“What’s Going on With my Ankle” Part 1.

There is a lot of variability in ankle and foot injuries.  Some are super common like the ankle sprain that most of us have had at one time in our lives.  While others we might see only once or twice every year or two.  Just like other joints some of these injuries are the kind that you know immediately when and how you hurt yourself while others are the kind that people say they ‘just woke up one day with pain’.  This is the first of two posts where we are going to discuss some of the more common ankle and foot injuries that we typically see.

Sprains

Ankle sprain: The most common ankle injury, maybe even the most common injury of the body, is the ankle sprain.  It occurs whenever any of the ligaments that hold the ankle together get stretched from excessive force.  The most frequent ligaments sprained in the ankle are the lateral ankle ligaments (which you can find out a lot more about in this post on ankle anatomy) with the number one sprained ligament being the Anterior talofibular ligament (ATFL).  It typically occurs when you your ankle goes through an excessive inversion force (rolling over your unturned foot).  If you roll your ankle bad enough you can also injure the other lateral ligaments as well.

Ankle sprain, ankle pain

Lateral ankle sprains are the most common type of ankle sprain. © Alila07 | Dreamstime.com

Less common than the lateral ankle sprain is the medial ankle sprain.  This involves the deltoid ligament and typically occurs with greater force like when people jump and land wrong, when people fall, or if their foot is planted and they get hit from the lateral side.

Ankle sprains are common among athletes who participate in sports that involve running on changing terrains, repetitive jumping, or frequent changes in direction, such as basketball, volleyball, soccer, football, and cross-country.

Depending on the grade/level of sprain symptoms may range from pain, swelling, bruising, tenderness to touch, difficulty walking or even an inability to walk or bear weight.

Immediately after injury the first course of treatment would be rest, ice, compression,and elevation.  Afterwards depending on the severity it could range from just rest, taping/bracing of some sort, all the way up to significant time being immobilized in a boot or non-weight bearing.  In the most severe cases involving a full tear of the ligament a surgical repair would be required.   Rehabilitation consists of exercises to improve swelling, range of motion, strength, balance, return to walking normally, and in athletes a return to running/sports.

Turf toe: Is a sprain of the ligaments around the big toe joint.   It typically happens with extreme hyperextension (bending upwards) of the metatarsophalangeal (MTP) joint.  In English this means basically your big toe gets pushed back like as if you were using your hand to push your big toe back towards your shin.  It is common in sports due to the constant explosive push off while running,  jumping, or cutting athletes do. Especially for athletes who play on turf fields such as football, as synthetic surfaces tend to be harder than grass and cleats are more likely to stick.

Individuals will present with pain during toe extension, weight bearing, walking/pushing off, tenderness to touch, and can have swelling and bruising in the area.

It is most commonly treated with ice, compression, elevation for swelling and immobilization. In most cases, physical therapy will bring people back to their prior level of function and only severe cases will require surgery.

Fractures

Ankle fracture. Ankle pain

Lateral Malleoli fracture repaired by surgery. ©Choochin | iStockphoto.com

Bone Fractures:  Due to how frequently ankles can get sprained, each episode creating a greater likelihood of laxity in the ligaments, it is no wonder that ankle fractures can occur.  They typically occur due to rotational force on the ankle that causes the ankle to turn, roll, or get twisted while walking, running, or when landing from a jump or fall.  Another major cause of ankle fractures can occur by a high force impact like in a motor vehicle accident.

The most common ankle fractures are:

  • Lateral malleolus fracture: This is the most common type of ankle fracture. It is a break of the lateral malleolus, that knobby bump on the end of the fibula on the outside of the ankle.
  • Bimalleolar ankle fracture: This is the second-most common type of fracture that involves breaking both the lateral malleolus and the medial malleolus (That knobby bump on the bottom of the tibia on the inside of the ankle).
  • Trimalleolar ankle fracture: This type involves breaks on three sides of the ankle: the lateral and medial malleolus as in a bimalleolar ankle fracture but also the back of the bottom of the fibula.  This is often called the posterior malleolus.
  • Pilon fracture: This is a fracture through the weightbearing “roof” of the ankle.  The “roof” is considered the part of the tibia that sits more on the talus and is towards the middle from the medial malleolus.   This is usually a high energy traumatic injury.

Stress Fracture: When repetitive small to moderate force occurs at one spot of a bone the bone can crack or break without moving apart.  If you think of an ankle fracture as an old tree branch that snaps in half when you try to break it then a stress fracture would be like those times you have tried to break a young sampling branch that kind of just splinters in one spot.

It typically occurs about 3 weeks after we start a new activity that causes increased impact through our feet and ankle.  Any sudden increase in training duration, increase in training intensity, change in training surface, sudden change in technique, or poor nutrition can also cause a stress fracture. It is most common in runners and jumpers as it will  occur due to the repetitive loading associated with both.  More often than not it will occur in the medial malleolus, talus, navicular, and the metatarsals (the 2nd metatarsal being the most common location out of the 5).

Common symptoms are nagging, localized pain, and pain to the touch where the fracture is.  Often times the pain will hurt at night and make it difficult to sleep as well.

Depending on the extent of the fracture, immobilization may be used as the most common form of treatment.

Mechanical Issues

Hallux Valgus (Bunion): Deformity of the big toe where the toe drifts in towards the second toe due to arthritis, hypermobility of the big toe, poor footwear or flat feet. It is diagnosed if the valgus angle (angle of base of the toe movement) is more than 15 degrees. Bunion is the lay term used to describe a prominent and often inflamed metatarsal head and overlying bursa.

Foot pain, bunion.

Hallux Valgus (Bunion) present on both feet, Right > Left. © Olga Akinina | Dreamstime.com

Symptoms may include pain, swelling, decreased range of motion of the toe, difficulty walking/running, difficulty putting/having on a shoe.  It occurs in about 2% of children age 9-10, 50% adults, most of which are females.

Some conservative treatments would include: making sure to wear comfortable shoes, using moleskin or gel-filled pads for toe separation, as well as utilizing orthotic shoe inserts.  Anther possible treatment is surgery.  The most common surgery being bunionectomy which is shaving off the enlarged portion of the bone and realigning the muscles, tendons, and ligaments. It takes about a year to fully recover from the surgery

Morton’s neuroma: Often mistaken for a stress fracture, Morton’s neuroma is a thickening of the nerve that runs between the metatarsals. Usually occurring under the base of the third toe and is described as feeling like walking on a pebble.  Often times there is a callus formation on the bottom of the foot where the pebble feeling is felt.  It is more common in females and may occur due to wearing high heels, high arches, over pronation or weight gain.  Common complaints usually include throbbing and burning in the ball of the foot, pins and needles, or increase in pain with weight bearing.

May be treated by providing cushion/orthotic inserts in the shoe, physical therapy and if all else fails, surgery.

 

Check back for our next post that finishes up some of the common injuries we can get in our ankle.  But in the meantime If you are having any symptoms described in this article or have a new pain, numbness, stiffness or tingling in any part of your body, arms or legs, contact us today!  With Direct Access in NJ we can get you in for an evaluation without you having to see your Doctor, probably quicker than you could get that appointment, while also saving you both time and money!  

Please, call us to schedule your evaluation at one of BeneFIT’s locations, Bridgewater (908.203.5200) or Chester (908.879.5700)  with one of our highly trained Doctors of Physical Therapy!

 

 

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