Injuries to the ankle joint are quite common, estimated at about 25,000 each day in ankle sprains alone, half of which are sports-related.
This is not surprising considering all your body weight is being supported by a relatively small joint between your foot and shin which sometimes is made more precarious by wearing high heels or thick soled shoes.
And even though ankle injuries are fairly common they can be quite debilitating and should be taken seriously and investigated since fractures can occur.
Twisting or ‘going over’ on your ankle usually occurs when you step on an uneven surface, like a rock or the edge of the pavement, or when you are moving laterally such as playing soccer or basketball and the muscles on the outside of the ankle fatigue and are not strong enough to hold the ankle in place. Most often the ligaments are stretched resulting in swelling and pain.
The ankle proper is made up of three bones: the tibia (shin bone), the fibula (splint bone) and the talus. It is classified as a hinge joint and resembles a rectangular mortise.
The bony structure and thick deltoid ligament on the inner ankle stops the ankle from being sprained to the inside very often (eversion sprain) though this can happen.
Most sprains are from rolling the ankle outward (inversion sprain) which creates the puffy swelling on the outer ankle that is typically seen.
Grade 1 sprains are the result of mild stretching of the ligaments up to a grade three sprain which is a complete tearing of the ligament. Recovery is usually one or two months.
Just above the ankle joint proper, there resides three ligaments that attach the tibia to the fibula called the syndesmotic ligaments and this plays an important role in ankle stability. The typical injury to this ligament results usually not from a lateral ‘rolling’ of the ankle but an outward rotation of the lower leg.
Hockey players get this injury when they are in a scrum along the boards with their foot flush against the boards and are pushed so that their shin rotates but their foot stays planted. This is called a ‘high ankle sprain’ and recovery is often six months or longer.
Another injury that sometimes gets passed off as a typical ankle sprain is the Lisfranc injury. The mechanism of this severe injury is similar to a typical ankle sprain or it can occur from a blow or a fall from a height. The bones of the forefoot and mid foot that make up the arch area can dislocate (thereby stretching the ligaments that connect the bones together), or they can fracture. Swelling and bruising can often be seen in the region of the arch of the foot.
Treatment for all these conditions varies with severity and injury type. Severe injuries may require casting or surgery while less severe sprains usually require rest, ice, compression, elevation in the early stages followed by gentle mobilization, balance and strength exercises.
It is very important for athletes to rehabilitate the injury very well – if the athlete returns to play too soon, the risk of re-injury is high and can lead to further ankle instability.
Kerry Senchyna is the founder, owner and president of West Coast Kinesiology, and is a registered kinesiologist.