Ankle Pain

In order to fully understand the ankle joint and associated injuries, we must understand the relevant anatomy and function of the ankle. Below is a picture of the ankle joint, the relevant bones and ligaments. Nothing explains better than a picture!

Terminology

  • Ligaments connect bone to bone
  • Tendons connect muscle to bone
  • Sprains - ligaments
    • Grade 1 - micro trauma to ligament(s)
    • Grade 2 - partial tearing of ligament(s)
    • Grade 3 - complete tearing of ligament(s)
  • Strains - tendons
    • Grade 1 - micro trauma to ligament(s)
    • Grade 2 - partial tearing of ligament(s)
    • Grade 3 - complete tearing of ligament(s)
  • Ligamentous laxity - looseness in ligament(s)
Fact

Did you know that 85% of all ankle injuries are sprains?

The ankle functions as a platform for stability and a hinge for mobility. The entire weight of your body is dispersed between your two ankles. Think about it, that's a lot of force placed on two small joints. Without proper mobility, stability, and strength in our ankles, our lives would be severely impacted. It would be difficult to walk, run, participate in recreational activities, swim, work, or do anything that requires us to be on our feet.

Lack in any area of ankle function can lead to injury. Ankle injuries are common. Don't be afraid if you have suffered an ankle injury. You can be fixed! You might require some help to restore your ankle function.

In the following pages we will discuss two common ankle injuries: sprains and chronic ankle instability.

Facts

  • About 15% of all athletic injuries are due to ankle sprains
  • A reported 23,000 ankle ligament injuries occur every day in the U.S.
  • Common activities which lead to ankle sprains: basketball, volleyball, soccer, modern dance, and ballet
  • An estimated 20-40% of people with ankle sprains develop chronic pain and/or instability2
Did You Know?

Ankle sprains can happen again and again if not treated properly.

Sprains

The phrase "I rolled my ankle" is synonymous with "ankle sprain." It is considered an overstretching of the ligaments and muscles with enough force to cause damage to those structures. Usually, it is followed by pain, swelling, inflammation, bruising, and impaired mobility. There are basically two major types of ankle sprains, lateral or medial.

Lateral Ankle Sprains

This type of ankle sprain is much more common than the medial ankle sprain. This sprain stresses the outside ligaments of the ankle joint. The most common ligament injured is the anterior talofibular ligament (ATFL), secondly, the calcaneofibular ligament (CFL), and thirdly the posterior talofibular ligament (PTFL). When a person "rolls" their ankle to the inside, these structures are overstretched, causing trauma to the ligaments and subsequent inflammation.

Medial Ankle Sprains

This is the most uncommon ankle sprain. The deltoid ligament comprised of the: anterior and posterior tibiotalar ligaments, tibiocalcaneal ligament, and the tibionavicular ligament, is a much more difficult ligament to sprain. It is in part due to the stout nature of this ligament, but also due to the increased stability on the medial (inside) ankle joint. This sprain would be associated with the ankle "rolling" outward.

Treatment

  • RICE
    • Rest - possible use of crutches depending on severity
    • Ice
    • Compression - ace bandages
    • Elevation
  • Gradual restoration of motion
  • Progressive strengthening and stabilization
  • Possible use of brace for increased ankle stability
  • Return to sports or recreational activities

Chronic Ankle Instability

Chronic ankle instability means just that, ligamentous laxity in the ankle which has been present for long time. Basically, the ligaments and muscles no longer support the ankle like they should, which leads to repeated injury, pain, and limitations. We have all heard of those people that "turn" their ankles after stepping onto a small pebble, causing them to plummet to the asphalt feeling sheepish and embarrassed. These are people that have chronic ankle instability. If you repeatedly turn your ankle, even at the smallest obstacle or no obstacle at all, you likely have chronic ankle instability.

Treatment

  • Strengthening exercises
  • Stabilization exercises
  • Balance exercises
  • Multidirectional drills for advanced patients
  • Possible use of ankle brace for increased stability
  • Return to sports or recreational activities
  1. http://www.hughston.com/hha/b_16_4_3a.jpg
  2. Stephenson K, Saltzman CL, Brotzman SB. Foot and ankle injuries. Clinical Orthopaedic Rehabilitation. 2003;5:371-387.