The ankle joint is able to move the foot in 3 directions, which includes: up and down, side-to-side, and tilting the foot. The ankle joint is composed of 3 different bones, which are called the talus, tibia, and fibula. Nine different ligaments and numerous muscle tendons surround the three ankle joint bones to help to keep the ankle strong and prevent injury when moving.
However, trauma, such as slipping on ice, can cause enough force to fracture the bones, or damage the ligaments or tendons. In fact, winter is the most common time for people to injure their ankle. This is mostly due to icy conditions, but with winter comes shorter days, so there is less sunlight to provide adequate visibility when outdoors walking in late afternoon and evenings.
If the bones are not damaged, this is classified as an ankle sprain. Ankle sprains are more common than fractures. Commonly patients will say they were walking and took a wrong step and their foot tilted to the outside. This is called an inversion sprain. Inversion sprains cause damage to the ligaments that support the outside of the ankle and foot. Sprains can sometimes be more painful and take longer to heal than an ankle fracture, since soft tissue, especially the ligaments heal more slowly than bones. Unfortunately, there is not a quick fix for an ankle sprain and it will heal with time. To provide relief, your podiatrist will give you an ankle brace or boot to help hold your ankle stable and possibly crutches to take weight off of the ankle, while the ligaments are repairing themselves. Additionally, RICE therapy is extremely beneficial. RICE stands for:
• Rest-Use crutches and avoid activities such as running or climbing stairs.
• Ice therapy-According to some research, ice is better or as effective as anti-inflammatory medications, such as ibuprofen, to get rid of the ankle swelling, which will help to reduce pain. However, ice therapy will usually be combined with taking an anti-inflammatory medication. Note: To avoid a cold injury, do not place ice directly onto the skin, but wrap an ice pack in a towel and ice ankle 2-3 times per day for 20 minutes.
• Compression-Use an ankle brace, splint, or boot in order to provide support to the ankle.
• Elevation-Prop your foot on 3-4 pillows while you are sitting to help reverse gravity, which will help drain the swelling out of the ankle, which will help to reduce pain.
There are numerous variations of ankle fractures. For example, one bone may be broken or all three bones may be fractured. In addition, to the fractures, there may also be damage to the surrounding ligaments and muscle tendons. Ankle fractures can be treated with non-surgical treatment, such as casting. In order for bones to heal, force needs to be put on the ends of the bone, so if the fracture is not severe, only a cast may be needed. The cast will push the ends of the bones together with the proper amount of force, and hold the bones in proper alignment for healing.
However, if it is a complicated severe ankle fracture, surgery may be needed. The surgery to fix complicated ankle fractures involves using metal hardware, such as plates and screws to provide the same compression and proper alignment as the cast; this surgical technique is called internal fixation. After the surgery, you will also be put into a cast or boot to help with the healing process. It may take up to 8-10 weeks to completely heal the bones. In order to prevent future ankle injuries, physical therapy is usually needed after an ankle injury to help regain strength of the ligaments and muscle tendons that support the ankle.
If you have injured your ankle, visit Platte Valley Foot and Ankle Clinic or Boulder Foot and Ankle for further evaluation. Ankle injuries will be x-rayed to look for signs of fractures, and if there are no signs of fractures, a MRI may be needed to see which ligaments or muscle tendons have been damaged.
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American Academy of Podiatric Sports Medicine