FAQ Category: Ankle

Ankle sprains are the most common ankle injury in today’s competitive athlete. Pain and swelling can keep an athlete benched at the heighth of the playing season. Restoring the joint to normal as quickly as possible becomes the goal.

It sounds like your daughter may have received a treatment called electrical stimulation (ES). An electrical current or impulse can be passed through the skin via flat electrodes applied to the muscle. The electric current applied is low-voltage with just enough energy to cause the muscle to contract. This type of ES is called neuromuscular electrical stimulation (NMES).

By contracting and relaxing the muscles through multiple cycles, a pump action is created. This muscle pump helps keep fluid from pooling thus decreasing or minimizing edema. Instead, blood and lymph fluid are moved away from the ankle into the leg and back up toward the heart.

Usually a 30-minute treatment session with five second contractions can create 360 cycles. This is far more muscle pumping than a person can do by actively contracting the muscle. As your daughter experienced, the result can be rapid recover and return to sports.

Many experts have looked at this question with an eye toward improving rehab for athletes such as yourself. A recent study from a group of physical therapists in Ireland may have some new information to help.

They studied two groups of adults in a controlled laboratory study. One group had recurrent ankle sprains (at least two). The other (control) group had no history of ankle sprain.

Both groups were tested on a treadmill walking four kilometers per hour. Measurements were taken of muscle activity and joint position throughout the testing.

They found that the ankle sprain group had a tendency to hold the ankle in a slightly inverted (toe in) position. This was especially obvious at the point of heel strike when the ankle should be in neutral. They also found that this position put the outer border of the foot closer to the floor with lower clearance during the swing-through phase of gait (walking).

The results of this study show that athletes need to start with basic retraining of their walking pattern after chronic ankle sprain. This step is advised before doing jump landing and agility drills.

It’s probably not too late to go back and add this into your program. A physical therapist can help you get set up to do this with minimal supervision. Taping and bracing may be needed at first to get the ankle back to a more neutral position.

The muscles along the outside of the ankle must be retrained to control and correct the ankle position at all points of the gait cycle. This includes the swing through phase as the toe pushes off and the lower leg moves forward up to and including the moment the heel strikes the ground.

Motor reeducation to restore normal motor control is often overlooked in an athlete’s rehab from acute ankle sprain. Even though you are past the acute phase of ankle injury, it’s probably not too late for you to recover these important skills.

When people report repeated ankle sprains, the condition is referred to as functional instability. You can walk on that foot, but as you described, every now and then without warning, the foot and ankle give way. This condition is the most common long-term problem after an ankle sprain injury.

Scientists aren’t exactly sure what causes this to happen. The obvious answer is that supporting ligaments damaged in the first injury aren’t holding the ankle in place. But there must be more to it than that, or the ankle would give way with every step you took.

There are a couple of theories to explain FI. The first is known as articular deafferentation. According to this theory, tiny receptors in the joint capsule and ligaments around the ankle are damaged. These are called mechanoreceptors.

Ankle stability depends on the muscles around the ankle to react quickly to sudden movements. Enough muscle tension is created to prevent the ankle from going too far in one direction of the other. The mechanoreceptors signal the muscles when the joint is in danger. The muscles respond to stabilize the joint. Damaged mechanoreceptors don’t allow a fast enough response and down you go!

Another idea is the feed-forward motor control theory. Recent research has shown that the body may react to certain positions and movements ahead of time based on past experience. So for example, when you go to take a step, the muscles contract to position and hold the ankle in just the right spot. The goal is to stabilize it and prevent injury.

After injury, the muscles may anticipate injury and start to contract too early. The intent is to protect the joint but the result is abnormal motor control and giving way of the joint. Sometimes this problem can be corrected with a fairly simple program of exercises and activities. A physical therapist can help you with this.

Ankle osteoarthritis (OA) isn’t as common as hip or knee OA so there aren’t as many studies on this topic to help answer this question. We do know that ankle OA is more common in people who have had a previous history of trauma.

It usually happens younger in life. Having this problem over a longer time period increases the chances of developing arthritis later. Arthritis linked with previous trauma or injury is called posttraumatic OA. If your grandfather had OA from aging, the condition would have been called degenerative OA.

Whether you have traumatic or degenerative OA, the symptoms and disability are similar. Early intervention may make a difference for you. It may be a good idea to see your orthopedic surgeon for a follow-up visit. Maintaining your motion and strength will help you stay active and may reduce your symptoms.

A short course of physical therapy to evaluate your ankle motion and set you up with a home program may be advised. Avoiding other musculoskeletal problems by staying active and fit will be of great benefit to your overall health and well-being.

You may be experiencing some symptoms of posttraumatic arthritis. It’s not uncommon for people with a previous ankle injury to start noticing pain, swelling, and/or stiffness years later.

In a recent study of patients with known ankle osteoarthritis (OA), one-third had jobs that required long periods of standing. The increased weight-bearing on a previously damaged joint may be linked with increased painful symptoms over time.

It may be a good idea to get a baseline X-ray to see what’s going on in the ankle joint. This may help you and your doctor track changes that occur over the next few decades of your life. Early treatment can help prevent other problems later.

When you can take a break from standing, elevate your legs and move your foot up and down. This pumping action can help keep swelling down and pump the fluid back up toward your heart. When standing at work, try to shift your weight back and forth from foot to foot. Avoid standing on one leg for more than a few minutes.

Many studies support the idea that general physical fitness helps prevent future problems. Try to get some form of regular exercise four to five times a week. Strengthening exercises for your legs may help reduce some of your symptoms if caused by leg fatigue.

Athletes ages 13 to 18 may actually be at increased risk for injury due to the hormones circulating throughout the body. Male hormones called androgens are present in both males and females. Women (and girls) have much smaller amounts compared to men (and boys).

Testosterone is the most commonly known androgen. Androgens function as steroids in the body. They build muscle mass, develop male characteristics, and inhibit fat formation. Androgen levels can also influence brain activity leading to aggressive behavior.

Elevated levels of androgens in the adolescent athlete can lead to injury from overuse or repetitive activity. Increased power, mass, and speed from the effects of androgens may overload the adolescent skeleton and joints. Poor posture (so common in this age group) may be a factor. Poor posture combined with weakness puts more stress on the back muscles, possibly leading to injury.

If the force of muscles contracting over and over is greater than the strength of the bone, then fatigue or failure can occur. The end-result is an injury. So although testosterone builds mass and strength, there is a limit to what the body can handle, especially at this age.

Until boys and girls grow in to their hormones, there is an increased risk of activity- and sports-related injuries.

Osteoarthritis of the ankle can occur as a result of the natural aging process and biologic changes that cause joint changes. This is called primary osteoarthritis (OA).

More often in the case of ankle OA, there has been an injury or previous trauma of some kind. This could be an ankle sprain, joint infection, or fracture. Do you recall anything like that in your past? It could have happened years ago.

Anything that can disrupt the stability of the ankle can result in OA. Over time the structures bear the load of your weight unevenly long enough that the cartilage wears away or even tears. You can end up with OA. OA of this kind is called secondary OA.

Most people with stage 2 or 3 OA of the ankle once played sports either competitively or for recreation. Ankle sprains during active play are the most common event linked with OA years later.

Weight-bearing X-rays are typical when evaluating the ankles for osteoarthritis (OA). Body weight and putting weight through the feet and ankles does affect the line up of the bones and stability of the joint.

In addition to the position of the ankle bones, the radiologist and the orthopedic surgeon will look at the X-rays to see the condition of the bones and joint. The amount of space between the bones called the joint space is measured and compared to normal. Narrowing of the joint space is common with osteoarthritis.

Bone spurs or other changes in the bone are also noted. For example, sclerosis, an abnormal hardening or increased density of the bone can also be seen on X-ray.

The physician uses the results of clinical tests performed on you in the office along with X-ray findings to make a diagnosis of osteoarthritis. OA can be further grouped on the basis of severity as stage 1, 2 or 3.

In stage 2 OA, there is a narrowing of the joint space, whereas in stage 3 the joint space is gone altogether. Patients with stage 3 OA can have much more pain because the joint is no longer protected by cartilage. You may be walking (or standing) with bone on bone. Standing or weight-bearing X-rays help show this.

Ligament injuries of the ankle can be graded as I, II, or III. The higher the number, the more severe is the injury. Grade II and III are often treated with casting for anywhere from 10 days to four weeks.

A recent study from the University of Vermont compared the results of Grades I – III ankle sprains using different treatment methods. Treatment options included an Air-Stirrup brace, Air-Stirrup brace combined with an elastic wrap, or a walking-cast for 10 days. Elastic wrap was used after the cast came off.

Using the Air-Stirrup brace with elastic wrap reduced the recovery time by half. Almost a week’s time was shaved off recovery with this method. If your sprain is severe enough to require a cast, ask about using a walking cast. This can help you get around your paper route more easily.

Be aware that switching to an elastic wrap after the cast comes off may also speed up your recovery time. It will still take longer to get back to ‘normal’ compared to a Grade I or II injury.

In this same study, some patients with grade III sprains treated with an Air-Stirrup (instead of a cast) did quite well. They were able to get back to full activity within three weeks’ time. This may be another option for you.

There may be! According to the results from a recent study of acute ankle sprains, short-term recovery time was greatly reduced with the use of an Air-Stirrup brace. Results were best when the Air-Stirrup was combined with an Ace elastic wrap.

An ankle sprain rehab program is also a good idea. The first phase tries to reduce the swelling and minimize the trauma. Crutches, ice, elevation, and exercises are used during the first week after injury.

Exercises are designed to restore motion and prevent fluid from building up around the area of injury and inflammation. Usually a physical therapist guides the patient through the process. Exercises may include toe curls, ankle rolls, walking, swimming, and biking on a stationary bike.

Balance training and agility skills along with strength training are the final phase of the program. You may not reach this phase of treatment before your trip. But the combined use of an ankle brace and elastic wrap should reduce your recovery time in the early phase by half.

Pain in any joint from arthritis can slow a person down and increase their overall fatigue. The major goal of bracing is to keep the joint in good position and control motion. The result should be to reduce pain and fatigue.

The type of brace can make a difference. Most of today’s bracing is with a rigid plastic called polypropylene. If the brace supports the calf, ankle, and foot, then it’s called an ankle-foot orthosis. Some orthoses start midcalf and support the hindfoot. Others support the hindfoot and the forefoot.

Studies show that wearing an orthosis gives better control over the ankle than just wearing a pair of standard shoes. With a good brace, deformity of the ankle can be corrected for arthritis patients.

With the right orthosis, you may be painfree longer each day. This would allow you to walk further. You may also be able to manage more difficult surfaces such as uneven slopes or ramps. Try to get an orthoses that restricts motion of the painful joint but still allows motion in the rest of the foot. Your doctor or the orthotist (person who makes orthoses) will help you with this.

Arthroscopy is a surgical techniques used to diagnose and treat joint problems. It can be used on any of the larger joints such as the shoulder, hip, knee, or ankle. A very small incision is made in the skin to allow the scope to be inserted into the joint.

Anytime surgery is done, there are risks. The patient is usually anesthetized so there are potential side effects from the anesthesia. Anytime an incision is made (no matter how small), there is a risk of skin or wound infection.

The surgeon can injure blood vessels or nerves with the scope. Likewise, tendons, ligaments, and even bone can be subject to damage by the needle-shaped instrument.

For the most part ankle arthroscopy is safe and problem-free. Studies report a range of complications from seven to 17 per cent. Overall, a 10 per cent rate is probably most representative. Neurologic problems are the most common. Some are only temporary but others cause permanent damage.

Researchers are striving to find safer and better ways to do arthroscopy on all the joints. Studies are underway to reduce the risk of problems, especially with ankle arthroscopy.

Ankle arthroscopy is on the rise. Surgeons use this method of diagnosing foot and ankle disorders more and more. Arthroscopy has made it much easier to “see” inside the joint. A long thin, needle with a tiny TV camera on the end is inserted through the skin into the joint. The surgeon sees what the camera sees displayed up on a video screen.

Surgery to remove bone fragments and other loose bodies is possible with this technique. Ankle replacement or fusion can be done arthroscopically. Many other ankle operations are performed using this method.

Usually there are two or three places where the needle can be inserted. The goal is to enter the joint without damaging the surrounding soft tissues. The surgeon must avoid piercing blood vessels or nerves. He or she must enter the joint without going too far and punching through the bone.

How this is done is determined using cadavers (bodies preserved after death for study). Anatomic studies of this type are used to find safe entrance called portals into the joint. Sometimes live patient studies are done.

Recently a new entry point has been discovered for the ankle. Surgeons from Gachon Medical School in Korea describe a posteromedial (PM) portal for ankle arthroscopy. They report the use of this PM portal to remove bone fragments in one case of a 29-year old man was safe and effective.

Neuropathy or loss of normal nerve function is a common problem in chronic diabetes. The hands and feet are affected most often. Patients report symptoms that range from mild tingling, burning, or numbness to a complete loss of sensation. Loss of sensation in the feet is a serious problem. It puts the patient at risk for trauma and joint destruction.

Over time, degeneration of the stress-bearing portion of the ankle causes Charcot’s disease. Sometimes this condition is called Charcot’s arthropathy or neuropathic arthropathy.

Treatment is important to preserve the bones of the foot and ankle function. Treatment begins with reduction of weight bearing. Joint protection is also important in conservative care. Surgical fusion can be done if all else fails but joint replacement is not advised in this condition.

For best results, patients with diabetes who have peripheral neuropathy, poor skin quality or poor circulation, and deficient bone stock don’t qualify for total ankle replacement.

You should contact your orthopedic surgeon to ask this question. He or she will have a better idea what you can and can’t do based on the type of implant and surgery done.

Research comparing active patients before and after total ankle replacement (TAR) offer a few suggestions. More studies are needed in this area. For now, some general guidelines include:

Most of the heavy leather and metal braces of years past have been replaced by more modern braces called orthotics. They are made of lightweight plastic (polypropylene) and slip inside a standard shoe. When the patient wears long pants, no one can even see the orthotic.

There are three main types of orthoses to help reduce ankle pain. They work by putting the ankle and/or foot joint(s) in good alignment. Holding them in place during walking activities helps reduce pain. Some restrict ankle and foot motion. Others only keep the ankle from moving while still allowing forefoot motion.

The standard or solid ankle foot orthosis (AFO) fits over the back of the calf, heel, and bottom of the foot. It is inflexible or rigid and doesn’t allow ankle or foot motion. A strap around the top of the calf helps hold it in place.

The second type is the rigid hind-foot orthosis (HFO-R). The upper part of the calf is free but the ankle is held stable. The orthotic ends where the heel ends and doesn’t support the forefoot at all.

The third ankle orthosis is the articulated hindfoot orthosis (HFO-A). It fits around the lower one-third of the calf, heel, and forefoot but it has a hinged joint to allow ankle motion when walking.

In a recent study at the Mayo Clinic Motion Analysis Lab, patients were tested wearing each type of orthotic. They walked on different ground surfaces to see how much ankle and forefoot motion was allowed by each orthotic. Patients walked on level ground, went up and down ramps, and walked on a side-slope.

The researchers found that the HFO-R gave the best overall results over all surface types. The HFO-R restricted ankle and hindfoot motion reducing joint pain. At the same time it allowed forefoot movement to navigate various ground conditions.

Your doctor may have already prescribed a specific kind of orthotic for you. The orthotist will advise you further. With a team approach, you should be able to get the orthotic that’s best for your situation.

There can be several sources of ankle joint pain and stiffness associated with osteoarthritis (OA). OA is fairly common years after trauma or injury to the joint.

X-rays are usually taken to confirm the diagnosis. The physician looks for narrowing of the joint spaces. The X-ray may also show the formation of osteophytes or bone spurs. A smaller joint space means more pressure is placed on the ankle joint. There may even be bone-to-bone contact.

Likewise bone spurs can cause bone-to-bone contact and increased compression. Sometimes they pinch against the nearby soft tissues or get squeezed between the joints causing pain. This is called impingement.

One other cause of joint pain after injury is the stretching of the joint capsule. The joint capsule is a band of thick connective tissue and ligaments around each joint in the foot. It provides stability and keeps the joints from slipping and sliding. Once it’s stretched the stability is lost and uneven and excessive joint wear and tear can occur causing painful osteoarthritis.

Studies show the number of adults with sports injuries is on the rise. Along with it is an increase in ankle arthritis years later. More than 70 percent of ankle arthritis is caused by previous trauma, especially bone fractures and ligament tears.

Many of these ankles are unstable with abnormal motion and uneven shear forces across the joint. The change in biomechanics from these factors can lead to cartilage damage and eventual osteoarthritis (OA).

Steps to prevention are unproven at this time. Surgery to repair the damage doesn’t necessarily prevent the development of OA later. Physical therapy and special exercises to restore normal motion and motor control may help but studies to prove this have not been done.

Some researchers suggest that proper nutrition is the key to cartilage repair. A well-known sports expert (Luke Bucci, PhD) has written a book on this topic (Sports Injuries through Nutrition and Supplements) that may be of some help. More studies are needed to answer your question completely.

A recent study from the Human Performance Lab at the University of Calgary in Canada reports a latency (delay) period of 30 years between severe ankle sprain and ankle osteoarthritis (OA).

Younger patients develop arthritis sooner than older adults. Patients with single episodes of ankle sprain also develop OA as much as 10 years before adults with chronic, recurring sprains. The reason for this remains unknown at this time.

It appears that the type of injury and side of the ankle injured have something to do with the development of arthritis later. Lateral ankle sprains along the outside of the leg are more likely to cause malalignment of the ankle and uneven wear on the joint.

The amount of damage at the time of the injury is another factor. Severe ligament tears lead to higher shear forces on the joint cartilage. The result may be damage to the cartilage in addition to the ligament injury.

Without strong ligaments to hold the ankle bones in place, instability occurs. Uneven or excess motion in any direction on either side of the joint comes with an unstable joint. A slow but steady amount of damage to the first layer of joint cartilage later leads to the start of osteoarthritis.

Studies show early treatment is best for malunion of ankle fractures. This is especially true for the calcaneus (heel bone) and the neck of the talus (the bone next to it). There’s a better chance of healing in a good position with surgery to stabilize the fracture.

Proper alignment is important in the ankle. Restoring the normal height of the calcaneus can be difficult. Early correction can help prevent further complications and problems. For example, mild residual pain can become chronic. Osteonecrosis (death of bone) or posttraumatic arthritis can occur.

Now would be a good time to schedule a follow-up appointment with your orthopedic surgeon. He or she will be able to advise you about the best timeline and treatment options available.