What Kinds of Ankle Injuries Are There?
Sprains, Strains, and Fractures
Ankle injuries are defined by the kind of tissue — bone, ligament, or tendon — that’s damaged. The ankle is where three bones meet — the tibia and fibula of your lower leg with the talus of your foot. These bones are held together at the ankle joint by ligaments, which are strong elastic bands of connective tissue that keep the bones in place while allowing normal ankle motion. Tendons attach muscles to the bones to do the work of making the ankle and foot move, and help keep the joints stable.
A fracture describes a break in one or more of the bones. A sprain is the term that describes damage to ligaments when they are stretched beyond their normal range of motion. A ligament sprain can range from many microscopic tears in the fibers that comprise the ligament to a complete tear or rupture. A strain refers to damage to muscles and tendons as a result of being pulled or stretched too far.
Muscle and tendon strains are more common in the legs and lower back. In the ankle, there are two tendons that are often strained. These are the peroneal tendons, and they stabilize and protect the ankle. They can become inflamed as a result of overuse or trauma. Acute tendon tears result from a sudden trauma or force. The inflammation of a tendon is called tendinitis. Microscopic tendon tears that accumulate over time, because of being repeatedly over stretched, and don’t heal properly lead to a condition called tendinosis. Tendons can also rupture. Subluxation refers to a tendon that slips out of place.
How Does the Doctor Diagnose an Ankle Injury?
The first thing a doctor will do is ask questions about how the injury occurred. Then the doctor will examine the ankle, noting the amount of swelling and bruising. The physical examination of the ankle may be painful because the doctor needs to move the ankle to evaluate the pain and swelling in order to make a proper diagnosis.
The doctor may order an ankle X-ray to determine whether there are any broken bones. In addition to an ankle X-ray, your doctor may ask for X-rays of the leg and foot to determine whether there may be other related injuries. If the doctor suspects a stress fracture, the doctor will ask for other imaging scans such as an MRI, which will show more detail about the injury. If there is a fracture, the doctor may also ask for a stress test, which is a special X-ray taken with pressure applied to the joint. This will help the doctor determine whether surgery is needed.
For most ankle injuries, pain is controlled by using an over-the-counter medication such as acetaminophen or other nonsteroidal anti-inflammatory drug such as ibuprofen. The specific treatment of the injury depends on the type of injury.
Treatment of Fractures
Fractures can be treated either surgically or nonsurgically. The doctor may treat the break without surgery by immobilizing the ankle if only one bone is broken, and if the bones are not out of place and the ankle is stable. Typically the doctor will do this by putting on a brace that works as a splint or by putting on a cast. If the ankle is unstable, the fracture will be treated surgically. Often, the ankle is made stable by using a metal plate and screws to hold the bones in place. Following the surgery, the ankle is protected with a splint until the swelling goes down and then with a cast.
It usually takes at least six weeks for the bones to heal. Your doctor will probably ask you to keep weight off the ankle during that time so the bones can heal in the proper alignment. Ligaments and tendons can take longer to heal after a fracture is fully mended. It can take as long as two years to completely recover full painfree motion and strength after an ankle fracture, although most people are able to resume their normal daily routine within three to four months.
After the doctor has determined it is safe for you to start moving your ankle, you may need physical therapy to provide gait training, balance, strengthening, and mobility exercises. The therapist will develop a home program that you can use to regain your previous normal function. It can take several months to return to a normal walking pattern without limping.
Treatment of Sprains
The treatment for sprains depends on the severity of the injury. They are graded as mild, moderate, or severe. Surgery is not usually a treatment option unless the damage is extensive, involves more than the ligaments, or when other treatment options fail.
Mild sprains — called grade 1 — are treated with the RICE approach for several days until the pain and swelling improve. With a mild sprain, you won’t need a splint or a cast. Your doctor will tell you to put weight on the ankle fairly soon — within one to three days — as long as you can tolerate it and will prescribe range of motion, stretching, and strengthening exercises.
If your sprain is classified as moderate, or grade 2, the doctor will use the RICE approach but allow more time for healing to occur. The doctor may also use a device such as a boot or a splint to immobilize the ankle. You will be given exercises to do first to improve range of motion and then to stretch and strengthen the ankle. The doctor may also prescribe physical therapy to help you regain full use of your ankle.
Grade 3 or a severe sprain involves a complete tear or rupture of a ligament and takes considerably longer to heal. It’s treated with immobilization of the joint followed by a longer period of physical therapy for range of motion, stretching, and strength building. Occasionally, especially if the sprain does not heal in a reasonable time, surgery will be considered for reconstructing the torn ligaments. On average, the initial treatment of a sprain, includes resting, and protecting the ankle until swelling goes down for about one week. That’s followed by a period of one to two weeks of exercise to restore range of motion, strength, and flexibility. It can take several more weeks to several months to gradually return to your normal activities while you continue to exercise.