Ankle Sports Injuries

Three major bones form the ankle: the tibia (shinbone), the fibula that is parallel to the tibia and the talus (a foot bone). The bump felt on the inside of the ankle is called the medial malleolus, which is part of the lower end of the shinbone. The bump on the outside of the ankle is called the lateral malleolus, which is the lower end of the fibula. 

The ankle joint allows the foot to move up and down, while side-to-side movement happens on the subtalar joint, located just below the ankle. In between any bones in the body, including the subtalar joint, there is a tough substance called cartilage, which cushions the bones and allows them to move fluidly against each other. 

On the outside of the ankle, there are multiple ankle ligaments that connect the bones in the ankle and the subtalar joint to each other. These ligaments are made of strong, flexible tissue, but they can also be stretched beyond their means. 

An ankle sprain, also known as a twisted ankle, occurs when at least one of the ligaments in the ankle is torn or stretched beyond its normal range. 

Athletes are especially susceptible to ankle sprains in sports that involve jumping like soccer, basketball and volleyball. The sprain is one of the most common injuries, particularly among athletes, but also among people in their everyday lives, with about 25,000 reported ankle sprains in the U.S. every day. 

Ankle sprains can range in severity from a minor injury in which the ligament is overstretched to a complete tear of the ligament. If a ligament in the ankle is fully torn, some people feel a popping or snapping sensation. 

Sprained ankle symptoms can vary from person to person, but one of the clearest signs is pain. Other sprained ankle symptoms include: 

• Swelling
• Bruising
• Tenderness
• Numbing
• Stiffness
• Itching in rare cases 

Because a sprain weakens the ankle, people who have had them before are more likely to have them again, especially without proper treatment. This can cause recurrent ankle sprains and other types of chronic ankle problems such as chronic pain and instability. 

Similar to sprains, but affecting the muscles around the ankle, is an ankle strain, which is frequently caused by intense physical stress and overuse. One potential source of a strain is heavy exertion while tired, or without warming up or stretching first. Strains are often recognizable by symptoms similar to a sprain, but usually develop gradually with activity rather than a sudden event or movement. 

After a sprain or strain is diagnosed, your Sports Medicine doctor may advise you to rest the ankle, ice it and take other steps to reduce swelling as a start to your treatment. The doctor may also recommend crutches or an ankle brace during recovery and prescribe gentle exercises to prevent stiffness and improve your range of motion. 

While you are recovering, you may work with a physical therapist to rehabilitate your ankle. The physical therapist could provide you with strengthening exercises and balance training to prevent future ankle sprains. As your ankle injury heals, your physical therapist will gradually add agility or endurance drills so your ankle’s strength and range of motion continue to improve.  

A sprained ankle’s recovery time ranges from just two weeks for minor sprains to several months if the injury is more significant. Surgery is rarely needed for ankle sprains, with the exception of extreme cases such as those involving a completely torn ligament or if there are bone injuries or fractures involved with the sprain. 

Just like other bones in the body, those in the ankle are prone to breaking or fractures. Sometimes, in more severe cases, multiple ankle bones can be broken.  

Despite an ankle fracture injury or broken ankle, you may still be able to walk with pain, but more severe breaks or multiple fractures can result in you not being able to bear any weight at all. 

Like ankle sprains, ankle fractures can happen when you twist or roll your ankle, land awkwardly during a hard fall or receive a serious blow to the ankle. Ankle fractures can feel and appear similar to ankle sprains with symptoms including:  

• Immediate sharp pain
• Swelling
• Bruising
• Tenderness to the touch
• Inability to put weight on the affected foot
• Throbbing pain that increases during use and subsides during rest 

The treatment your Sports Medicine doctor recommends will depend on which bones in your ankle are fractured and the severity of the fracture. If the fracture does not shift any of the bones out of place or cause joint instability, your doctor may recommend non-surgical treatments. You may have to wear a removable brace, walking boot or a short leg cast during recovery in cases like these. 

More complicated fractures often require an Orthopedic surgeon to reset the bones and sometimes pin or plate the bones before healing. A fractured ankle takes approximately six to eight weeks to fully heal, though it may take longer if there are other complications like tendon or ligament damage around the joint. 

Some conditions in the ankle can take a long time to heal and can be debilitating for athletes. One of these conditions affecting the ankle is Achilles tendonitis, and it can take months for a full recovery. 

Behind the ankle joint is a large tendon that connects the calf muscles in the legs to the bones in the foot called the Achilles tendon. It is the largest tendon in the body, allowing you to walk, run and stand on your toes, while also acting as a shock absorber during activity. The Achilles tendon tolerates frequent high-stress activities, but it can become inflamed with overuse. The tendon also becomes weaker with age, making you more susceptible to injury over time. 

There are two types of Achilles tendonitis, depending on which part of the tendon is inflamed: non-insertional, or mid-substance Achilles tendonitis, and insertional Achilles tendonitis. Non-insertional Achilles tendonitis affects the middle of the tendon, while insertional Achilles tendonitis impacts the part of the tendon that attaches to the heel bone. 

Some common Achilles tendonitis symptoms include: 

• Pain and stiffness in the morning
• Pain and stiffness that worsens during activity or after exercising
• Thickening of the tendon
• A large bump behind the heel with insertional tendonitis
• Inability to walk on your toe or lift your heels due to pain 

Most Achilles tendonitis can be diagnosed without further imaging tests. In some rare cases an X-ray or MRI may be used to distinguish between tendonitis and a tear of the Achilles tendon or another injury, but in many cases this can also be accomplished using musculoskeletal ultrasound. 

Non-surgical Achilles tendonitis treatments can provide pain relief, but it often takes time, up to a few months, for the pain to subside, or even longer if the treatment is delayed. Common non-surgical treatments for Achilles tendonitis include: 

• Rest and ice
• Stretching of the calves and hamstrings
• Non-prescription anti-inflammatory medication 
• An immobilizer walking boot for temporary pain relief
• Supportive shoes or orthotic inserts
• Physical therapy focusing on a specific set of exercises called “eccentrics”
• Night splinting of the ankle 

Your Sports Medicine doctor may consider injections if the standard non-surgical treatments are not working. Cortisone injections are contra-indicated, or not recommended, because they can potentially cause a tear of a weakened tendon. Other injections are often not covered by insurance, but may be helpful in treating slow-healing tendons. Those injections include platelet rich plasma or prolotherapy injections. These injections are often always paired with continued physical therapy. An Orthopedic surgeon may consider surgery for Achilles tendonitis if your pain doesn’t go away after six months to 12 months of non-surgical treatment. The location of your tendonitis and the amount of damage to your tendon will determine the type of recommended surgery. After surgery, recovery time may involve months of rehabilitation and physical therapy before the pain is completely gone. Many times up to 12 months of rehabilitation is needed before Achilles tendonitis pain is no longer an issue. 

Osteochondritis dissecans of the ankle, or OCD, occurs when a small piece of bone or cartilage begins to separate or collapse in the ankle due to a lack of blood flowing to it. This condition can affect almost any joint, but it is more common in the knees, shoulders and ankles and often affect children and young adults. 

In growing children, cartilage and bone affected by OCD can often heal on their own if rested appropriately. In some cases, especially those involving grown children or young adults, OCD lesions can lead to the separation of cartilage from the bone or a collapse of the bone.  

The exact causes of OCD are unclear, but doctors believe the disruption of blood flow may be related to repetitive trauma or stress to the bone. Symptoms can appear after high-impact activities like running or jumping, or after injuring the ankle. Osteochondritis dissecans symptoms in the ankle include: 

• Pain, especially during physical activity
• Swelling around the ankle
• A popping or locking sensation
• In some cases limited range or loss of range of motion 

Your doctor may examine the affected joint, but X-rays can confirm if there is an OCD lesion in the ankle and help the doctor identify the location and size of the OCD lesion. Often times if an OCD lesion is discovered on X-ray, an MRI or CT scan is ordered to evaluate the age and stability of the lesion. 

Most of the time, osteochondritis dissecans ankle treatments include rest and avoiding sports that involve strenuous ankle movements like soccer, baseball or football until the symptoms are gone and swelling has subsided. Patients with OCD in the ankles often notice improvement after resting for two to four months and return to athletic activity after symptoms have improved. Your doctor may also recommend physical therapy during recovery to strengthen and stabilize the ankle. 

In more serious cases, OCD might not respond to conservative treatments or cause a loose fragment of bone to float in the joint. These situations usually require surgery. Osteochondritis dissecans ankle surgery may also be necessary for larger lesions, especially in older patients. Your Orthopedic surgeon will help determine if surgery is right for you. 

Ankle arthritis is less common than other forms of arthritis, such as in the knee or hip, but ankle osteoarthritis, or degenerative joint disease can develop over time. Ankle arthritis is often linked to joint instability or long-term results of an injury. 

Osteoarthritis is any painful condition of a joint due to gradual thinning of cartilage over time. Ankle arthritis symptoms start off mildly but gradually get worse with time, especially if left untreated. Symptoms of ankle osteoarthritis include: 

• Pain in the ankle
• Ankle stiffness
• Swelling 

Your doctor may rely on your medical history during your physical exam to diagnose ankle osteoarthritis. He or she may also order X-rays or other types of imaging to confirm you have osteoarthritis in your ankles or if another condition may be causing your ankle pain. 

Typically, your Sports Medicine doctor or Orthopedic surgeon will offer non-surgical treatment options before considering joint replacement surgery or fusion. Non-surgical treatments for ankle arthritis might include: 

• Low-impact arthritis ankle exercises like swimming, walking and cycling
• Non-prescription and prescription anti-inflammatory medications
• Corticosteroid injections
• Shoe modifications or insoles
• A weight loss regimen 

These treatments may not adequately relieve the symptoms of ankle arthritis pain after a while. Your Orthopedic surgeon may discuss whether you are a good candidate for ankle arthritis surgeries such as total ankle replacement surgery or joint fusion surgery. 

Sauk Prairie Healthcare’s Sports Medicine doctors use personal, hands-on examination, aided by a range of imaging technology to find the source of your ankle pain. Once there is a diagnosis, your doctor will explore the options of non-invasive treatment, such as joint supplementation, anti-inflammatory treatment and physical therapy. 

In some cases, a patient may be referred to our Orthopedic surgeon specializing in foot and ankle surgery, Dr. Andrew Ertl, who can explore other surgical options. 

Doctors at Sauk Prairie Healthcare work with you to get you safely back on your feet again as early as possible, while also helping you avoid re-injury and long-term joint damage. 

Our Orthopedic Surgeon Specializing in Foot and Ankle:
Andrew M. Ertl, MD