Dr. O'Donnell treats the ankle and foot injuries common in running, court and field sport and in daily life: lateral ankle sprains and chronic instability, high ankle sprains, Achilles tendinitis and rupture, ankle fractures, osteochondral lesions of the talus, and plantar fasciitis. His patients include University of Miami athletes, recreational runners and tennis players, and adults in Coral Gables and Miami with heel pain on the first steps of the morning or an ankle that keeps rolling.
Nearly every sprain, including a complete grade III tear, is treated without surgery, and the part of rehabilitation that prevents the next sprain is balance and proprioception, progressed from single-leg stance to wobble board to hopping. Achilles tendinopathy follows a 12-week eccentric loading program, and plantar fasciitis a stretching, night-splint and load-management program. Structural injuries are decided on imaging: an ankle fracture with a displaced or unstable joint is fixed; a ruptured Achilles is repaired in athletes and active patients under about 60, or treated in a boot when the tendon ends sit together on ultrasound; a cartilage lesion that stays painful after 3 to 6 months in a boot is treated arthroscopically. When surgery is the better option, Dr. O'Donnell performs Achilles repair, ankle fracture fixation, arthroscopic microfracture or grafting for cartilage lesions, and Broström ligament repair for instability that has failed 3 months of rehabilitation.
Weight bearing, boot removal and return to running follow Dr. O'Donnell's written protocols for each operation. Procedures are outpatient at Bayside Surgery Center; patients outside South Florida can send X-rays or an MRI through mymedicalimages.com and arrange telemedicine consults and post-operative visits.
When to see a specialist
A rolled ankle that can bear weight within a day is usually a sprain that will improve with a brace and early movement. The signs below need an examination and usually an X-ray or ultrasound within a day or two:
- Inability to take four steps on the ankle immediately after the injury or in the clinic
- Bone tenderness at the tip of either ankle bone, the base of the fifth metatarsal or the navicular, which are the X-ray criteria for a fracture
- A snap or a feeling of being kicked in the back of the calf, with weakness pushing off, which is an Achilles rupture until proven otherwise
- A visibly deformed ankle, or the foot pointing in an abnormal direction, which needs emergency care
- An ankle that keeps giving way on uneven ground more than 3 months after a sprain
- Deep ankle pain, catching or swelling that persists 6 to 8 weeks after a sprain that should have settled
How Dr. O'Donnell decides between rehab and surgery
Ligament injuries are rehabilitated, tendon ruptures are individualized, and fractures are decided on the joint. An ankle sprain of any grade starts with compression, a lace-up brace and walking as soon as tolerable, then strength and balance work; surgery is discussed only when the ankle still gives way after 3 months of that program and the exam and imaging confirm lax ligaments. A high ankle sprain needs 4 to 8 weeks of protection and is the exception where a boot is used early.
An Achilles rupture can heal in a boot with heel wedges when the ends are apposed on ultrasound within two weeks and the patient will keep the boot on; the trade-off is a somewhat higher re-rupture rate and less push-off. Dr. O'Donnell recommends repair for athletes, active patients under about 60, a gap that does not close in plantarflexion, and injuries more than two weeks old. An ankle fracture is fixed when the joint is displaced or unstable on stress X-ray, because a talus that sits even 1 mm out of place wears the joint; a stable, undisplaced fracture goes into a boot.
Foot & Ankle conditions we treat 5
Foot & Ankle procedures 2
Rehabilitation protocols
Dr. O'Donnell's written physical therapy protocols for this joint, shared with your therapist and progressed on criteria rather than dates.
Frequently asked questions
Do I need an X-ray for a sprained ankle?
Only if you cannot take four steps on it, or there is bone tenderness at the tip of either ankle bone, the base of the fifth metatarsal or the navicular. Those are the Ottawa criteria, and without them a sprain is treated in a brace with early movement. An MRI is reserved for pain or instability that persists at 6 to 8 weeks, when a cartilage lesion or high ankle injury is suspected.
Can a torn Achilles heal without surgery?
Yes, when the tendon ends sit together on ultrasound within two weeks and the boot with heel wedges stays on for the full protocol. The trade-off is a somewhat higher re-rupture rate and less push-off strength. For athletes, active patients under about 60, a gap that does not close, or an injury more than two weeks old, repair gives a more reliable result. Return to sport is 6 to 9 months either way.
How long is recovery after ankle fracture surgery?
A splint for about two weeks, then a boot with weight bearing started as the fracture allows, usually by 6 weeks, and a return to shoes at 6 to 8 weeks. Desk work is possible within days; driving once out of the boot on the right side. Running starts at about 3 months and cutting sport at 4 to 6 months when strength and balance match the other leg; see the fixation page.
Why does my ankle keep rolling after a sprain?
Either the ligaments healed long and the ankle is mechanically loose, or the balance system that protects the ankle was never retrained, which is the more common reason. Three months of strengthening and proprioception work fixes most cases and a sport brace roughly halves the re-sprain rate. An ankle still giving way after that program, with lax ligaments on exam, is a candidate for a Broström repair.
