Ankle injuries are common among sportsmen and women, as well as occurring during everyday living. It is easy to sprain your ankle simply from walking on an uneven surface or missing your step so you jar your ankle joint.
Sprains and fractures are the mostly frequently occurring injuries but you can also tear or strain your tendons. Some ankle injuries can be treated at home while others may require professional medical attention, even surgery.
Treatments can be minimally invasive or can involve surgery; fracture fixation or later fusing parts of the ankle and foot joints to relieve pain.
Ankle injuries are defined by the type of tissue that is damaged; bone, ligament or tendon.
- Three bones meet in your ankle: the tibia and fibula of your lower leg and the talus of your foot.
- Ligaments are strong elastic bands of connective tissue that keep the bones in place but stretch to allow the ankle to move.
- Tendons attach the bones of the foot to the muscles. They enable the foot and ankle to move and keep the joints stable.
Sports associated with ankle injuries:
- Basketball
- Hockey
- Football
- Golf
- Rugby
- Running
- Tennis
- Volleyball
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Common injuries & symptoms
Some of the common injuries that can occur include:
- Ankle ligament sprain and rupture – this is what happens when ligaments are stretched beyond their normal range of movement causing them to tear or rupture.
- Ankle tendon sprain or tear – this is what happens when muscles or tendons are stretched too far, causing damage.
- Peroneal and Achilles Tendinitis – these are two commonly affected tendons in the ankle, the peroneal tendons and the Achilles tendon that are there to stabilise and protect it. They can become sprained or torn through overuse or trauma, leading to inflammation and pain. This is referred to as tendinitis and it can develop over several years. Symptoms include: weakness or instability of the ankle; sporadic pain on the outside or back of the ankle.
- Plantar fasciitis – the plantar fascia is the flat band of tissue that connects your heel bone to your toes, supporting the arch of your foot. Straining the plantar fascia causes pain in the bottom of your foot or your heel when you stand or walk. Symptoms include: pain particularly first thing in the morning and as you get tired later in the day. The pain is particularly pronounced when climbing the stairs or standing for long periods of time. You need to talk to your doctor who will ask about your symptoms and may send you for an X-ray or scan. There is no single, effective treatment. Possible treatments include: resting the foot; anti-inflammatories; ice packs; toe/foot and calf stretches; shoes with arch support and a cushioned sole or orthotics; splints to wear at night or platelet rich plasma (PRP) / steroid injections. It may take a few months to a year for the pain to go completely.
- Morton’s neuroma – this is a painful condition that affects the nerves between the toes. It is caused by a nerve becoming irritated and thickened, which can cause severe pain. It often affects middle-aged women as a result of wearing tight or high-heeled shoes and is also common in runners. Symptoms may begin with a tingling sensation between and into the toes, developing into a sharp or burning pain in the ball of the foot or at the base of the toes. It can feel like a small stone in your shoe. Treatments include: changing your footwear or activities, orthotics, painkillers, weightless and steroid injections.
- Ankle fracture – this is a break in one or more of the bones. The symptoms of ankle fracture are very similar to the symptoms of sprains and tears so it is important to get the injury looked at by a doctor as soon as possible. Symptom can include:
- Pain which can be sudden, sharp and severe
- Unable to put weight on the injured ankle
- Swelling and bruising
- Stiffness – this is more likely to occur with sprains
- Tender to the touch over bony areas – this is more likely to occur with fractures
- Deformed ankle – this indicates a possible fracture
Causes
Ankle injuries occur because the ankle joint is forced out of its normal position as a result of twisting or jarring. Many occur during high impact sports, or while walking or running on an uneven surface. Ill-fitting shoes or high-heeled shoes can also contribute to ankle injury. The most likely times for ankle injuries to occur are:
- During a trip or fall
- Twisting or rotating the ankle
- A sudden impact, such as a car crash
- Landing awkwardly after jumping
- Rolling the ankle
Ankle pain can also be caused by osteoarthritis of the ankle joint.
Treatments range from non-operative or minimally invasive care through to complex joint reconstruction and replacement.
Diagnosis
The doctor will ask how the injury occurred and will want to examine the ankle to see how much bruising and swelling there is. If there is a suspected fracture or tendon or ligament damage there may be some pain as the doctor needs to move the ankle to diagnose what might be causing the swelling and symptoms.
You may be sent for an X-ray to ascertain if you have fractured your ankle. In some instances you may need a stress test, which is an X-ray taken while pressure is being applied to the joint. This is necessary to determine if surgery is needed. An MRI scan may also be taken to show more details about the injury.
Treatment
Some sports related ankle injuries could improve by reducing or stopping the activity that causes painful symptoms.
However, this can be frustrating if you enjoy sports and want to continue with your usual routine.
Many sports related injuries require proper treatment, following accurate diagnosis.
If you injure your ankle, in the short term you can use RICE to help manage your symptoms:
- Rest – keep weight off the ankle to avoid further damage
- Ice – use ice to reduce the swelling and numb some of the pain. You can use a frozen bag of peas or ice cubes in a bag with a towel to protect your skin. Don’t leave the ice on for longer than 20 minutes and allow 45 minutes before reapplying the ice to allow the tissues to return to a normal temperature.
- Compression – wrap the injured ankle in an elastic bandage or a compression wrap to immobilise it. Check that it’s not too tight. If your toes go blue, get cold or lose sensation, you need to loosen it.
- Elevate – elevating the injured ankle to at least the level of your heart will reduce swelling and pain.
You can also take painkillers to manage the pain.
Non-operative and minimally invasive ankle treatments
Ankle injuries are very often caused by accidents, or injuries whilst playing sports and many can be helped either with non-operative or minimally invasive treatment.
Operative treatments for the ankle
In some cases though, where injuries are severe, or to treat symptoms of ankle osteoarthritis, surgery may be necessary and could involve arthroscopic (keyhole) surgery, an ankle replacement or ankle fusion (arthroscopic or open).
Risks
One main risk of sports related ankle injuries is not seeking the correct treatment in a timely manner.
Injuries that are not treated may lead to long-term arthritis or require joint resurfacing or replacement surgery at a later date.
FAQ’s
Is there anything I can do to avoid ankle injuries?
To avoid injuring the ankles, doctors recommend maintaining a healthy weight, avoiding exercising while you are tired or in pain; wearing well-fitting shoes that are appropriate for the activity you are doing and warming up properly before exercising.
I tore a ligament and it is taking a long time to heal, is that normal?
Unfortunately, it can take a long time for ligaments to heal – sometimes as much as two years. In the meantime, keep doing whatever strengthening exercises have been recommended.
My son injured his ankle during football practice, what should I do?
Follow the RICE procedure outlined above – Rest, Ice, Compression, Elevation. Fractures and sprains that go undiagnosed or aren’t treated properly can lead to long-term ankle problems, such as weakness, repeated injury and arthritis.
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