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Ankle Injuries

Ankle Injuries

What is commonly referred to as the ankle is actually two joints, with one providing the up and down movement of the foot and the other providing the sideways movements.

About the Ankle

The bones of the lower leg (tibia and fibula) meet the talus bone in the foot to form the ankle joint which provides the up and down movement of the foot. The bones you can feel on the inside and outside of your ankle are the ends of the tibia and fibula. The heel-bone (calcaneus) forms the subtalar joint with the talus bone, which provides the sideways movement of the foot. The foot is made up of the talus and calcaneal bones, seven tarsal bones, five metatarsals and fourteen phalanges which form the toes.

Ankle Diagram

The calf muscles connect to the heel through the Achilles (Calcaneal) tendon. If there is any damage to the tendon then the heel cannot be lifted and the foot will drag. The muscles running down the front of the lower leg connect to the bones in the top of the foot through several tendons, with these muscles helping to control both the up, down and sideways foot movements. There are four ligaments at the ankle joint which provide stability; the most common ankle injuries are due to damaging these ligaments.

Set Descending Direction

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Set Descending Direction

7 Item(s)

Types of Ankle Injuries

Sprained Ankle

Sprained Ankle

Causes

A sprain is caused when the ligaments of a joint are torn, stretched or twisted, causing pain and inflammation at the site of the injury. A sprained ankle is one of the most common forms of injury and occurs with a high prevalence across a number of sports where the ankle is subjected to sudden twists and turns whilst supporting the entire weight of the body i.e. football.

The most commonly injured ligament is the calcaneofibula ligament which happens when the ankle is inverted i.e. turns in towards the body whilst your weight goes towards the outside of your body.

A diagram showing different types of ankle sprains

Statistics show that accident and emergency departments diagnose over 1.5 million ankle related injuries every year, of which the sprained ankle is one of the most common. This type of injury can happen following a trip, a slip or even landing awkwardly from a jump. They can be common in the workplace with same level falls one of the most common sources of injury.

Symptoms

These will vary depending on the severity of the condition and you as an individual, since we all react differently to injuries and have varying pain thresholds.

Symptoms can include:

  • Pain in the affected area (the side of the ankle which has been twisted)
  • Inflammation (swelling) of the ankle and surrounding areas
  • Bruising (though this will not normally be instantaneous and is an after effect)
  • Limited range of motion (if your ankle is swollen then your movement will be limited)
  • Instability of the joint (you may be unable to put any weight on it or be comfortable being mobile)

In certain cases you may even hear a popping or tear at the time of the injury which would suggest it is a more severe injury and something which may require medical attention straight away.

Diagnosis

An ankle sprain can be graded as one, two or three depending on its severity with grade three injuries being the worse.

Grade 1: Sprains involving mild stretching of the ligament are painful but usually heal quickly and easily following a period of rest. You may experience a degree of swelling and bruising as a result.

Grade 2: Usually indicate some tearing of the ligament but not at a level which compromises the overall integrity of the ligament. Again, this can be painful and you will experience swelling and bruising and can expect it to take a few weeks to fully recover from.

Grade 3: These sprains are classed as severe injuries which cause joint instability, often due to a complete rupture of the ligament. This will normally require surgery to remedy and can take several months before you’re back to full fitness.

Sprains can be extremely painful and can require medical attention to ensure that there is no severe underlying injury such as a break or fracture. Hairline fractures can be difficult to diagnose as they sometimes fail to show up on x-rays within the first few days after injury.

Any condition which fails to respond after a few days of rest, pain relief and inflammation management through the application of ice should be referred to a specialist to ensure that the structure of the foot has not been compromised.

On arrival at a hospital a doctor will assess the ankle to understand the symptoms and the impact of range of motion on the joint, as well as looking to understand the source of the injury and anything else which may be relevant i.e. did you hear a popping or tearing sound. They will be focussed on examining the syndesmotic ligaments and the stability of the sub-talar joint.

An x-ray may be taken to understand whether there is any underlying damage to the bones, as a severe sprain may actually be a fracture or broken ankle as the symptoms can be fairly similar. In order to identify the severity of a ligament sprain an ultrasound may be used as this will allow for a clear diagnosis to differentiate between a grade 2 and 3.

Management

Treatment options will vary depending on the severity of the injury, but you will know when you have suffered a mild sprain and when it is something more serious.

RICE

Immediately following injury the RICE principles should be followed to help manage the injury and also prevent you from doing further damage.

Resting the affected joint is paramount as continuing to apply weight on the ankle can cause further tears and create further pain and swelling. It's important to provide support and cushioning to the joint and to avoid the risk of twisting the joint thus aggravating the condition. Continuing to remain active on a grade 1 sprain could result in a grade 2 or even 3 should you roll your ankle again.

Ice packs are recommended to offer initial treatment to reduce inflammation and swelling after an ankle sprain, along with pain relief such as paracetamol or other NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen.

Compression normally comes in the form of an ankle support which works to manage inflammation when active and with some types also offering stability.

Elevation is important following an injury to reduce the flow of blood to the affected region by elevating the ankle above the level of the heart.

Physiotherapy

The purpose of physiotherapy is to work on strengthening the affected joint and enhancing your range of motion so that you can return to full fitness.

The objective from strengthening the joint is to minimise the risk of it happening again, as there will be a weakness in the joint following the initial injury and the last thing you want is for it to happen again.

In contrast to RICE medical advice is to avoid HARM, which stands for Heat, Alcohol, Running and Massage, as these are all likely to exacerbate the original injury.

Surgery

Surgery will only be used in in the most severe cases where the sprain will not get better on its own, though this is not very common (unless you’re a professional sportsperson). The type of surgery undertaken depends on the injury but the intention is to repair the damage which will involve stitching the ligament back together.

Following surgery you will be placed in a cast or a walker boot to protect the surgeons work, with the latter allowing you to remain mobile which allows for the application of controlled forces through the injured joint which can help with your recovery. If you’re in a cast then you can’t walk in it or use your leg which will lead to muscle wastage.

 

Sometimes injuries happen and there is nothing you can do about it.

If you’ve suffered a sprained ankle in the past then you are more likely to suffer from one again, with certain sports increasing that likelihood further i.e. running off road. There are however certain things which you can do in order to reduce the risk of a sprain.

Strengthening the joint

Strengthening the affected joint is an important part of your rehabilitation programme but it shouldn’t stop when you feel you’re ready to return to action. You should continue to follow this routine to minimise the risk of the injury happening again in the future, especially as many injuries can happen when you are fatigued, therefore your chances of injury can be increased even further.

Improving your technique

As with any sport, technique is a key factor in success and not only that but in minimising the risk of injury. If you lift something heavy with your back rather than your legs then you increase the chance of hurting your back and it’s the same in sport. If you are suffering from the same injury repeatedly then take a look at your technique (among other things) to see if there is anything you can do to tweak it which could make a world of difference, not only to your performance but your fitness.

Running is one sport where you are more susceptible to knee and ankle injuries since it puts a lot of pressure on the lower joints. Poor technique can lead to a multitude of issues so it is advisable to look at a guide of how to run better.

If you looking to start out in running then you should seek some top tips for new runners.

Wearing the right shoes

Shoes are very important. How many times have you or heard someone else complain that their shoes are hurting their feet?

If your shoes hurt and continue to do so then you run the risk of causing further problems. If you’re out running and don’t have a pair of trainers which offer the support you need then there is an increased risk of injury either to your ankle or even to your knee from poor alignment of the foot.

When you go into a sports shop there are loads of trainers so the choice can be quite overwhelming but the importance of selecting the right running shoe cannot be overstated enough as we all run differently and therefore have different needs. In the majority of sports shops they will be able to analyse your running style and offer the best pair to help you get the most from them.

High Ankle Sprain

High Ankle Sprain

A high ankle sprain (or syndesmosis sprain), is an extremely common type of sports injury. It generally results in pain and swelling around the affected area. The intensity of this will depend on the severity of the sprain.

Causes

high ankle sprain is typically caused by a sudden change in direction or speed when taking part in sports or exercise. It can also be as a result of landing on the ankle awkwardly or running into someone or an object. By following the correct form of treatment, most people will recover completely from such an injury. However, it might be necessary to wear some form of ankle support in the future to prevent further injuries.

Symptoms

A sprained ankle is caused when the ligaments around the syndesmosis joint (between the Fibula and Tibia bones) are damaged because they have been twisted, stretched or torn. When these types of ankle injuries occur, the patient will feel pain when the ligament is moved and there will be some element of swelling around the ankle.

The extent of this pain and swelling will depend on how severe the injury is. With a first degree sprain, pain will be felt when the ankle is used or pressure is put on the area. A second degree injury will be characterised by swelling and it becomes painful when walking. Severe ankle injuries are where the pain becomes considerably worse and the patient is unable to walk on the affected joint.

Management

In the majority of cases, this injury can be treated through a combination of rest, pain relief and physiotherapy. However, in more severe cases, surgery may be required to fix the damaged ligament. For first and second degree injuries, it typically takes up to two months to fully recover.

When an injury first occurs the PRICE (Protect, Rest, Ice, Compression, Elevation) system should be used to limit the severity of the injury. By resting the injury, the ankle will be protected from any further damage. An ice pack should be applied at regular intervals to help reduce the intensity of the swelling and then a compressive ankle support can be used to manage the affected region. If required, pain relief medication can be used.

This treatment method should be adopted in the early stages following injury. However, once the pain starts to subside, it’s important to start moving the joint once again. For more severe cases, it might be necessary to follow the guidance of a physiotherapy to help re-build strength in the ankle.

It’s not always possible to prevent an ankle injury, but some people will be more prone to suffering one than others. There are ways in which the risk can be reduced, such as ensuring the right footwear is worn; following an effective warm up and stretching regime and doing specific exercises to strengthen the area.

If you feel a twinge in your ankle then you should cease your activity to minimise the risk of further damage being caused to the joint, resulting in a potentially lengthier spell on the sidelines.

Os Trigonum Syndrome

Os Trigonum Syndrome

Causes

Complaints over ankle bone pain are often just written off as too much walking, wearing the wrong shoes or over exertion. But there is a condition, known as OS Trigonum Syndrome, which is specifically recognised as pain in the back of your ankles. This is caused by soft tissues in the ankle being pressured by bones in the back of the joint, resulting in swelling and pain.

Diagnosis

This syndrome is fairly common, with around five per cent of the population believed to suffer from it. With ankle injuries particularly predominant in sports people, footballers are at an increased risk with around 20 per cent suffering from it.

If you think you have OS Trigonum Syndrome then your first port of call should be your GP or physiotherapist, who can diagnose the condition. They may refer you for an x-ray or an ultrasound, which will confirm this diagnosis.

Management

Rest: You will need to rest as much as possible, so this means taking a complete break from anything which has caused or contributed to the condition for around six weeks, helping to prevent further ankle injuries. You can also try applying regular ice packs - about 20 minutes every few hours - as a localised treatment to reduce any inflammation or swelling.

Painkillers: If you are in a lot of pain then you can take painkillers such as anti-inflammatory tablets - these often come in cream or gel form too, so you can apply directed to the affected area. Your GP might prescribe painkillers or anti-inflammatory tablets for you. Alternatively you can ask for a corticosteroid injection, which will help to alleviate the swelling in your soft tissues.

Surgery: These methods are usually successful in treating the problem and you should be able to resume your activities as normal once your ankle is healed. In a few cases, however, the symptoms are persistent, and you may need to have the bony prominence removed altogether by an orthopaedic consultant. If this is necessary, you will need up to eight weeks to recover before taking up any sports again, and you will be seen by a physiotherapist for rehabilitation exercises. Any types of ankle injuries are preventable by taking due care when exercising, especially if you know you are prone to problems in this area. Make sure you warm up properly before undertaking any type of exercise, and cool down afterwards too. This helps to prevent sprains and tears, warming your muscles up gradually and carefully and preventing ankle injuries.

Lisfranc Joint Injury

Lisfranc Joint Injury

Causes

A foot injury caused by a massive trauma to the top of your foot is known as a Lisfranc joint injury, and is either a ligament sprain or fracture dislocation. It’s a rare type of injury, annually affecting just 1 in 55,000 people.

If you have foot pain that is localised in the top of your foot, then there is a chance it could be a Lisfranc injury.

Symptoms

It is not an easy condition to diagnose, as its symptoms can be similar to bone bruising or a tarsal fracture. Your foot will be bruised and swollen and tender to the touch and you will not be able to bear to put any pressure on it. A good foot support may help you to walk a little more easily, but it is important to seek medical advice.

Diagnosis

Your GP will very likely send you for an x-ray, but these are not always definitive. Your x-ray will need to be taken while you are standing up, and your clinician will need to check for any displacement between your tarsal and metatarsal bones, effectively a ruptured tarso-metatarsal ligament.

Management

Casting: For less severe injuries you could expect to be in a cast for around six weeks. These tend to be removable for this type of injury, but will help to keep your foot immobilised, reducing foot pain. You will be referred to a physiotherapist, who will usually suggest exercises which are not weight-bearing, such as pool running. You will need to remove your cast for this, and a buoyancy belt is often recommended to help optimise the exercises. After six weeks you will usually be able to remove the cast completely and walk normally, although you may still benefit from some physiotherapy and massage and may still experience some foot pain. You can also gradually return to your normal sporting activities.

Surgery: 

More severe injuries will often require surgery, and screws or wires will be used to reposition your bones. You will then have a removable cast — this time for up to three months. You can then start to gradually reintroduce your sporting activities under medical advice. It is particularly important to take care with sports such as football, as kicking and twisting motions can exacerbate your injury. With any type of foot pain or injury it is always a good idea to rest as much as possible and only do the exercises recommended to you by your doctor or physiotherapist. A good foot support can help, but it is vital that you do not try to get back into your normal sporting regime until you have the all-clear from your clinician. You will need to ease yourself back in gradually and not attempt to go back to your former levels immediately, as you could undo the benefits of therapy or surgery.

Rehabilitation: Once you have recovered from surgery to repair your Lisfranc Joint it is important to strengthen the muscles in the foot in order to support the arch of the foot. Strengthening the affected region is important in order to minimise the risk of future injury being caused, the same can be said following any injury you may incur. There are a number of exercises which you should look at as part of your rehabilitation, though your physiotherist may offer a tailored programme to suit your individual needs.

Snowboarder's Ankle

Snowboarder's Ankle

Causes

Commonly known as snowboarder’s ankle - and the cause of significant discomfort - injuries to this area of the body can be a regular occurrence. This particular injury, the snowboarder’s ankle, is caused when there is a fracture Talus bone. This bone is a little above the heel on the outer edge of the ankle. Statistics show that this particular kind of injury is as many as fifteen times more likely to occur amongst snowboarders, hence the colloquial name.

Diagnosis

Ankle injuries are often minor sprains, as a result of a twist or fall. Generally, sprains heal with minimal impact after a period of rest. As with most ankle injuries, they manifest similarly: both a simple sprain and a more serious fracture will first show as extreme tenderness and sensitivity to pressure, swelling to the area and a degree of bruising. But where the pain persists and the swelling does not subside even with the help of an ankle support, a Talus bone fracture becomes the more likely explanation. Most people with this kind of ankle injury do not have it diagnosed immediately. It is typically only after the initial stages of treatment for a sprain are shown to be unsuccessful that this option begins to be a consideration. A fractured Talus bone can be seen in an x-ray or within a CT scan, both practices being used widely by medical practitioners to explore patients' ankle injuries.

Management

Treatment options vary, but one of the most important steps is to be aware of the possibility of this kind of injury. For most people, initial treatment will be very similar to the management of a simple sprain. Ice packs and cold treatments can help to reduce the pain and inflammation, alongside standard pain killers and medications available from the chemist. An ankle support with inbuilt cooling technology can offer soothing and pain-reducing therapy alongside compression and support to the joint, which when combined can lead to the most rapid recovery.

The initial swelling needs to subside in order to make a thorough assessment of the injury, so reducing the inflammation is an important first step in treatment. Where a Talus bone fracture is identified, an ankle support is the most common option used. Six to eight weeks of wearing the support while resting the area and using crutches to avoid placing weight on the joint, is the usual recommendation. This is used for fractures where no bone shards have been displaced.

In cases where there are loose pieces of the fracture moving within the joint then there will usually be a need to undergo surgery. Following this, the same period of restriction will be recommended, accompanied by restorative exercises and physiotherapy including water treatments and pool running.

Ankle injuries are common, particularly for those with active lifestyles, but there are two main ways to try and avoid the issue. Strengthening the area with use of a wobble board can help to build protective muscle tone and support movement, whilst wearing an ankle support or strapping during activity can also be beneficial in reducing the likelihood of an injury.

Ankle Strengthening Exercises for Snowboarders from EZIA Athletic Club Nantucket on Vimeo.

Broken Ankle

Broken Ankle

Causes

Breaking a bone in the ankle is quite a common injury, especially among those who play sport. It can be caused when the ankle is badly twisted or during a fall.

Symptoms

Symptoms that may indicate an ankle fracture include:

  • Swelling around the ankle
  • Pain, particularly around the ankle
  • The inability to walk
  • A crack or popping sound on impact
  • A misshapen or dislocated ankle
  • Bone protruding through the skin (known as a compound or open fracture)

Sometimes it can be hard to differentiate between a broken ankle and a sprain. An x-ray will confirm the injury and determine the most suitable treatment.

Types of Bone Fractures

Diagnosis

Avoid using the ankle and get a friend to accompany you to the hospital. Applying an ice pack, such as a bag of frozen peas, and keeping the foot elevated can reduce swelling. Ibuprofen and paracetamol, which can be purchased over the counter, may offer some pain relief. If the injury is more severe and there is a compound fracture, an ambulance may be required.

Management

Once doctors have ensured the pain is under control, they will order an x-ray so they can assess the injury. Sometimes the bones are dislocated or misaligned and will need to be manipulated back into the correct position.

Plaster Cast / Walker Boot: A plaster cast and painkillers are used to treat simple fractures. Crutches will be required as it will be important not to put any weight on the joint. Follow-up appointments in the fracture clinic with an orthopaedic doctor will be necessary. An alternative to casting which is often employed is a walker boot. There are various designs available but as an example the Rebound Air Walker is a completely rigid boot with padded lining offering protection to the affected ankle whilst still offering the mobility which casting cannot offer. Mobility is actually a key part of rebailitation following a broken ankle in being able to apply controlled loads to the joint which help tell the body how to heal the bone correctly.

Surgery: 

If the broken ankle is severe enough to require surgery it may take place under general anaesthetic. The ankle may need to be held in place internally using plates, screws or wires (Open Reduction and Internal Fixation, ORIF). These will not usually be removed unless they subsequently become a problem for the patient. Very occasionally, the surgeon will need to secure the fracture using an external frame.

Recovery: A broken ankle may take six to twelve weeks to heal and sometimes longer to return to full range of movement. It is important to follow the doctor’s advice regarding recovery. Sometimes a broken ankle will require a referral to a physiotherapist, who can provide an exercise programme to aid rehabilitation. If the pain does not get better or becomes worse, a GP should be consulted. He or she can check the ankle for problems and prescribe stronger painkillers where necessary. Surgery can increase the risk of deep vein thrombosis when flying. Therefore it is important for the GP to assess risk factors beforehand. If the ankle becomes more swollen, the foot or toes turn blue, pins and needles develop or the surgical wound becomes red or discharges pus, return to the nearest A&E department as there may be a problem with the nerves around the ankle or a wound infection. Following a broken ankle, once the cast has been removed, it is helpful to wear a light ankle support until muscle strength returns.

Ankle pain can be a serious problem for those affected, but there are a number of options available in terms of supports and braces to help limit its impact on daily life.

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