Table of Contents
What are Ankle Injuries
Ankle Injuries are Sprains and fractures of the ankle resulting from accidental trauma. The ankle is vulnerable to twisting under the pressure of sudden, unexpected movement. Though ankle injuries are common ATHLETIC INJURIES, they also occur during routine activities such as stepping off a curb, walking on uneven surfaces, and walking in high heels. OBESITY AND HEALTH conditions that impair balance increase the risk for ankle injuries. Doctors in the United States treat about 4 million ankle injuries each year, most of which are sprains (injury to ligaments and tendons).
Three bones come together to form the ankle: the tibia and fibula, the long bones of the lower leg, and the talus, a platform-like BONE that forms the back of the foot. Three sets of strong ligaments hold these bones in place; equally strong muscles and tendons give the ankle range of motion. This structure is necessary because the ankle bears the body’s weight. Transferring that weight from one foot to the other when walking places the equivalent of 11⁄2 times the body’s weight on the weightbearing ankle and foot.
Most ankle injuries occur when the foot rolls inward, which stretches, tears, or otherwise damages structures on the outside of the ankle; these are lateral or inversion injuries. When the foot rolls outward, the damage occurs to the structures on the inside of the foot; these are medial or eversion injuries. A sharp blow or twist can break the base of the tibia or more commonly the fibula (the smaller of the lower leg bones). A severe LIGAMENT stretch or tear can pull a piece of the bone away, called an avulsion FRACTURE. Repeated stress such as occurs with intense running or jumping can cause stress fractures in the bones of the ankle or OSTEOARTHRITIS within the ankle JOINT.
Symptoms of Ankle Injuries and Diagnostic Path
PAIN and swelling after a sudden twist or blow to the ankle are the typical symptoms of ankle injury. Both can be intense, and most people are reluctant to or cannot bear weight on the affected ankle. There is a strong correlation between the severity of symptoms, including the ability to walk or bear weight, and the type or seriousness of injury. When it is possible to bear weight on the ankle immediately following the injury and there is no pain to the lower portion of the fibula, fracture is unlikely. The doctor may order an X-ray of the ankle to rule out fracture.
Ankle Injuries Treatment Options and Outlook
The mainstay of treatment for ankle injuries of any kind is RICE—rest, ice, compression, and elevation. An elastic wrap may help support the injured ankle, though caution is necessary to make sure the wrap is not too tight, particularly during the first 48 hours when the ankle may continue to swell. The doctor may choose to cast a serious sprain. Fractures require casting or surgery or both. Casting is generally adequate for simple fracture in which the broken bone remains nondisplaced (stays in relative alignment). Displaced, comminuted, and open fractures typically require pins, screws, or plates to hold the bones in place while they heal. Sometimes this hardware remains in place and sometimes the surgeon removes it when HEALING is complete, depending on the nature of the fracture.
Most simple strains (injury to the muscles and tendons) heal in 4 to 6 weeks. A simple sprain (injury to the ligaments), which doctors may classify as grade 1 or grade 2, generally heals in 4 to 6 weeks. A severe sprain (grade 3) may take 12 to 16 weeks to fully heal. Doctors consider healing complete when the injured ankle can bear the body’s weight without pain and with normal range of motion during normal activities, though very severe injuries may result in permanent limitations or laxity.
Ankle Injuries – Risk Factors and Preventive Measures
Slipping, twisting, and falling are the most common risks for ankle injury. MOTOR VEHICLE ACCIDENTS, athletic activities that involve running and jumping, and recreational activities such as downhill skiing are also frequent causes of ankle injuries. People who are physically inactive or who have had multiple ankle strains may have WEAK ANKLES, a circumstance in which the ligaments supporting the ankle are soft or lax. Excessive body weight places further stress on the ankles and may cause the foot to turn inward, stretching the muscles and connective tissues in ways that limit their ability to provide stability during movement such as walking. OSTEOPOROSIS, a condition of diminished BONE DENSITY, makes the bones of the ankle vulnerable to fracture under circumstances that otherwise would not cause injury. Osteoporosis is a particular risk in women who are past MENOPAUSE and in men over age 65.
Regular weight-bearing activity such as walking helps strengthen the structures of the ankle. People who are prone to ankle injuries may choose to wrap, tape, brace, or otherwise support their ankles during activities that involve increased risk for unexpected twisting, such as running or sports. A physical therapist can teach specific exercises to strengthen weak ankles and improve FLEXIBILITY. WARM-UP exercises to stretch and loosen the ankles are important before engaging in physical activities. It is important to wear the right shoes for the activity, to give the foot and ankle proper support. Worn-out shoes, even if designed for the particular activity, increase the risk for injury.