Learning to Love Your Ankles

joints in a runner's foot

Give these sturdy, yet vulnerable, joints a little tender loving care, and they'll always carry you through.

Our ankles literally carry us through our days, allowing us to walk, dance, run and play sports. Yet these joints can be vulnerable to the substantial force they are required to absorb. It’s not surprising that 25,000 people reportedly sprain an ankle each day. "Ankle sprains are the most frequent injuries I see,” says Chudi Mgbako, DPM, a podiatrist and foot and ankle specialist with Robert Wood Johnson University Hospital (RWJUH) Rahway.

"Doctors and patients often don’t take these sprains seriously enough,” says Dr. Mgbako. “A common misconception is that all sprains are the same and can always be treated adequately with icing and rest. Yet they all need to be X-rayed and evaluated by a physician.”

Types of injuries

The ankle joint is made up of three bones: the tibia (or shinbone) the fibula (the smaller bone of the lower leg) and the talus, a small bone that sits between the heel and the other two. A number of ligaments surround the ankle, binding the bones of the leg to each other and to those of the foot.

With a sprain, one or more of these ligaments is damaged by an accidental twist or turn of the foot. Sprains often happen quickly from stepping off a curb, rolling the ankle while running or tripping in high heels. There are several levels of sprains, says Dr. Mgbako:

A Grade 1 sprain, which consists of a slight stretch but no ligament tears, generally becomes better within five days to a week. Treatment involves rest, ice, ankle range of motion exercises and an elastic bandage or ankle brace.

A Grade 2 sprain, with partial tears, requires the same treatment, but a longer period of rest—between two to four weeks. Physical therapy is sometimes required.

A Grade 3 sprain, where ligaments are completely torn, usually requires either a boot or a cast with crutches, and two weeks of immobilization in order for ligaments to repair. Physical therapy is recommended for every sprain of this type. Fractures are another common ankle issue. These can range from avulsion injuries, where small pieces of bone have been pulled off, to shattering breaks of the tibia, fibula or both.

Fracture symptoms include inability to walk, swelling, pain at touch and deformity around the ankle. A bone that breaks through the skin is a compound fracture and is more serious than a simple fracture. Whether a fracture requires surgery depends upon the type of injury and whether the fractured bones have been displaced, Dr. Mgbako says. A non-displaced fracture, without injury to the ligaments of the medial—or inner—side of the foot, usually heals without surgery. If inner and outer bones are fractured, however, surgery is usually required.

Long-term damage

Dr. Mgbako often sees patients who’ve had chronic ankle sprains that haven’t been treated appropriately. Scar tissue also may develop in an untreated ankle sprain, along with inflammation. In these cases, surgical repair is sometimes needed to clear the scar tissue from the area. An inappropriately treated sprain can result in other conditions as well. “Once ligaments have been pulled and stretched over a long period, they lose their elasticity, resulting in an unstable ankle,” explains Dr. Mgbako. Ankle instability is characterized by a repeated giving way of the outer side of the ankle. This is accompanied by a sense of imbalance or wobbliness, especially when walking on uneven surfaces. Tenderness and swelling may also be present.

"Sometimes people don’t even realize they need treatment, but continue to sprain their ankle,” says Dr. Mgbako. “Over time, this can cause the breakdown of cartilage, the cushion that separates bones in the ankle joint. When that breaks down, it eventually can cause bone-on-bone arthritis.” Dr. Mgbako notes that osteoarthritis, the most common form of the condition, can also result from normal wear and tear. In that case, stiffness and swelling can make walking difficult, especially on steps or uneven surfaces.

Treatment for ankle arthritis includes strength building exercises, as well as custom ankle braces and anti-inflammatory medications. If pain persists, injections of cortisone may be used before surgical options are considered.

For severe ankle arthritis, fusion of the ankle—in which remaining cartilage is removed and hardware is used to hold the joint in place—was once the only surgical option. Total ankle replacement is a newer surgery in which weight-bearing parts of the ankle are resurfaced. This procedure allows more normal ankle function and movement.

Protecting the ankle

There are a number of ways that you can help protect this important joint. One of the best is to pay attention to your body’s signals and slow down if you feel fatigue or discomfort. Other tactics include:

  • Wear well-supported shoes, which can help prevent rolling of the ankles. Avoid high heels or flat sandals.
  • For support, use an elastic ankle brace or cuff.
  • Avoid walking on uneven terrain, or use a cane.
  • Try range-of-motion, balance and flexibility exercises to strengthen ankles.

If you injure your ankle and pain and swelling persist for more than a few days, be sure to consult your physician.

To find a foot and ankle specialist, visit RWJUH Rahway or call 888.724.7123.