nkle sprains are so common that most people have suffered at least one. According to Susan Bonar, M.D., orthopedic surgeon and foot and ankle specialist at Rockhill Orthopaedics, over 90 percent of ankle sprains heal well with very little treatment.

"If people will follow the RICE formula-rest, ice, compression, and elevation-they can do what they want as long as they're comfortable," Dr. Bonar said. "We tell them to let the sprain dictate their activity."

Casting used to be considered necessary for severe sprains, but could leave the ankle so weakened that the injured person lost significant muscle strength. Today most physicians forego casting and often recommend follow up physical therapy to strengthen the tendons so they won't be prone to re-injury.

About five percent of the time an ankle won't heal with standard treatment. Anyone suffering persistent pain after three months should see an orthopedic surgeon who can search out the underlying cause. Dr. Bonar estimates there are at least 50 diagnoses-many very subtle-that require the attention of a specialist.

"One of the most common is scar tissue that builds up at the site where the ligaments were torn," she said. "This type of injury responds extremely well to arthroscopic surgery and heals quickly.

"Another fairly common reason for persistent pain is significant instability. This means there's a lot of looseness in the ankle, causing it to turn under, which can lead to recurrent sprains-and mere injury. The best treatment is a really good strengthening program."

Yet another reason for persistent ankle pain is that the injury is actually to the midfoot. On it can be a torn tendon at the back of the foot or a tendon that has slipped over the bone. Still another cause may be a bone or cartilage chip. All of these problems can be addressed once there's a proper diagnosis.

"My approach is to get people as comfortable as possible with conservative measures, shoewear modifications, and simple stretching and strengthening exercises," Dr. Bonar said. "If all that fails, then we will talk about surgical correction. Surgery is a last resort."

Dr. Bonar joined the staff of Rockhill Orthopaedics last spring. She is a native of Kansas City and a graduate of Hickman Mills High School. After completing undergraduate work at the University of Chicago and graduating from Yale School of Medicine, she returned to the Midwest for a five-year residency in orthopedic surgery at the University of Iowa, followed by fellowship in foot and ankle at Carolinas Medical Center.

She met her husband, Dave Benson, at the University of Iowa. He is a Des Moines native and works as an environmental engineer and environmental attorney.

Dr. Bonar's interest in orthopaedics began in high school when she had to wear a much-hated back brace for scoliosis for four years.

"I knew I wanted to be a doctor and I chose this specialty because orthopedic problems generally require some ongoing treatment and you get to know your patients well," she said. "You also have the opportunity to affect people's lives by helping them through a challenging medical situation."