Ankle Injuries

To be completely honest with you, recently, it feels like I've been living at the physio's. Therefore, it seemed appropriate to take a further look into ankle injuries. Ideally, I intended on doing a bit of research into my own "disability" but it turns out that my specific case is fairly uncommon due to the fact that I went over on the inside of my ankle rather than the outside (which is a lot more common). The ligaments on the inside are a great deal stronger than on the outside, meaning that although it'll heal more effectively and return back to its original condition, the recovery time could be up to three times as long. Unsurprisingly, there wasn't much on the worldwide web in relation to my injury so I thought I'd look into ankle injuries in general.

The Anatomy of the Ankle:

Tibia, Fibula, Talus, Ankle Joint

The Ankle Joint is surrounded by two ligaments:

1) Syndesmotic ligaments - (high ankle sprain)

2) Anterior talofibular ligament - (collateral ligament injury - ankle sprain) 

Anterolateral Ankle Pain:

High Ankle Sprain:

This consists of the sprain or tear of the syndesmotic ligaments that connect the tibia and the fibula at the ankle. It can be diagnosed through rotational stress with visual examinations or through a CT (computed tomography) scan and may require surgery.

Anterolateral Impingement:

Anterolateral Impingement is essentially the restriction of the ankle's full range of motion due to soft tissue or osseous (bone) pathology. This often occurs when the soft tissue thickens or undergoes fibrosis, causing adhesions that extend into the ankle joint. On the other hand, however, a spur in the tibial bone can impinge the talus is also a major cause of the aforementioned limitation in the ankle's motion as the spur's anterior lip gets in the way of the talus during dorsiflexion, which can also lead to chronic ankle pain. In this case, the patient may require debridement of the spur. This type of impingement has been found to be common in athletes who have had previous recurring ankle injuries of a similar nature.

Ankle Sprains:
In the case of ankle sprains, pain is normally anterior and localised in the fibula and can normally be attributed to a ligament sprain. They are more often than not the result of when the ankle is forced into an unusual/unnatural position, the ligaments will either get partially or completely torn. An ankle sprain is usually treated with: immobilisation, ice therapy, physical therapy and, in some extreme cases, surgery. It is normally fairly easy to distinguish the difference between a sprain and a fracture by assessing the patient's ability to walk. Although a certain amount of pain will have to be endured, someone with a sprained ankle should be able to walk. Conversely, if the patient is not able to walk, he/she has more likely than not suffered a fracture. Pain that is localised posterior to the fibula can usually be attributed to an injury of the peroneal tendons, which line the back of the fibula and lateral malleolus.

AT = Achilles Tendon

PL = Peroneus Longus

SPR = Superior Peroneal Retinaculum

IPR = Inferior Peroneal Retinaculum

PB = Peroneus Brevis

Lateral Ankle Pain:

Patients with this problem usually describe the pain as coming from the outer part of the ankle or just behind the lateral malleolus, more specifically, occurring in the area where the tendons in the two muscles (superior and inferior fibular retinacula) glide within a fibrous tunnel.

Peroneal Inflammation/Tendonitis:

Occurs when the tendons are subject to excessive and repetitive forces which lead to pain and swelling.

Peroneal Tendon Subluxation:

Is similar to an ankle sprain, occurring after a retinaculum injury, especially in dorsiflexion or eversion (turning outward) of the foot.

Posterior Ankle Pain:

Achilles Tendonitis:

When the achilles tendon is overused, it can cause irritation and inflammation. More often than not, this will result in pain, swelling and tears within the tendon. With age, lack of use or overexercising, it can become prone to injury/rupture. To check for the existence of an achilles tendon rupture, it is necessary to perform the Thompson Test (essentially the squeezing of the calf muscles). A positive result (i.e. showing that there is a rupture) would be demonstrated by the fact that the ankle would not move.

Posterior Ankle Impingement:

This can occur due to the os trigonum or large posterior process of talus (stieda syndrome) and is common among athletes such as ballet dancers.

Medial Ankle Pain:

Tarsal Tunnel Syndrome:

This refers to the compression/squeezing on the posterior tibial nerve that produces symptoms of pain and numbness, localised on the medial (inside) area of the ankle. If conservative treatment methods were to fail, surgical treatment, more specifically, tarsal tunnel release surgery may be required. A similar syndrome is the posterior tibial tendon tear, which is one of the leading causes of failing arches in adults.