DETROIT -- Elusive high ankle sprains -- most commonly found in athletes -- usually are not seen in regular ankle x-rays, preventing the athletes from receiving proper treatment and delaying their return to activity, according to a study by Henry Ford Hospital researchers.

In a study to be presented Thursday at the annual meeting of the Radiological Society of North America in Chicago, Tony Bouffard, M.D., a Henry Ford radiologist, said high ankle sprains differ from the classic ankle sprain in that there usually is minimal swelling, tenderness and pain but it takes longer to heal. The Henry Ford researchers concluded that ultrasound can help diagnose high ankle sprains.

"If a person has a high ankle sprain, he or she usually doesn't feel the pain until they put some extra weight on it," Dr. Bouffard said.

High ankle sprains occur when a person plants down on the inside of the foot and pushes, causing a twist in the upper part of the ankle where it meets the mid-calf, he said. Often, it is made worse if someone falls on top of the leg.

Physicians need to get a good history from the patient with ankle problems and determine how the injury occurred, Dr. Bouffard said. "Because these injuries usually only happen when the person lands on the foot in a certain way, taking a good history becomes very important."

Physicians also should squeeze the patient's mid-calf to see if pain is caused in the ankle. "Because there usually isn't much swelling, x-rays won't give you the answers. At Henry Ford Hospital, we use ultrasound to diagnose high ankle sprains."

By treating the patient's injury earlier, Bouffard said it is possible that the patient resume normal athletic activity in a matter of weeks. "Sometimes, the person is back playing football in four weeks."

The study was supported by Henry Ford Hospital. Athletic medicine specialist Henry T. Goitz, M.D., and radiologist Marnix van Holsbeeck, M.D., both of Henry Ford, co-authored the study.

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