FAQ Category: Ankle

Very definitely. Many studies have shown a link between ankle sprain and a loss of ankle position sense. The joint’s sense of movement and position is called proprioception. That wobble you’re seeing may be a sign of postural instability, seen most often during landing from jumps.

Ankle sprains can leave the joint unable to accurately put the foot down before landing. She could be at increased risk for re-injury of that ankle.

There are ways to test for loss of joint proprioception and ankle instability. Talk to her coach or athletic trainer. They might be able to do a quick assessment and guide you in making a decision. An orthopedic surgeon or physical therapist can do more advanced testing if it’s needed.

Functional ankle instability is a condition that occurs most often after an ankle sprain. Like you, the patient describes a sense that the ankle is going to give out from underneath him or her. Often that’s exactly what does happen.

X-rays and ligament testing are normal. That means there are no fractures and the ligaments aren’t loose or “lax.”

A recent study of electrical activity of the peroneus longus muscle in the lower leg and ankle may offer some clues. It seems the muscle is slow in responding to changes in the foot position after an ankle sprain. This decreased activity may be part of what’s causing the ankle instability.

Ankle sprains can often lead to problems with an unstable ankle lasting months to years later. It usually happens when there’s weakness of the ankle muscles and a loss of proprioception.

Proprioception is the sense the joint has of its own position. Studies show ankle sprains result in damage to the receptors that signal the joint about its position. These receptors are located in the ligaments, muscles, and tendons. Injury to any of these structures can result in decreased proprioception.

A rehab program to restore muscle strength and proprioception can be helpful.

The type of sprain you are describing is called an inversion injury. It’s likely that you sprained a ligament inside the joint, not the muscle around the ankle. Ligaments can’t be strengthened with exercises. Instead, the muscles around the ankle are improved. In this way, the muscles can help protect the weakened joint.

Ankle rehab does include muscle strengthening, along with other exercises, as well. Stretching to keep flexible and exercises to help the joint sense what position it’s in are important parts of the program. In the past, exercises focused on muscles along the outside of the lower leg.

A new study by physical therapists in Australia has challenged this method. They found that weakness of the muscles along the inside of the ankle (called invertors) is the real problem. Exercises after an inversion ankle sprain should focus on the invertors.

Yes. Anytime there’s an injury, problems can occur in the joint above or below that injury. It’s possible that you hurt your knee and your ankle at the same time. If the ankle injury is more painful or obvious, the other trauma may be missed for some time.

The force of the injury through the ankle can also put a twisting load on the joint just below the knee. This is the tibiofibular joint, the place where the two bones of the lower leg (tibia and fibula) meet.

Before continuing training, it would be a good idea to have this evaluated. There could be a bone fracture, torn ligament, or stretched nerve causing these symptoms. Treatment now may help prevent a worse injury later.

The first few days after an ankle sprain are key to recovery. Ice, compression, and elevation are needed to keep the normal inflammatory process from going overboard. Too much swelling in the area can delay recovery.

The first few days after an ankle sprain are key to recovery. Ice, compression, and elevation are needed to keep the normal inflammatory process from going overboard. Too much swelling in the area can delay recovery.The first few days after an ankle sprain are key to recovery. Ice, compression, and elevation are needed to keep the normal inflammatory process from going overboard. Too much swelling in the area can delay recovery.

Damage to the receptors of the ligaments, tendons, and muscles can also result in impaired proprioception. Proprioception is the joint’s ability to sense change in position. This is very important for a dancer.

It makes good sense for a dancer to follow an ankle rehab program after an injury of this type. Decreased muscle strength and change in proprioception increase your risk of another ankle sprain.

Most soft tissue injuries are healed after four to six weeks. Recovery of normal function may take a little longer. Since this only just happened a week ago, you’re in time to get the help you need in time for your show.

Muscle strength is important in holding a joint steady or stable. But, there are other factors as well. For example, the joint must be able to sense what position it’s in at all times. This helps the body adjust itself over the ankle and keeps us from losing our balance.

The sense of joint position is called proprioception. Most ankle rehab programs include exercises for proprioception. A new study also reported that the muscles that pull the foot and ankle inward (called invertors) are weak after an ankle sprain.

Exercises for ankle sprain usually focus on the muscles along the outside of the ankle called the evertors. However, it may be that weakness of the invertors is the real problem. Consult a physical therapist if you haven’t been in an ankle rehab program. The therapist can set you up with a program to restore normal ankle function.

Physical therapists are trained to measure muscle strength. A simple method of strength measurement is called manual muscle testing. The therapists resists the movement of each muscle and gives it a score from 0 to 5. This test is subjective, which means it’s based on the therapist’s opinion. It does give some general information.

For more specific details, a device called a dynamometer can be used. Again, the physical therapist is the one who uses this tool. Recent research using dynamometry to measure muscles around the ankle has been reported.

The researchers found that weakness of the muscles along the inside of the ankle may result in ankle sprains. A dynamometer test will show you if this is your problem. Specific exercises can be prescribed based on the results of the dynamometer test.

Posterior ankle impingement means that some soft tissue structure in the back of the ankle is getting pinched. Open incision is still the most common way to approach ankle surgery. It’s difficult to reach the posterior compartment of the ankle with current arthroscopic methods. If the problem is outside the joint, then arthroscopy doesn’t help.

More and more joint surgery is being done with arthroscopy. This is common now with the knee and shoulder. Studies are being done to find safe ways to use arthroscopy on the ankle. Most of this research is still in its early stages. Doctors start with animals and then progress to human cadaver studies. These two steps must be done before trying new methods on live patients.

It’s only a matter of time before doctors have perfected arthroscopic surgery on the ankle. Anything outside the ankle will still require open surgery.

The os trigonum is a bump on the side of the talus bone in the ankle. It’s sometimes also called the lateral talar tubercle. The os trigonum syndrome is a painful condition of the ankle most common in ballet dancers. It’s also known as posterior ankle impingement (PAI).

The dancer’s repeated motions and jumping cause a bone contusion or “bruise.” There is usually fluid around the nearby tendon. Of course, ankle pain is the most common symptom. This occurs along the back or outside (lateral) edge of the ankle.

Treatment is often rest and drugs for inflammation. Surgery to remove the bump on this bone can be done. The doctor often releases the tendon at the same time. After rehab, the dancer is usually able to return to previous levels of dancing.

The ankle’s ability to sense its own position while moving or standing is called proprioception. The positioning of the feet and ankles is very important for people with diabetes as this can help prevent injuries. Scientists suspect that proprioception is changed in people with diabetes, but not much information is available on this topic.

Studies of healthy adult volunteers have shown that fatigue can alter ankle proprioception. Tests of muscle fatigue and joint position in people with diabetes have not been done. Until more information is available, you may want to try a program of exercises to improve ankle proprioception. Physical therapists typically prescribe these exercises after ankle injury and can help you in this area.

This is actually a common experience for people who play basketball or volleyball. After intense activity, the ankle’s ability to sense its position may be impaired. This could explain the awkward or clumsy feeling some people have after exercise.

The ability of a joint to sense its position is called proprioception. It is possible to improve proprioception through a series of specific exercises. Physical therapists typically use these exercises to rehabilitate people after injury. The same exercises could be used as part of an athletic training program.

Physicians rely on various tests to examine injured joints. There are several tests for the ankle to check the severity of the sprain. These are performed in the doctor’s office and do not require X-ray or MRI (magnetic resonance imaging).

Some research shows that these hands-on tests are not as reliable as once thought. A true ankle assessment would require additional imaging studies such as X-rays taken while the ankle is angled in various positions (stress radiographs). These additional tests provide a more valid means of classifying ligament damage.

There is no simple answer to this question. In team sports, the athlete returns to full play or competition when all tasks related to the sport can be done easily, without pain or other symptoms.

Rehabilitation for ankle injuries progresses through a series of exercises. These include range of motion as well as exercises to restore endurance, strength, and power. Usually, the ankle’s sense of its own position must be retuned, too.

Check with the coach or trainer about movements that are required for gymnastics. If possible, have a physical therapist evaluate your daughter and design a specific program that will bring her back into gymnastics with less risk of another injury.

For most injuries, ice is recommended during the first 24 to 48 hours. This helps reduce the pain and swelling that are part of the inflammatory stage of healing.

You can switch to heat when the ankle swelling goes away. The area should not be red or hot to the touch. By this time, the progress with ice has come to a halt. No further improvement in symptoms occurs after using ice.

Heat can be applied for 15 to 20 minutes, depending on the type of heat used. Extreme caution is advised when using a heating pad at home. Never fall asleep with the heating pad on. This can cause skin burns, increased tissue swelling, and delayed healing.

Cold therapy, sometimes called cryotherapy, can be applied in several ways. Usually it depends on the body part involved. A bag of crushed ice wrapped in a towel is easily applied to the knee or ankle. A commercially made cold pack works better for the back or neck.

Ice massage is an easy way to cool a small area of tissue, like an injured ankle ligament. Freeze water in a paper cup. Tear the top off   the cup, exposing the ice. Hold the cup to protect your fingers from the cold while applying the ice to your ankle in a circular motion. This cools the area without causing frostbite.

Studies show that cold therapy cools the skin and upper layer of tissue quickly–within eight minutes. It usually takes 12 to 15 minutes of cold therapy to decrease pain and muscle spasms. More than 30 minutes of cold therapy can cause frostbite and nerve damage. The recommended time for cold therapy is around 15 to 20 minutes.

Though activity may drop off a little, most athletes are able to keep active after surgery to stabilize the ankle. Athletes in a recent study had two different types of ankle surgeries. In one surgery, the original ankle ligament was used. In the other, tendon was taken from the lower leg to fix the ankle.

Before surgery, athletes’ activity level was a nine on a 10-point scale. Five years after surgery, the average activity level was an eight. Athletes for whom the original ankle ligament was used were able to keep a little more active than the other group. These athletes had better movement and stability in the ankle.

Talk with your doctor about your concerns. A physical therapy program after surgery may help.

There are many surgical techniques, but they basically fall into two groups. One is anatomic reconstruction. With this technique, surgeons use the original ankle ligaments to repair the ankle. The other technique is called tenodesis. In this procedure, surgeons reconstruct the ankle ligament using tendon from elsewhere in the body, such as the lower leg. Surgeons attach the transplanted tissue to bones in the ankle joint.

Researchers evaluated the results of both kinds of surgery in a group of athletes. For these patients, anatomic reconstruction resulted in better ankle movement and stability. It also led to fewer degenerative changes in the joint. Compared to tenodesis, anatomic reconstruction more often gave a good or excellent result. For athletes and other active patients, researchers think anatomic reconstruction is the method of choice.

Researchers think the first surgery you describe, called anatomic reconstruction, may be the best choice for athletes with chronic ankle sprains. In one study, this procedure had good or excellent results 88 percent of the time, versus 58 percent for tenodesis, the other type of surgery. More than tenodesis, anatomic reconstruction allows athletes to maintain their activity level. Years later, they wind up with better ankle movement and stability, and fewer degenerative changes. Talk with your doctor to see which method he prefers in your case.

According to a recent study, not much. Twenty-nine patients with new ankle sprains were in the study. The authors found that a measure of ankle swelling wasn’t related to patients’ ability to do sports and daily activities. Swelling also wasn’t related to whether or not patients could put weight on their hurt ankles.

The authors believe that patients’ own reports are the best gauge of ankle function. This makes sense given the number of personal factors that go into how patients recover from injuries.