ANKLE INJURIES

Ankle Injuries

The ankle is a complex joint in your body that is very susceptible to injury.  It is comprised of three bones: the tibia, the fibula, and the talus. The tibia and fibula are the leg bones that make up the top half of the ankle joint, and the talus is a bone in the foot that makes up the lower portion of the ankle joint. 

Listed below are five of the most common ankle injuries that patients may encounter:

ANKLE SPRAINS

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue – like rubber bands – that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side and front-to-back movement, while still letting the ankle flex.​

The symptoms of ankle sprains, which may vary in intensity, depending on the severity of the sprain, can include:

  • Pain or soreness

  • Swelling

  • Bruising

  • Difficulty walking

  • Stiffness in the joint

When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Dr. Baxter may recommend one or more of the following treatment options: rest, ice, compression, elevation, offloading, and/or physical therapy. In more severe cases, surgery may be required.

PERONEAL TENDON INJURY

The peroneal tendons are located behind the fibula on the outside of the ankle. They have several functions, and one is to stabilize the ankle joint and prevent the motion that causes a lateral ankle sprain. In the process of trying to prevent an ankle sprain, the tendons themselves may tear or rupture. 

Symptoms of peroneal tendon injury are similar to that of a sprain. This includes increased swelling behind the ankle joint and pain with motions controlled by the peroneal tendons. Either or both of the tendons may become injured during an ankle sprain. The particular tendon can be differentiated by the motions they control and where they attach to the foot.  

An MRI is usually required to diagnose peroneal tendon injuries. Conservative treatment may be used for partially torn tendons, but surgery is required if there is complete rupture of a tendon.

PERONEAL TENDON SUBLUXATION

There is a fibrous band (peroneal retinaculum) that holds the peroneal tendons near the ankle joint, which can tear and cause peroneal tendon subluxation. This allows the tendons to dislocate from behind the fibula. Sometimes this can be seen visually under the skin, or the patient may notice a popping sensation as the tendons dislocate. 

Peroneal tendon subluxation can usually be identified on physical exam during your office visit. An MRI may be performed due to other associated injuries. 

Bracing and taping can temporarily relieve pain associated with peroneal tendon subluxation, but ultimately surgical repair of the peroneal retinaculum is required to resolve this issue.

TALAR DOME LESION

Talar dome lesions have several names including osteochondral defect (OCD), osteochondritis dessicans, or osteochondral lesion of the talus (OLT). This issue may arise with moderate to severe ankle sprains, or with forceful impacts of the ankle joint. A talar dome lesion occurs when the cartilage and underlying bone of the ankle joint (usually the talus) becomes cracked or fractured. Pieces of cartilage or bone may even become loose in the joint and cause the ankle joint to catch or lock. 

There is usually pain and swelling associated with an OCD/OLT defect. In mild cases, it may be difficult to diagnose the cartilage damage when there is no underlying fracture of the bone. In more severe cases, the fractured bone may be seen on x-ray. An MRI is usually ordered to fully determine the amount of damage to the joint and underlying bone. 

These are usually treated conservatively at first with offloading. If the damage is severe or does not heal with conservative treatment then surgery is required. The type of surgical procedure selected depends on the amount of damage and can range from being treated completely arthroscopically (using a small camera to see in the joint) to having to surgically open the joint. 

ANKLE FRACTURE

There are many types of known ankle fracture patterns, which are usually classified by low or high energy trauma and the directions that forces were applied to the ankle bones. Ankle fractures are common injuries in active people as well as elderly due to falls. 

There is usually intense pain associated with ankle fractures, and the patient usually can not walk on the affected foot after the injury. Swelling usually sets in quickly and will lead to bruising and possibly even blistering afterwards. 

Treatment for ankle fractures should not be delayed. X-rays are required to diagnose an ankle fracture, and in some cases a CT scan may be required to determine the extent of the fracturing. In less severe cases, the patient may be treated with casting for a minimum of 6-8 weeks. In ankle fractures that are unstable, surgical correction is required to make sure the ankle joint is returned to proper alignment. This starts with the physician reducing the deformity and getting the ankle back in proper alignment, and temporarily holding this position with a splint. If the joint is left in poor alignment, this can lead to difficulty with walking and increases chances of suffering from early onset of arthritis in the joint. Once the soft tissue swelling has decreased to an acceptable amount, final surgical intervention is performed to repair the fracture.