Ankle sprains are the most frequent musculoskeletal injury seen by primary care physicians. It is estimated that thousands of people around the world on a daily basis require medical care for ankle sprains of the ankle joint, which is made up of three bones held together by ligaments that provide stability by limiting side-to-side movement.
Ankle sprains are common sports injuries but can also happen during everyday activities. An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outer side of the ankle. The severity of an ankle sprain depends on whether the ligament is just stretched, partially torn, or completely torn, and on the number of ligaments involved in the injury. Ankle sprains are not the same as strains, which affect muscles rather than ligaments and an ankle fracture means broken bones.

Causes
Ankle sprains are usually caused by an unnatural twisting motion occurring in the ankle joint, most commonly when the foot is pointing downward and is forced inward awkwardly. Persons would describe this as "rolling their ankle". This stretches the ligaments on the outer side of the ankle. Sprained ankles often occur during sporting activities and can result from a fall, a sudden twist, stepping on uneven surfaces or in a hole and even wearing the wrong shoes.

Symptoms
When the ankle is sprained the soft tissues around the ankle are injured and inflamed. The symptoms may include pain or soreness, swelling, bruising or redness, difficulty walking or stiffness in the joint. The symptoms vary depending on the severity of the sprain.
There are four key reasons why an ankle sprain should be promptly evaluated and treated by a podiatrist.
o An untreated ankle sprain may lead to chronic ankle weakness/instability and more injury.
o Sometimes it may be difficult for you to tell the difference between a sprain and an ankle fracture.
o An ankle sprain may be accompanied by other foot injury that must be treated as well.
o Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.

Diagnosis
When evaluating your injury, the podiatrist will get a history of the injury and the symptoms you are experiencing. X-rays or other imaging studies such as a CT scan may be ordered to help determine the severity of the injury. A complete physical exam will be done, touching and moving the parts of the foot and ankle to determine which parts have been injured.
The initial care for a sprained ankle at home involves reducing pain and speed up healing. Persons will often report that immediately after a suspected ankle sprain they would soak their foot in hot water. This is not recommended! In fact, it increases swelling and can make the ankle worse. Always remember RICE -- rest, ice, compression and elevation. All of these are done to reduce and prevent inflammation and can be started at home even before you see the podiatrist.
Rest: For the first 24 to 48 hours after the injury your activities need to be seriously decreased or stopped all together.
Ice: For the first 48 hours after the injury, place an ice pack or frozen vegetables wrapped in a towel on the sprained ankle for 20 minutes at a time every three to four hours.
Compression: Wrap the ankle in an ace bandage from the toes to above the ankle. The wrap should be snug but not too tight so that it's uncomfortable.
Elevate: Keep your ankle elevated as high as possible by sitting in a recliner, or putting books or pillows under the ankle.
After twisting your ankle, if you have pain, swelling and difficulty walking or standing, it is time to see the podiatrist. Treatment by the podiatrist will continue the RICE treatment. The podiatrist may also apply an ankle brace or cast boot to reduce motion in the ankle joint. Crutches are also used to prevent people from walking or bearing weight on the ankle. The most common medications used to treat ankle sprains are anti-inflammatory, that reduce both pain and help control the inflammation.
When you have an ankle sprain, rehabilitation is crucial -- and it starts the moment your treatment begins. Early therapy helps to promote healing and increase your range of motion. This may include doing prescribed exercises or even seeing a physical therapist, who will help with flexibility and strengthening exercises. A follow-up visit is usually scheduled one to two weeks after the initial treatment to monitor healing progress.
Most ankle sprains heal without complications or difficulty, leaving the person able to walk and play their sport without pain or swelling. The healing time depends upon the severity of the ankle sprain and if there was any other accompanying injury. If people do not get treatment and rehabilitation after an ankle sprain, chronic ankle instability results which makes the ankle weak, "gives way" at times and increases the risk of more injuries in the future. Very seldom surgery may be needed to repair torn ligaments around the ankle.
Ankle sprains can be prevented by wearing proper shoes for the activity you are engaged in. Always wear stable shoes that give your ankle support -- like high-top basketball shoes. High heels or platform shoes are not the best choice if you want to prevent an ankle sprain. For athletes, balanced training may keep the ankles strong and flexible. They may also consider having a weak ankle taped or wear an ankle brace for extra support during the game.

oFor more information on ankle sprains visit www.apma.org or www.footphysicians.com. To see a podiatrist visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates, Albury Lane, telephone 394-5820.

The Cultural Center at the Inter-American Development Bank (IDB) has extended the deadline to apply for grants worth up to $10,000.
The program, geared towards nations in Latin America and the Caribbean, has received a disappointing number of applications from The Bahamas. The new deadline, set at February 11, gives more Bahamians the opportunity to apply.
Nathalie Bethel, an IDB representative at the country office, said she will submit as many as seven proposals to receive final consideration at the bank's Cultural Center in Washington D.C.
"This is an opportunity to compete for micro financing," she said.
"Especially with what is now going on in the country, this is a way to get youth
involved in projects. People are always saying they don't know what the bank offers. In this sense, it's helping with the promotion of cultural development."
Mandated with restoring and preserving cultural heritage, and improving education and forms of artistic expression, the grants are included within the IDB's drive to help countries on the road to prosperity and development.
The degree of financing for the projects will range from $3,000 to $10,00, Bethel told Guardian Business.
"One issue we've had is the concern over requirements," she added. "Having a minimum of five years of operating in some capacity has been a challenge. The guidelines stipulate only legally registered non-profits with five years of experience may apply."
The project also requires that the venture has an amount of money no less than one third of the amount requested and an explanation of how the funds will contribute to the project's sustainability over the long term.
Funding expires at the end of each year. The IDB further stipulates at least two-thirds of the project must be completed within the calendar year in which the funds are received.
Submissions must include a title, project description, its duration, the person responsible for the project, the overall cost and a section detailing its sustainability.
According to Bethel, examples of applications made so far include after school programs for film and drama, establishing clubs or safehouses for disfunctional youth, a Junkanoo museum, and proposals concerning agriculture and other aspects of arts and culture.
The selection committee will announce the winners at the end of May.

Police yesterday arraigned a 21-year-old man for allegedly using Volunteer Bahamas to scam two clergymen and a local doctor out of hundreds of dollars.
Jerron Bain, 21, of Saunders Acres, was arraigned on five counts of fraud before Magistrate Guillimina Archer.
The charges include three counts of fraud, one count of possession of a forged document and one count of uttering a forged document.
Prosecutors alleged that on November 8, Bain fraudulently obtained $300 from Reverend T.G. Morrison and $200 from Reverend Rupert Smith a month later.
It is also alleged that Bain defrauded Dr. Cleveland Eneas of $150 last November.
Bain, who was not represented by a lawyer, initially pleaded guilty to the charge. However, he changed his plea to not guilty after insisting in court he did not receive the money fraudulently.
The case was adjourned to July 18.
Bain was granted $5,000 bail with one surety.

The issue of mold in buildings has entered into public consciousness as a result of some high-profile examples of its existence in commercial buildings, resulting in temporary relocation of staff and other expensive measures.
This particular problem can be rather pervasive in a climate like ours that for most of the year experiences hot humid conditions. Unfortunately, there is a tendency for designers and building owners alike to overreact when faced with the presence of mold in their structures. This often leads them to use high energy consuming solutions that may or may not be effective in resolving the issue once and for all.
Mold is a very broad term used to describe a wide range of fungi and it reproduces through spores that are spread by wind, rain or physical movement. It colonizes and thrives in indoor environments where the control of moisture is an issue and ineffective management of it can lead to many indoor air quality concerns. In fact, we breathe in these spores all the time in the indoor or outdoor environment. This is only a problem when the concentration levels become great and is especially difficult for persons with allergies or asthma to handle.
The role in the air-conditioning system, often the primary consumer of electricity, is partly to extract excess moisture from the building to create comfort conditions. Most of the time the air-conditioning system is blamed for the existence of the mold when in fact this is not the case. However it can usually be blamed for its spread, which can be just as bad.
Maintaining a mold free building is as much a function of design as it is of building operation. Every effort must be taken to keep excess warm moist air away from your building and the key arsenal is to build an air-tight structure. All wall penetrations for windows, doors and mechanical ventilation shall be properly sealed so as to prevent air from leaking into the building around these openings. No more air should enter the building than is designed to keep the humans occupying the space well ventilated.
There is also the matter of ensuring the building delivers a positive air pressure whether occupied or unoccupied and this is where we often fall down and go a little crazy with overuse of air conditioning.
Simply put, we just need to ensure that when exterior doors are opened, for example, this results in air slightly rushing out the building and not the other way around and this is why for most structures in our climate we will need to have the air-conditioning system pretty much always on. But to be clear, use of a programmable thermostat will mean you can set the temperature just that much higher for times when persons are not present in the building to reduce cycling of the air-conditioning system. To achieve the right pressure over the lifetime of the building, the design intent must be available and known by anyone operating the building.
Rightly so, visible mold growing on walls and other surfaces in a building is a cause for grave concern. It is not an excuse, however, to drive the thermostat down so low that the air-condition system never cycles off.
Indeed, this might end up keeping more moisture in the building. Your steps to guarding against the proliferation of mold are simple - seal the building envelope, maintain a positively pressurized building and control indoor devices that generate moisture. The double benefit you get is that these good practices will also reduce the energy consumed in keeping your building cool.
 
We would like to hear how this article has helped you. Send questions or comments to sbrown@graphitebahamas.com.
 
oSonia Brown is  the principal of Graphite Engineering Ltd. and is a registered professional engineer.