Getting Back on Your Feet: An Empowering Guide to Understanding and Treating Ankle Injuries

Part 1: Laying the Groundwork: Navigating Ankle Injuries and Symptoms

Introduction

Ankles. They carry our weight, help us stand, walk, run, and dance, and give us the freedom to move in every which way without us giving them a second thought.

Yet, when ankle pain strikes, we quickly realize just how integral they are to our overall mobility and comfort.

Ankle injuries, whether the result of a sporting mishap, an unfortunate twist on an uneven sidewalk, or the outcome of a health condition, are very common. According to Hospital for Special Surgery, every day in the U.S., about 30,000 people sprain their ankles. If you are part of this statistic or want to understand more about ankle injuries to prevent them, you are in the right place.

Today, we will explore the world of ankle injuries. From understanding your ankle anatomy to identifying causes and symptoms to learning how to manage and heal your ankle injury right at home, this guide aims to empower you. So grab a comfortable seat, and let's explore the journey to getting you back on your feet.

Anatomical Overview

Now, let's talk anatomy for a moment. Ankle Joint and the structures around it make a complicated mechanism but I promise to keep it simple!

1. Understanding the Ankle Joint

At the most basic level, the ankle is a hinge joint composed of three primary bones:

• The Tibia: The larger bone in your lower leg, the tibia makes up the inner part of the ankle.

• The Fibula: A smaller bone running parallel to the tibia, it constitutes the outer part of the ankle.

• The Talus: Nestled atop your heel bone, it fits snugly into a socket formed by the tibia and fibula, completing the ankle joint.

In addition to these bones, the ankle structure includes ligaments, strong bands of tissue that stabilize the joint, and tendons, which connect muscles to bones and facilitate movement.

By Laboratoires Servier CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=89066270

Which one of these ligaments is most commonly injured in an ankle sprain?

What is the most common type of ankle sprain?

The answers are below!

2. How the Ankle Works

You can think of a hinge joint just like the hinge on a door. A door hinge allows the door to swing open or closed, but it doesn't let it move from side to side, right?

The ankle, as a hinge joint, works in a similar way. It allows your foot to move up (this is called dorsiflexion) and down (known as plantarflexion), much like how a door swings open and closed. However, it doesn't naturally allow for a lot of side-to-side movement. That's the job of other joints in your foot.

The design of the ankle joint primarily allows two movements: plantarflexion and dorsiflexion. Plantarflexion occurs when you point your toes downward (as when pushing down on a car pedal), and dorsiflexion happens when you pull your toes up toward your shin (as when letting off the pedal).

However, the ankle joint does not operate in isolation. Adjacent joints contribute to other essential movements, such as inversion (turning the sole of the foot inward), eversion (turning the sole of the foot outward), and rotation (a combination of all 4 movements), allowing for a versatile range of motion.

ALERT: Medical Terminology Overload!

When I mentioned "adjacent joints," I was referring to the sub-talar joint and the transverse tarsal joint, also known as Chopart’s joint.

Don't let these fancy terms intimidate you.

I will explain them in a moment.

These joints are located in the foot just below the true ankle joint, and they play an important role in enabling the foot to move in a variety of ways beyond the up-and-down motion controlled by the ankle.

The sub-talar joint is located below the talus and above the calcaneus (the heel bone). This joint allows for the inversion and eversion of the foot - in simple terms, turning the sole of your foot inward (inversion) or outward (eversion).

The transverse tarsal joint (or Chopart’s joint) consists of the talonavicular and calcaneocuboid joints. It also aids in the inversion and eversion of the foot and provides additional flexibility for complex movements.

• Talonavicular Joint: The talus bone is where the foot and ankle meet. The navicular bone is located in the middle of the foot. The talonavicular joint is crucial for foot movement, especially when you move your foot inwards and outwards (inversion and eversion).

• Calcaneocuboid Joint: The calcaneus is the largest bone in the foot (our heel bone) and serves as a shock absorber when we walk or run. The cuboid bone is sitting on the lateral (outer) side of the foot. The calcaneocuboid joint is particularly important when you walk on uneven surfaces or dance, allowing your foot to adjust to different positions for balance.

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So, the talonavicular and calcaneocuboid joints play vital roles in helping your foot move smoothly and adapt to various surfaces.

These adjacent joints work together with the ankle joint to provide the wide range of motion we need in our feet for various activities, from walking on uneven surfaces to running and jumping.

However, it's also important to note that this complexity makes the area more prone to injury.

This is why understanding the various types of injuries, their causes, and symptoms is vital for proper care and recovery.

Think of the ankle joint as a finely tuned instrument, equipped to carry out complex actions, but also susceptible to stress and injury if not properly maintained.

Now, let's move on to what might cause disruptions in this intricate system.

Causes of Ankle Injuries

Ankle injuries, like most other bodily injuries, come in different forms and can occur for various reasons.

They can be broadly categorized into acute injuries, which happen suddenly, and overuse injuries, which occur over time due to repetitive stress. Some people may also experience ankle problems due to pre-existing conditions.

1. Acute Injuries

Acute ankle injuries are often the result of a specific incident or accident, such as a fall, twist, or direct impact.

• Sprains and strains: Sprains are perhaps the most common type of ankle injury. They occur when the ligaments that support the ankle stretch beyond their limits or tear.

Strains, on the other hand, involve injury to muscles or tendons, but these are less common in the ankle than in areas like the back or hamstring.

• Fractures: Fractures happen when one or more of the ankle bones break. This could be a small, hairline fracture that's difficult to detect or a larger, more obvious break. Fractures often result from a fall, twist, or direct impact, such as a collision during sports.

2. Overuse Injuries

Unlike acute injuries, overuse injuries develop gradually over time due to repetitive stress on the ankle.

• Stress fractures: These are tiny cracks in the bone that occur over time due to repetitive force, often from overuse, such as jumping or running long distances.

• Tendonitis and bursitis: Tendonitis is inflammation of a tendon, while bursitis is inflammation of a bursa, a small fluid-filled sac that cushions your joints. Both can develop due to overuse and repetitive motion.

3. Pre-existing Conditions

Certain medical conditions can also contribute to ankle problems.

• Arthritis: This is a group of conditions that cause inflammation in the joints, leading to pain and stiffness. In the ankle, the most common types are osteoarthritis (caused by wear and tear over time), rheumatoid arthritis (an autoimmune disease), and post-traumatic arthritis (which occurs after an injury).

You can read more about osteoarthritis in the article Neck Pain: Causes, Symptoms, and Simple Solutions and in the article Cracking the Code of Knee Pain: Understanding the Root Causes and Relief Solutions.

Rheumatoid arthritis is explained in the article Top 10 Causes of Shoulder Pain: Understanding Your Symptoms

• Gout: This is a type of inflammatory arthritis that usually affects the joint at the base of the big toe but can also occur in the ankle. It's caused by high levels of uric acid in the blood, which can form crystals in the joints and cause sudden, severe pain. You can find out more about gout on the site called Versus Arthritis.

Let's dive deeper into the injuries mentioned above.

Sprains and Strains

1. Inversion Ankle Sprain: This is the most common type of ankle sprain and happens when the foot rolls inward, stretching or tearing the ligaments on the outside of the ankle (most often the anterior talofibular ligament).

Symptoms typically include pain, swelling, and bruising on the outside of the ankle.

2. Eversion Sprain: Less common than inversion sprains, an eversion sprain happens when the foot rolls outward, injuring the ligaments on the inside of the ankle.

Pain, swelling, and bruising occur on the inner side of the ankle.

3. High Ankle Sprain: This sprain involves the ligaments above the ankle that join together the two lower leg bones (tibia and fibula).

High ankle sprains often occur from a twisting or rotational injury, common in sports like football, basketball, pickleball, or tennis.

These sprains tend to take longer to heal than the typical ankle sprain.

Modified from Public Domain, https://commons.wikimedia.org/w/index.php?curid=1176993

Tendonitis and Tears

1. Achilles Tendonitis: This condition occurs when the Achilles tendon, which connects your calf muscles to your heel bone, becomes irritated and inflamed from overuse or strain.

It is common in runners and jumpers.

If not treated, the tendon can degenerate and become prone to rupture, a sudden and severe injury that typically requires surgical repair.

https://www.injurymap.com/free-human-anatomy-illustrations

2. Peroneal Tendonitis: This affects the peroneal tendons, which run down the outer part of the ankle to the foot. Overuse or improper foot alignment can cause these tendons to become inflamed, resulting in pain on the outside of the ankle and foot, swelling, and possible instability of the foot and ankle. A tear can occur from acute injury or chronic inflammation, leading to similar but more severe symptoms.

Modified from: Polygon data were generated by Database Center for Life Science (DBCLS)[2] - Polygon data are from BodyParts3D[1], CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=87560547

Stress Fractures

Stress fractures in the ankle often result from overuse, typically in endurance sports like running. Because these are small cracks in the bone, they can be hard to spot on standard X-rays, making them difficult to diagnose.

Symptoms might include gradually increasing pain with weight-bearing activities, tenderness to touch, and possible swelling.

If you continue stressing the area, these fractures can eventually become full breaks in the bone.

Symptoms and Differential Diagnosis

Recognizing the signs and symptoms of an ankle injury is the first step toward healing. Here's what you might experience with the various injuries.

1. Common Symptoms

• Pain: The hallmark of most ankle injuries, pain typically centers around the injury site. It can range from mild (a dull ache or tenderness when you press on the area) to severe (sharp pain that worsens with activity or weight bearing).

• Swelling: Swelling occurs after an injury because of small tears in the surrounding blood vessels. It can appear immediately after the injury or develop gradually over hours or days.

• Bruising: This can occur with more severe injuries like a sprain or fracture, showing as a blue or purple discoloration around the injured area.

• Limited movement: Depending on the severity of the injury, you may find it difficult to move your foot or ankle.

2. Differential Diagnosis

It is crucial to differentiate between the types of ankle injuries to ensure you are treating them correctly. Here's how to tell them apart based on symptoms:

• Sprains and strains: These typically cause

- pain, swelling, and sometimes bruising.

- With a severe sprain, you might also feel a pop or tear at the time of injury.

- Strains, while less common in the ankle, may cause muscle spasms or cramping in addition to pain and swelling.

• Fractures: These injuries are often more painful and may cause

- more swelling than sprains. You might see

- deformity in the ankle (it looks "out of place"), and it may be

- difficult or impossible to put weight on the injured foot.

• Stress fractures: Unlike a typical fracture, a stress fracture develops gradually and might initially cause only

- mild pain that worsens over time with activity.

- The pain improves with rest but returns when you resume the activity that caused it.

• Tendonitis and tears: Tendonitis usually causes

- pain and swelling in the affected area.

In the case of a tear or rupture, like in the Achilles tendon, you might feel a

- sharp, stabbing pain and

- difficulty moving the foot.

Understanding these injuries is the first step in recognizing them.

The next step is to know how to respond when they occur and what you can do to relieve pain and promote healing at home, which I cover in Part 2 of this article.

Remember, it is always better to err on the side of caution. If you are experiencing any of these symptoms and don't improve with home treatment, or if the symptoms are severe, please seek professional help. Healthcare professionals can diagnose the specific type and severity of your injury, using techniques like physical examination and imaging tests (like X-rays or MRI), and guide you on the path to recovery.

Disclaimer

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