ankles for life

Who is at risk of an ankle injury?

Athletes and dancers whose sports involve high impact on the feet and ankles, such as gymnasts, runners and basketball players, are even more likely to injure their ankles. In addition, sports that involve intricate footwork, like hockey, tennis and ballet, also put added pressure on the ankle joint.

Ankle injuries can either be caused by a traumatic event or repetitive overuse. Traumatic injuries, such as ankle sprains, fractures or tears, are usually caused by an immediate, sudden movement or impact. Overuse injuries develop over time due to repeated stress, often from over-training and lack of rest.

Some of the most common ankle injuries:

Achilles Tendonitis

The Achilles tendon attaches the heel bone to the calf muscle. This tendon got its name from the mythical story of Achilles, who died in the Trojan War from a poisoned arrow to his heel. The term, “Achilles heel,” refers to weakness and vulnerability, so the Achilles tendon got this name because it is easily injured during certain activities.

Achilles Tendonitis occurs when the Achilles tendon becomes inflamed due to events such as increasing the level of physical activity too quickly, tightening in the ankle/heel area from lack of stretching or repetitive stress to the area. In general, Achilles Tendonitis is caused by doing too much too soon without giving the body enough time to rest. This condition, common in high-intensity athletes and dancers, typically causes pain in the back of the leg toward the heel.

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Achilles Tendon Rupture or Tear

An Achilles tear is when the tendon is partially torn, and a rupture is when the tendon is completely torn. An Achilles tear or rupture can be caused by any activity that requires a forceful push off of the ground from the ankles, like in soccer, basketball, gymnastics or diving. It can also be caused by an immediate, stressful event such as landing after a vault jump in gymnastics. Many who experience an Achilles tear or rupture hear a “pop” and then experience an immediate sharp pain in the lower leg/heel.

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Ankle Sprain

Sprained ankles are the most common ankle injury in athletes. An ankle sprain occurs when ligaments which support the ankle are torn or stretched as the ankle moves outside of its usual range of motion.

Common ligaments involved in sprained ankles are the anterior talofibular ligament, which connects the talus to the fibula on the outside of the ankle, and the calcaneal fibular ligament, which connects the fibula to the heel bone (the calcaneus).

Less commonly, the ligaments that hold the lower tibia and fibula together may also be torn during forceful external rotation of the foot, which is referred to as a high ankle sprain. Additionally, the deltoid ligament on the medial (inner) side of the ankle can also be torn or stretched.
Ankle sprains are divided into three grades, based on the severity of the injury.

Grade I ankle sprains are tiny, microscopic tears in the fibers of the ligaments in the ankle joint. Patients with a Grade I ankle sprain will feel mild tenderness around the ankle.

Grade II ankle sprains, the most common among athletes, are defined as an incomplete tear of the ligament. The ankle joint can also feel loose and the patient will experience moderate tenderness around the ankle joint.

Grade III ankle sprains, which occur when a ligament tears completely, are the most severe form of ankle sprains. Patients with this condition will experience significant discomfort and instability on the affected ankle.

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ankles for life

Ankle Fracture

An ankle fracture occurs when the ankle moves outside of its normal range of motion and a bone in the ankle joint breaks. The most common symptom of a fractured ankle is pain, an inability to walk on the affected ankle and bruising around the fractured bone.

In some extreme cases, when the bones are out of place, the ankle may look deformed and bones may even protrude from the skin. This is called an open fracture.

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Os Trigonum Syndrome

An estimated 10 percent of all people are born with a small, triangular shaped extra bone in the back of the ankle joint called the os trigonum. Many people with this bone live without symptoms. But, in some people, this bone can become loose and cause os trigonum syndrome, a condition in which the tissue that connects this bone to the ankle is over-stretched or torn. Symptoms are inflammation and pain in the back of the ankle.

Os trigonum syndrome is typically caused by repeatedly pointing toes downward or when trauma occurs to the ankle. It most often occurs among ballet dancers. Physicians call this a “nutcracker injury” because the os trigonum bone is crunched between the ankle and heel, just like a nut is broken in a nutcracker. Patients with os trigonum syndrome are more prone to posterior Ankle Impingement (see below).

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Ankle Impingement

Ankle Impingement occurs when tissues in the ankle become compressed at the front (anterior) or back (posterior) due to wear and tear during sports that rely heavily on the ankles, such as ballet or football. Ankle impingement patients have painful, abnormal mobility in their ankle joints.

There are two types of impingement: anterior and posterior. With anterior impingement, the foot and tibia bone move toward one another, compressing the bones at the front which may cause a bony growth, called a bone spur, to form at the front of the ankle. With posterior impingement, the soft tissue between the tibia and the heel may compress to form a bone spur at the back of the ankle. Patients with either anterior or posterior impingement will feel pain and tenderness around the bone spur, if present.

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