FAQ Category: Ankle

Female basketball players have a higher number of knee and ankle injuries associated with basketball. This is compared to soccer, lacrosse, and field hockey. Studies show the rate of injury is the same between practice and games. It also appears that the number of high school injuries and college injuries is about the same.

Scientists aren’t sure all the reasons for the increase in injuries for women over men. There may be strength issues. Neuromuscular control has also gotten a lot of study lately. Alignment of the bones, joints, and ligaments is another possible factor. More study is needed to sort this all out and find ways to prevent injuries.

Yes — ankle sprains. According to a recent study from the University of Vermont high school and college female athletes are more likely to sprain their ankles compared with men in the same sport.

Other sports were also studied including soccer, lacrosse, and field hockey. First-time ankle sprains occurred about once in every 1000 days of play (practice and games).

Researchers are trying to identify risk factors to help athletes avoid such injuries. More studies are needed before specific recommendations can be made.

Ankle reinjury depends on many factors. Ankle sprains can be mild, moderate, or severe. The more severe a sprain, the more soft tissue structures are damaged. The healing response varies from person to person with all levels of injury.

So in theory it’s true that having an ankle sprain can put you at increased risk of another sprain. It’s just that researchers haven’t been able to predict who is at greatest risk. This makes it harder to prevent re-injury.

We do have some information that suggests rehab must include retraining the proprioceptive system. This is the mechanism in the ankle that allows it to make small changes in movement when needed. For example, if you step on a stone and need to make a sudden correction in your foot position, it’s the proprioceptive system at work to do that. Preventing twists and turns of the ankle depends on this system.

Most ankle sprains stretch or tear the ligaments along the outer (lateral) border of the ankle. Sometimes a medial (inside) ankle sprain occurs.

A “high” ankle sprain is used to describe an injury of the ligament that joins the two lower leg bones together. This ligament is called the syndesmosis ligament. The ligament is above the ankle, which is why it’s called a high sprain.

This type of injury occurs most often in hockey players and skiers. The foot and ankle get turned out or externally rotated. Since the foot is in a rigid skate or ski boot there’s no “give” and the ligament tears.

A syndesmosis ankle sprain is a tear of the syndesmotic ligament. This ligament joins the two lower leg bones together (tibia and fibula). Patients with this type of injury often have pain when the ankle is externally rotated (turned to the outside) or when the calf is squeezed. In fact, the “squeeze test” is often used to make the diagnosis.

There are special X-ray studies of the ankle that can be done to confirm this diagnosis. The radiologist takes “stress views.” Abnormal motion between the bones with these X-rays
is a telltale sign of a syndesmosis ankle sprain.

This type of injury does present the way you describe your ankle. Walking or skating in a straight line isn’t a problem. Any movement that requires external rotation of the ankle and lower leg causes pain and/or stiffness. It takes most players four to eight weeks to get back to full play.

You ask a very good question. Ankle injuries are common in sports athletes, even hockey. The foot and ankle are protected inside the rigid hockey skate but the players travel at high rates of speed and slam into the boards, the goals, and other players.

The most common ankle sprain among athletes in general is the lateral sprain. Ligaments along the outside of the ankle get torn or damaged. The rigid hockey skate does offer some protection from this type of sprain.

Hockey players are more likely to sprain the syndesmosis ligament. This ligament is actually above the ankle joint. It joins the two lower leg bones (tibia and fibula) together. A syndesmosis ankle injury occurs after a fall when the foot is twisted or tuned outward (external rotation) and the player crashes into another object.

Basketball players can wear a special splint to protect their ankles from injuries. Hockey players can’t fit a splint into a pair of skates. With the increased popularity of ice hockey, we may expect to see a rise in these types of ankle injuries.

Metal plates and screws are often used to hold bones together during healing after an injury. There are some problems with this. As you noted, a second operation is needed to
remove the hardware after healing takes place.

Even before the screw is taken out there’s a risk that it could loosen or break beforefull ligament healing occurs. Scientists are trying to use new materials to make a bioabsorbable screw. It could be left in place, and it will slowly break down and get
absorbed by the body.

There’s still the problem of infection and bone breakdown around the screw, even the bioabsorbable type. More studies are underway looking for other ways to repair this injury while minimizing additional problems.

The two lower leg bones (tibia and fibula) have a fibrous sheath between them called the syndesmosis. It’s designed to hold the two bones together while allowing the motion needed for normal ankle movement.

Screw fixation holds the area together and doesn’t allow motion while it’s healing. If you don’t wear a cast, and if you do put weight on that foot and leg, the screw may come loose or even break.

Doctors are especially concerned about patients who are overweight or who have brittle (osteoporotic) bones. These factors increase the risk of screw failure. A new way to repair this injury is under investigation.

Doctors in Ireland are trying a flexible, plastic suture material. It holds the two bones
together while itself being held in place by buttons on the outside of each leg bone. The patient still wears a cast but can put weight on the leg sooner and get the cast off sooner. If studies show it’s safe, the suture-button may become the standard way to treat a syndesmosis problem.

There are two kinds of ankle instability. The first is called mechanical instability. This refers to an ankle that is unsteady for physical reasons–either the joint is loose or the ligaments are torn.

The second type of instability is called functional. No damage to the joint structures can be found but the ankle isn’t stable during movements. With functional instability there may be a loss of joint position sense or decreased strength.

People with ankle injuries can have one or both of these kinds of instabilities. In fact instability is very common after lateral ankle sprains. A lateral ankle sprain affects
the ligaments along the outside edge of the ankle.

A rehab program is usually advised to restore strength, motion, and joint position sense. Such a program can help you regain normal function of the joint and prevent any further giving-way episodes.

Acute ankle injury takes about four to six weeks to recover and heal. This means the pain and swelling are gone and you can put your full weight on that leg.

Moderate to severe ankle sprains often involve a torn ligament. Ligaments do not heal like muscles do. Once they are torn, scar tissue fills in. The elastic quality of the ligament is gone. The result can be changes in the joint’s sense of movement and position in space called proprioception.

Loss of proprioception may result in ankle instability. Changing position and keeping balance can be difficult. The skill may not come back without a rehab program to “reset” joint proprioception.

A physical therapist can test your ankle and let you know if rehab is needed. He or she can also set you up on a rehab program. With careful practice on your part, your ankle can be restored in several weeks to several months.

Studies show the re-injury rate after ankle sprain is 70 percent or more. For those who don’t reinjure the ankle, ongoing symptoms may be a problem. Pain during activity and swelling that comes and goes are commonly reported symptoms. Having the ankle give-way is another.

Predicting who will and who won’t have a re-injury isn’t easy. Scientists do know that a loss of joint position sense called proprioception puts the ankle at increased risk for injury. A recent study at the University of Florida found a test called Time to Stabilize (TTS) that may be useful.

TTS is a measure of ankle stability. The test looks at how well the ankle stays balanced when moving from one position to another. For example jumping and landing without taking an extra step and without losing footing is measured by the TTS.

Further study is needed before this test is ready to use but it looks hopeful as a way to predict future ankle injury.

Your results may depend on how you use the tape measurer. A standard way to assess swelling at the ankle is to wrap a tape measure around the foot and ankle in a figure 8. The advantage of this method is that it gives a standard way to measure each time.

By comparing one day to another or one week to another, you can see if there has been any change. You can measure both ankles and compare the injured ankle to the uninjured leg. The disadvantage is that you are really measuring the ankle and the foot
with the figure-8 method.

A simple tape measure is still used in many clinics to look for swelling. It’s even used to measure patients for custom-fit stockings used with burns or severe edema after surgery.

It’s important that a plastic tape measure is used. It should be one that hasn’t been stretched out. The same tape should be used each time. Measurements can be compared from the normal side to the injured side and from one day to the next.

There is a device called the Perometer to take accurate measurements of the arm or
leg. This piece of equipment costs up to $50,000. It’s used most often by research centers. Infra-red rays allow the Perometer to take length, circumference, and volume measurements of an extremity.

The biggest plus of this tool is to show very early signs of swelling or edema. Such changes wouldn’t be seen with an ordinary tape measure. The Perometer also gives the therapist a much quicker and more reliable reading to compare results before and after treatment. Since it’s computerized, graphs can be printed out to show changes.

There are some who say, “swelling is the greatest enemy of healing.” Early treatment for any acute sprain or injury is to limit painful swelling that occurs with inflammation. Holding off swelling altogether or at least reducing it may also improve joint function.

There may be some research to call this assumption into question. A recent study of ankle and foot swelling early after injury showed no link between ankle swelling and ankle function. There may be some long-term benefits of limiting ankle swelling. Less swelling may mean less joint damage. Less swelling may also mean return to normal function sooner for the nearby muscles.

Your experience is very common. In fact, this is more likely to happen than not happen. When joints are immobilized (can’t move) in a cast, the muscle fibers start to shorten. Injury to the bone and surrounding tissue may change the way the soft tissues work and move. This can also delay return to normal motion.

Loss of dorsiflexion (moving the toes up toward the face) is called a plantar flexion contracture. Three out of every four people have this type of contracture when the cast comes off. In fact, 22 percent of those people still have a contracture two years later.

Physical therapists are working to find the best way to treat this problem. Right now it looks like exercise is enough. Adding stretching exercises doesn’t appear to help.

There are two reasons why stiffness seems to last a long time after casting a joint for a fracture. First there’s the joint itself. After injury, the repair processes can be damaged and slow to return to normal.

At the same time, animal studies have shown us that muscles shorten up when joints are immobilized. The tendons shorten up and the cartilage in and around the joint becomes unable to slide and glide.

Exercise seems to be the best solution to this problem. Studies haven’t shown that one type of exercise is better than another. In fact, a recent study from Australia showed that patients who exercised without stretching did just as well as those who exercised with stretching.

Give yourself at least four to six weeks to regain your full motion. Check with your doctor if you have any questions or concerns.

You’ll want to check with your surgeon about this question. Returning to previous levels of activities like horseback riding may not be allowed until full healing has occurred. This is especially true if there are metal pins, screws, or plates in the joint.

Most expert riders agree a dorsiflexed ankle is important in riding. This means your toes
are pointing up and your heels are pressed down while in the stirrups. When the motion in the healing ankle is within five degrees of the other ankle, then activities like horseback riding may be allowed.

You may want to think about buying some breakaway or safety stirrups. If your horse falls, spooks, or throws you, the stirrups drop off the saddle. Your feet won’t get stuck in the stirrups while you get dragged around or crushed by the horse.

The cuboid bone is a small, cube-shaped bone in the foot. It’s actually part of the ankle. It connects with the heel bone in the back and the long bones of the last two toes on the outside of the foot.

Cuboid syndrome refers to a painful foot from a disruption of the cuboid bone. This can occur from overuse or injury. The injury is usually a fast, forceful motion of the foot and ankle downward (plantar flexion) and inward (inversion).

Treatment can include using a pad under the cuboid bone or taping the foot and ankle. A chiropractor or physical therapist trained in joint manipulation can also perform a manipulation called the cuboid whip. This maneuver helps realign the bones and restore full pain free motion.

Your son may have had a partial dislocation of a bone in the ankle causing his symptoms. It’s not uncommon for a manipulation to realign the joint and restore full motion and function.

A second manipulation may be needed if the injury has been present a month or more. Sometimes the therapist will advise the athlete to tape the joint for the first week back on the field.

Stretching and self-mobilization can be taught to maintain the good results. Many athletes never have a relapse or return of symptoms, even months later.

In 1994 a study of 30 high school athletes involved in high-impact aerobics was published with this very idea. The inner ear is a vital part of our balance.

Tiny hairs inside the fluid-filled cochlea sense a change in movement or direction of the fluid. They signal these changes to the brain and the body adapts in response to the information. In this way we keep our body upright during all kinds of changes in our own body position or changes in our surroundings.

It was suggested that repeated, jarring motion could damage the delicate vestibular system. Running up and down a basketball court and jumping and landing are just two examples of the kinds of activity that could cause this to happen. These actions occur 100s of times during practices and games.

There may be a connection between vestibular malfunction and ankle sprains. More study is needed before the full impact of this finding is known.