preventing recurrent sprains 1

5. Overlooking Contributing Factors: Address potential contributors to the injury such as:

   • Footwear
   • Training errors
   • Biomechanical factors 1

By following this evidence-based approach, you can effectively manage a sprained foot joint after a long run, minimize recovery time, and reduce the risk of recurrent injury.