Ankle anatomy

The ankle is made of the lower leg bones, the tibia and fibula, and the foot bone called the talus. It is a hinge joint which allows movement of the foot up and down. There are five major ligaments that tie the two leg bones to the foot bone. They allow ankle movement and contribute to ankle stability.

Ankle injuries can damage ligaments, muscles, tendons and bones. A sprain is injury to a ligament and may be caused by trauma or repetitive stress that causes microtears of the ligament. A strain is damage to the muscles or tendons caused by stretching beyond normal limits. A broken ankle is a fracture in any of the three bones (tibia, fibula or talus), usually caused by trauma.

What are the risk factors?

Most ankle injuries occur in men between the ages of 15 and 24, and women over age 30.

Ankle sprains are more common in women. A history of recurrent and acute ankle injury, being overweight, chronic ankle joint laxity or looseness, and impaired balance increase the risk of both ankle sprains and strains.

What are the common ankle injuries?

• Ankle Sprains: A sprained ankle is caused by a twist or turn of the foot that can stretch or tear a ligament. An acute ankle sprain is the most common lower limb injury in physically active individuals.  It often results from sports that require jumping such as basketball, soccer and volleyball. Genetics play a role and having one sprain can increase the risk of another ankle sprain. However, you can sprain your ankle by walking on an uneven surface, stepping off of a curb or walking on the beach. A high proportion of patients (up to 40%-50%) experience lingering symptoms including chronic ankle instability and recurrent injury. Rehabilitation is key to preventing chronic pain and swelling.
• Ankle Strains. These are injuries of the muscle, or a tendon that attaches a muscle to bone. An ankle strain can occur from sudden trauma and inflames the muscle or tendon. It can cause muscle cramps in the shins, calves and feet. Symptoms are similar to those found in sprains.
• Ankle fractures. Ankle fractures are common and usually occur during twisting of the ankle, tripping, falling or trauma from an auto accident. It may be a simple break of one bone or several fractures. An ankle fracture may also involve ligament damage. Treatment may be nonsurgical but when the ankle is unstable surgery may be recommended.  Depending on the extent of damage and treatment, recovery can take at least six weeks for bone to heal. Studies report that return to daily life activities can take 3-4 months, but full recovery can take up to two years.

What is involved with rehabilitation?

Rehabilitation is extremely important to recovery. Acute ankle sprains require early mobilization and ankle support rather than immobilization. Early weight bearing with support (a crutch or boot) can reduce the symptoms of an acute sprain, including reducing swelling and restoring range of motion.  Orthotics may be recommended to support recovery.

Rehabilitation for an ankle strain will include range of motion exercises, stretching, strengthening, balance and control exercises, and sport specific exercises. Exercise therapy is the main component of rehabilitation because it can reduce the risk of recurrent injuries and ankle instability and facilitate earlier recovery and improved function.

Ankle fractures will be immobilized with or without surgery. It usually takes at least six weeks to heal a broken bone. Rehabilitation is focused on restoring range of motion, mobility, strength, weight bearing and balance plus hip and knee exercises to improve the ability to walk. Return to sport depends on the type of fracture and the motivation of the athlete. A variety of functional tests will be used to determine whether the patient is able to return to play.

At Centers for Advanced Orthopaedics we work closely as a team to include the sports/orthopedic physicians, physical therapists, occupational therapists, and trainers to get you back to the life you love.