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Ankle Injury

Dr. Rajalakshmi VK (AIIMS)MBBS

January 05, 2021

January 05, 2021

Ankle Injury
Ankle Injury

Ankle problems plague active and inactive people alike. They are one of the most common - even painful - musculoskeletal injuries one can experience.

Unlike the majority of leg injuries which are sustained on a sports field, while running or while pursuing any recreational physical activity, ankle injuries like sprains can occur at any time, anywhere. Sometimes all it takes for you to injure your ankle is a misstep that causes the front of your foot to suddenly move inwards, and the ankle joint to move out, resulting in a sprain.

While most ankle injuries tend to go away with rest and time, a ligament injury, tendon injury or fractured bones tend to be more severe and need medical attention to make a full recovery.

Function of the ankle joint

Unlike the ball-and-socket joint of our shoulders, the ankle is a hinge type joint - similar to our knees and elbows.

It is made up of three bones:

  • Tibia and Fibula in the lower legs.
  • Talus, which completes the joint with the foot.

The three bones are joined together by a group of four ligaments that allow the ankle to move up, down, sideways as well as to rotate. The ligaments of the ankle joint are:

  • Deltoid talofibular ligament
  • Anterior talofibular ligament
  • Posterior talofibular ligament
  • Calcaneofibular ligament

The ankle also helps in the catapulting movement achieved by pushing from the toe with the heel in the air, and even during simpler walking or running movements by landing on the heel first.

Types of ankle injuries

While the most common ankle injuries are twisting or spraining the ankle (rolling or turning are other names for the same conditions), there are several types of ankle injuries:

  • Sprain: The most common type of ankle injury begins by twisting it suddenly. The degree of pain and inflammation or swelling in feet determine its classification into grade 1, 2 or 3 - the higher the grade, the more serious the injury.
  • Chronic ankle instability: People with this condition often feel like the outer part of their ankle is giving way, which obviously affects their stability and balance. They may also experience frequent ankle sprains and persistent symptoms like pain and swelling in the ankle. A previously injured ankle can make you more vulnerable to this condition.
  • Tendonitis: Inflammation of one of the tendons in the ankle region.
  • Bursitis: Bursae are like fluid-filled pouches that create a cushion between the bone and muscles in a joint. Bursitis is a condition in which one of these pouches is inflamed and causes discomfort.
  • Ankle stress fracture: The foot and ankle are susceptible to overuse injuries. Constant impact with the ground while walking, standing and running can cause small cracks or bruises to forms in the bones.
  • Fracture: If any one of the three bones that make up the ankle suffers a break, this is known as a fractured ankle.
  • Arch pain: Although not part of the ankle, the arch of our feet can lead to aggravation of ankle pain or other complications due to the inability to land the feet correctly. Arch problems include plantar fasciitis, cavus foot or even if one has flat feet or bunions in the toes.
  • Osteoarthritis: This is a bone-degenerative problem. General wear and tear and advancing age increase your chances of developing osteoarthritis along with its attendant problems in the feet and ankle.
  • Dislocation: A more extreme case of ankle injury when one of the three bones that make up the ankle joint is separated from the others, or when one of them suffers a break.

What are the symptoms of ankle injuries?

Ankle injuries are usually painful and instantly limit the range of your movement and prevent you from putting weight on the affected ankle. Here are some of the symptoms that you should look out for in the case of an injured ankle:

  • Inflammation or swelling of the affected part.
  • Mild to severe pain. In some cases, even a fracture can be mistaken for a sprain depending on the severity of the pain. Your doctor may advise you to get an X-ray to confirm the diagnosis.
  • Inability to put your full weight on the ankle and limping.
  • Tender to the touch.
  • Bruising or discoloration.
  • Not being able to stand up on your toes and doing a calf raise.
  • Stiffness and reduced range of movement.
  • In the case of a dislocation, the ankle joint will look deformed and be accompanied by significant pain.

What causes ankle injuries?

Ankle injuries are primarily divided into three categories - sprains, strains and fractures. They usually occur when the ankle joint is pushed beyond its usual degree of movement, such as by:

  • Twisting or rolling the ankle
  • Sudden direct impact, like in an accident
  • Landing incorrectly after a jump
  • Uneven surfaces that cause the foot to land differently each time
  • Ill-fitting shoes or slippers 
  • Tripping or slipping that results in a fall

Risk factors for ankle injury

Despite being a common occurrence, ankle injuries can be extremely painful as well as frustrating as they can take a long time to heal. Some of the factors that put you at greater risk of suffering an ankle injury are:

  • A previous history of ankle injury.
  • Playing high-intensity sports that require frequent changes of direction.
  • Walking or running on unpaved or uneven surfaces like trail running or hiking.
  • Being overweight.
  • Smoking, as it lessens oxygen flow to various tissues and joints.

True, those who play sports that involve sudden changes of direction like football, basketball, tennis and badminton are at a higher chance of suffering ankle injuries. But, even walking or running on uneven surfaces can make one vulnerable to spraining their ankle.

It is estimated that younger male adults are more prone to injuring their ankles because their joints are yet to develop strength.

Older women are also susceptible to ankle injuries due to the weakening of their joints.

Anyone who has sustained an ankle injury before is also more likely to get affected again, especially if the injured ankle hasn’t healed fully.

Resuming activity without proper rehabilitation also means the risk of re-injuring the area and developing chronic ankle instability, which makes you prone to repeated ankle problems.

How to prevent ankle injuries

Whether you’re an active person or a weekend-warrior, taking good care of your ankles is of the utmost importance as an injury can put you out of physical activity for a long period of time. Here are some precautions you can exercise in order to keep your ankle joints healthy:

  • Maintain healthy body weight. Being overweight puts more pressure on your joints.
  • Try to consume a balanced diet that boosts muscle build-up as well as aids muscle recovery.
  • Do not train or play with worn-out or ill-fitting shoes.
  • Exercise. There is no other activity that can keep your joints and muscles in good shape and health.
  • Warm-up and stretch before beginning a game or an exercise, or going for a run.
  • Avoid wearing high heels on uneven surfaces.
  • Stop exercising or playing if you’re feeling tired or fatigued.
  • Wear ankle braces or tapes if you’re feeling sore or uncomfortable.

Ankle injuries may look innocuous at first but they can be debilitating. Even a slight twist can cause immeasurable pain and discomfort. Maintaining a good physical regimen, eating healthy and listening to your body when it tells you to stop are key for avoiding ankle injuries.

How are ankle injuries diagnosed?

If you have suffered an ankle injury, it is advisable to visit a doctor as soon as possible. The ankle injury will have limited your mobility almost instantly, but the severity of the injury can only be determined by a doctor.

  • A local physician or doctor will conduct a physical exam to assess the extent of the damage to the injured ankle by attempting to move the ankle - this process can be a bit painful, but it is necessary.
  • The doctor will most likely advise imaging tests to be conducted, like an X-ray, to locate or rule out a fracture, either at the joint or around the foot or leg.
  • Additionally, the doctor may suggest an MRI scan to locate a possible tear in the ligaments or stress fracture.

Ankle injury treatments

Based on the findings of the imaging tests, the doctor will chart out a treatment plan for your injured ankle:

  • If it’s a case of a minor sprain (grade 1 or grade 2) or tendon injuries without any torn ligaments, conservative treatment is par for the course with rest, ice, compression and elevation to reduce swelling due to leg injury (RICE). Keeping the injured ankle in compression support keeps it firm and positioned at one place, and helps bring the swelling down.
  • Over-the-counter pain medication like ibuprofen may be taken to keep the pain under control. However, avoid aspirin if you have any blood clotting disorder
  • In the case of fractures or torn ligaments, the doctor may use the joint in a cast for a few weeks. This will immobilise the ankle joint, and help it heal.
  • In the case of an unstable ankle joint after a fracture or torn ligaments, surgery may be advised. In worse-case scenarios, metal plates and screws may be installed to keep the ankle stable. Alternatively, tissues taken from other parts of the body may be used to surgically repair the torn tendons and ligaments.
  • Long periods of rest are advised after undergoing surgery to fully recover from the injury. Fractures can take a long to recover from - even after the bone has been repaired, the ligaments take longer to fully stabilize and gain back their strength.
  • Physical therapy may be advised, based on the severity of the injury. This will help to regain the full range of motion and the strength to bear your body weight on the injured ankle.


References

  1. Doherty C et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports medicine (Auckland, NZ). 2014 Jan;44(1):123-40
  2. Alexandre de Paiva Luciano et al. Epidemiological study of foot and ankle injuries in recreational sports. Acta Ortopedica Brasileira. 2012 Dec; 20(6): 339–342.
  3. Health Harvard Publishing. Harvard Medical School [Internet]. Recovering from an ankle sprain. 2007. Harvard University, Cambridge, Massachusetts.
  4. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Ankle Dislocation
  5. MedlinePlus Medical Encyclopedia. [website]. US National Library of Medicine. Bethesda, Maryland, USA; Ankle Injuries and Disorders
  6. Powden CJ et al Rehabilitation and Improvement of Health-Related Quality-of-Life Detriments in Individuals With Chronic Ankle Instability: A Meta-Analysis. Journal of Athletic Training. 2017 Aug;52(8):753-765.
  7. Jay Hertel et al An Updated Model of Chronic Ankle Instability. Journal of Athletic Training. 2019; 54(6):572–588.
  8. de Vries, JS et al Interventions for treating chronic ankle instability. Cochrane Database of Systematic Reviews. 2011 Aug; 8(CD004124).

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