49ers LaMichael James Goes Down With Ankle Injury

The San Francisco 49ers second round pick LaMichael James twisted his ankle late in the fourth quarter of the second preseason game.  He had to be helped off of the field.  It was a tough night for the 49ers running backs.  In the first quarter Brandon Jacobs had to leave the game with a knee injury. 

To some a twisted ankle may not seem serious but there are many things that can go wrong.  If you experience a twisted or sprained ankle please get it looked at to rule out something very serious.

When assessing an ankle sprain, the doctors at Gulfcoast Foot and Ankle will want to know the mechanism of injury and history of previous ankle sprains. Where the foot was located at the time of injury, "popping" sensations, whether the runner can put weight on the ankle are all important questions needing an answer. If past ankle sprains are part of the history, for example, a new acute ankle sprain can have a significant impact.


The physical examination should confirm the suspected diagnosis, based on the history of the injury. One looks for any obvious deformities of the ankle or foot, black and blue discoloration, swelling, or disruption of the skin. When crackling, extreme swelling and tenderness are present, together with a limited range of motion, one may suspect a fracture of the ankle. A feeling of disruption on either the inside or the outside of the ankle may indicate a rupture of one of the ankle ligaments.

To check for ankle instability, you should be evaluated while weight bearing. Manual muscle testing is also valuable when checking for ankle instability. One of the more critical tests that you should be able to perform before allowing resumption of activity is a "single toe raise" test. If you are unable to do this, one might suspect ligamentous injury or ankle instability.

X-rays help rule out fractures, "fleck fractures" inside the ankle joint, loose bodies, and/or degenerative joint disease (arthritis). Stress X-rays are taken when ligamentous rupture or ankle instability is suspected. When a stress test is taken of your ankle, don't be surprised if the same test is performed on the other ankle. This is done to compare the two ankles, particularly in cases of ligamentous laxity (loose ligaments).

In the past, more commonly, ankle arthrography has been used. This involves injecting a dye into the ankle joint as it is X-rayed. This helps determine if a rupture of a ligament or tear of the ankle capsule has occurred. However, this procedure does involve some discomfort during the injection process, and, on rare occasions, an allergy to the dye occurs.

Other diagnostic tests include computerized tomography (CT Scan) to discover injuries of the bone, and magnetic resonance imaging (MRI) to isolate and diagnose specific soft tissue injuries (ligaments, tendons, and capsule). The MRI is very specific, and gives a clear-cut view of these important structures