FAQ Category: Ankle

A recent study suggests that, while the figure-of-eight is a good measure of swelling, it may not show how patients are actually doing.

Twenty-nine patients were seen within a few days of spraining their ankles. Swelling was measured with the figure-of-eight. Patients also filled out questionnaires about their pain and ability to do activities.

Figure-of-eight measurements were not related to patients’ pain and function, nor did the measurements relate to whether patients could put weight onto the hurt foot.

The authors think that patients’ own reports may be a better way to gauge treatment results. Of course, there are questionnaires you can use to get this information. Getting feedback from patients will usually give a better sense of how they’re doing from day to day.

An avulsion fracture occurs when a small piece of bone breaks off from the main bone while still attached to the tendon or muscle. This type of foot fracture usually only requires a splint or short walking cast until the symptoms are gone–usually a couple weeks.

Your daughter can return to dancing when she is pain-free. A careful review of what caused this injury is important to prevent it from happening again.

The foot and ankle are complex parts of the body. Sometimes it is impossible to tell what the injury is without an X-ray or other tests, such as a bone scan or MRI (magnetic resonance image). Computed tomography (CT scan) is also helpful for seeing if there is serious damage to a bone. If there is pain, swelling, tenderness to touch, redness, decreased motion, and inability to put weight on the foot, then a visit to the doctor is necessary.

When in doubt, you can use the RICE advice. These four letters stand for Rest, Ice, Compression, and Elevation.

• Rest the sore ankle so it can begin healing.


• Ice the ankle for 20 minutes every three to four hours.


• Compress the joint with an elastic wrap or splint.


• Elevate the sore and swollen limb for 24 hours.

If after 24 hours the symptoms are much improved and it is possible to put full weight on the ankle, a fracture is unlikely. If there is little or no change in how the ankle looks and feels, see your doctor.

Your son’s injury is called a “high-energy injury” because of the force of the impact. His injury was caused by coming down on the heel with his full body weight at just the right speed and angle.

Pain long after the injury has healed is common in cases like this. Sometimes unseen damage to the bone occurs. This can affect how the bone moves with the other bones and joints in the ankle. Ask your physician to re-examine your son if this has not been done yet.

Physical therapists often use ankle swelling as a way to gauge treatment results after a sprain. If the swelling goes down, a therapist may assume the ankle is improving.

A recent study showed that swelling isn’t necessarily a good measure of improvement, however. Among 29 patients with ankle sprains, swelling (as measured by a “figure-of-eight” around the ankle) wasn’t related to the amount of pain patients had or their ability to do daily activities.

Swelling is just one measure of recovery. Talk with your therapist about the problems you have with your ankle from day to day. When it comes to gauging your recovery, your experiences are more important than what a measuring tape can tell you.

People who sprain their ankles sometimes find the ankle continues to give out without warning. Many times, the ankle gives out and actually sprains again, a condition called recurrent ankle sprain. The tiny sensors within the joints, muscles, and ligaments of the ankle are often injured in the initial injury. These sensors normally give the body a sense of joint position. Damage to these sensors puts the ankle at risk for additional sprains.

An effective treatment for ankle sprains is disk training. A circular platform with a small sphere under it, the disk looks a bit like a spaceship. Patients place their feet on it and work the ankle by tilting the disk in various positions.

Doctors and therapists have used this type of training with success. Patients doing this kind of exercise often show improved balance and decreased ankle pain. The disk improves mobility in the ankle joint and responsiveness in the muscles that support the ankle. Disk training appears to be an excellent way to protect against future ankle sprains.

Disk training is an effective treatment for ankle sprains. The disk is a circular platform with a small sphere under it. People place their feet on it and work the ankle by tilting the disk in various positions.

Disk training can improve balance, ease ankle pain, and protect people from having repeated ankle sprains. A unique study also showed how this type of training quickens the response of muscles around the ankle. The main shin muscle, the anterior tibialis muscle, showed the greatest improvement. By getting the ankle muscles to respond faster in the event the ankle turns inward, the disk helps protect your ankle from being sprained again.

It sounds like you are on the right track with the treatments you describe. Continue to follow the advice of your doctor and therapist.

Research suggests that patients who’ve had major ankle sprains may benefit from doing special training of their healthy ankles. Disk training has been used to rehabilitate ankle sprains. Now there is evidence that these benefits may actually cross over to the other side. Researchers studied patients who worked only their sore ankles on the disk. A circular platform with a small sphere under it, the disk looks a bit like a spaceship. Patients place their feet on it and work the ankle by tilting the disk in various positions.

The study showed that disk training quickened the response of muscles around the ankle at the moment the ankle started to sprain. The main shin muscle, the anterior tibialis muscle, showed the greatest improvement. Surprisingly, this muscle got faster on the other leg, too–the one that wasn’t worked on the disk.

This certainly raises the question whether patients with severe ankle sprains might benefit by starting disk treatments right away on their uninjured ankles. Be sure to talk with your health provider before experimenting with this type of treatment.

Examining the ankle using X-rays has been standard in the medical world. This method is very accurate for diagnosing bone fractures. Because of the complexity of the ankle structure, several different views on X-rays are usually needed. X-rays are not always able to show damage to the surrounding ligaments. However, with the progress in optical technology, arthroscopic examination of the ankle is now possible.

The arthroscope is a tiny camera that can be inserted into the ankle joint to see if there are any broken bones or torn ligaments. One set of ligaments, called the ankle syndesmosis, joins the two lower leg bones together. X-rays are about 50 to 64 percent accurate in showing if the syndesmosis has been damaged. By comparison, ankle arthroscopy is 100 percent accurate. This new method is sometimes necessary for correct diagnosis of soft tissue damage that occurs with ankle injuries.

There are many ways to sprain an ankle. The two most common are turning the ankle in or out. Some people twist the foot in, causing damage to the ligaments on the outside of the ankle. Others land on the inside of the foot, tearing or partially tearing a different set of ligaments.

By using cadavers (human bodies preserved for study), scientists have been able to study the foot and ankle. By moving the cadaver ankles in different directions, it is possible to see which surrounding ligaments are stretched. When a force is applied that is strong enough to tear the ligaments, the ankle is said to be “sprained.”

It is likely that you and your brother twisted your ankles in different ways. This could account for the different locations of pain and symptoms.

In some cases, it is possible to look for signs of ankle injury such as swelling, bruising, tenderness, and decreased motion. The doctor may also use other tests such as squeezing the bones together or moving one part of the foot by itself. Usually ankle pain prevents a thorough examination. Even with a good exam, it is not possible to use signs and symptoms to tell the difference between a torn ligament and a bone fracture.

An X-ray can show if any bones are broken. A new procedure using an arthroscope allows doctors to see inside the ankle joint. An arthroscope is a tiny TV camera that can be placed inside the ankle to see the bones and ligaments directly. This makes it possible to see and identify any structures that are torn or broken.

Better technology makes it possible for doctors to make the right diagnosis. Accurate diagnosis helps them determine the best possible treatment.

Minor ankle sprains usually heal within two to four weeks. If the ligaments were badly strained or actually torn, the healing period may be longer. Persistent problems this long after an injury may signal an underlying problem such as a talar dome fracture. 

The talar dome is made of two two small bones on the top of the talus, or ankle bone. When the ankle turns inward during a sprain, the lower leg bones can squeeze against the talar dome.

In just over 6 percent of ankle sprains, the pressure can chip the talar dome. If the chip loosens, and gets in the way of movement it can cause the joint to “lock up.” This kind of fracture is often overlooked during a routine ankle sprain examination. If normal activities continue to cause pain, stiffness, and swelling long after the initial sprain, doctors usually suspect a problem with the talar dome.

The fracture doesn’t always show up clearly on X-ray, so a CAT scan or even a bone scan may be required. If the bone scan shows a problem, an MRI will often be recommended because it gives doctors the information they need in order to choose the best type of treatment. You should alert your doctor to the problems you’ve described.

This unsteady feeling in your ankle may start to improve once the swelling and pain subside. Swelling can put pressure on the nerve sensors that are responsible for your sense of joint position. Also, pain can keep muscles from doing their job of protecting the joint. The effects of swelling and pain may combine to make your ankle feel unstable. 

However, it is possible the ankle could feel unsteady even after the swelling and pain have gone away. This usually involves injury of the nerve sensors. The injury can be caused either by the trauma of the sprain itself or the pressure from the swelling.

You may need to do special training exercises, called proprioception exercises, to improve the joint’s stability. These types of exercises are a lot like doing balance training. Examples include balancing on one leg with your eyes open and then closed, walking on uneven or soft surfaces, and practicing on a special balance board. If your ankle keeps feeling unsteady, you may need the help of a physical therapist who will design a program that will probably include these types of exercises.

Ankle sprains are notorious for happening again once you’ve had one. When the ankle is first hurt, the sprained ligament gets stretched or torn, and the area swells. This can cause the ankle to feel unsteady and roll inward occasionally. This condition is called “give-way” and happens when the ligaments don’t support the joint. This is a sign that the nerve sensors that give a sense of position, called “joint sense,” have been harmed. Once injured, they don’t recover. The loss of position sense puts the joint at further risk of injury.

Proprioceptive exercises help retrain the sense of joint position, by getting the other sensors in the area to do the work of the damaged sensors. These exercises are similar to balance training. Examples include balancing on one leg with your eyes open and then closed, walking on uneven or soft surfaces, and practicing on a special balance board. If the problem continues, you may need the help of a physical therapist who will design a program that includes these kinds of exercises.

Snowboarders are at a moderate risk for ankle injuries, especially once they get into aerial maneuvers. When coming down from a jump, your foot flexes upward at a sharp angle, and your ankle takes the pressure of the landing. Add to this the tendency of the foot to point outward while landing, and you have a recipe for a broken ankle. Keeping the foot straight ahead provides a safer landing.

You’ll lower your risk of injury if you practice good technique and don’t push yourself beyond your skill level. Watch for boots and bindings that better protect the ankles in the coming years.

Most doctors in the United States would not do surgery right away. In rare cases, such as with an elite athlete, surgery may be done immediately. Because surgery carries higher risks and costs, most doctors rely on nonsurgical treatments first. These treatments commonly include a period of rest, along with the use of an ankle brace. Cold treatments, anti-inflammatory medication, and a compression wrap with elevation of the sore limb are generally helpful for the pain and swelling. If you start to get relief and can gradually get back to activities without having extra swelling or unsteadiness in the ankle, you most likely will not need surgery. 

A recent study comparing types of treatment for this condition showed that people who had surgery experienced fewer problems over a longer time period. However, because the surgery is costly and has greater risks, it is usually only done only if other types of treatment haven’t improved stability in the injured ankle.

Absolutely. What feels like a series of ankle sprains could actually be a break in the main ankle bone, called the talus. The fracture commonly involves a small bump on the outside of the talus. This kind of injury is common among snowboarders but hard to see on an average X-ray. Doctors can identify ankle fractures by X-raying the ankle at a specific angle and by using a CAT scan. The CAT scan provides a detailed X-ray that looks like “slices” of the bone tissue.

If left untreated, an ankle fracture can lead to bigger problems, such as ongoing pain, ankle arthritis, and the inability to do sports. Once your doctor identifies the problem, he or she can suggest ways to treat it. Whether you wind up having a cast or an operation, you’ll be better off in the long run if you tend to your ankle now.

Doctors tend to think that it’s the position of the foot while landing from a jump. During a landing, the foot flexes upward and the heel presses slightly inward. The ankle joint takes the pressure of the landing, which could lead to injury.

A recent study suggested that there may be an additional ingredient. This study found that pointing the foot out is the main cause of a fractured ankle. When placed in the normal “landing position,” ankles didn’t fracture. But when the foot bent up and pointed outward, nearly all of the ankles tested broke. (The researchers used ankle bones from cadavers in their experiments.)

Researchers hope that more protective boots and bindings will prevent this kind of injury. Until then, snowboarders are advised to watch their foot position when landing.

Yes. When a ligament is torn, as can happen with a moderate or severe sprain, the bone it’s attached to can also be damaged. The injury can cause the bone to lose its ability to absorb shock, resulting in more wear and tear on the joint. This condition is called osteoarthritis, or degenerative joint disease. This could be the cause of your symptoms. Ask your health care provider to look at it and give you an opinion.

Many people stop exercising after an injury. However, it is very important that you get back to some kind of exercise program. You may want to start with activities that keep weight off the ankle, such as swimming or biking. If you haven’t been trying to rehabilitate your ankle, talk to your health care provider about what you can do. You may need physical therapy if your ankle hasn’t been improving.