Treating Ankle & Heel Injuries
By John Lindsay, D.P.M.
Podiatrist with Saint Anthony’s Physician Group
April 4, 2012
Whether you’re playing a sport that requires running and jumping or just making your way through daily life, your ankles carry the entire weight of your body and are vulnerable to a wide range of injuries – some more serious than others.
The ankle is basically a juncture of three bones:
- the major bone of the lower leg, known as the tibia, that comes down to form the bump on the inside of the ankle;
- a smaller bone, known as the fibula, that comes down to form the bump on the outside of the ankle; and
- the talus, or top bone of the foot.
Nearby is the heel bone, or calcaneus, the largest bone in the foot.
Several muscles come together at this point, controlling motion. An ankle with normal range of motion is generally capable of flexing about 45 degrees down and about 20 degrees upward.
Tendons connect muscle to bone. Ligaments, tightly strapping each side of the ankle, connect bone to bone. When you twist your ankle, it’s usually these ligaments that suffer most of the damage.
ANKLE SPRAINS: The pain you feel when you twist an ankle is no true indication of the damage. Ligament injuries are graded -- I to III -- on the basis of how much tearing has taken place.
The best treatment for any soft tissue injury is RICE: rest, ice, compression and elevation. The goal is to reduce the accumulation of fluid and the swelling that accompanies it. Rest means relative rest, though, not total immobilization which can allow the joint to stiffen as a result of swelling and fibrous scar tissue.
The most common ankle sprain occurs when the ankle is turned inward. That stretches and tears ligaments on the outside of the ankle. When the ankle is turned outward, the injury is known as a high ankle sprain, which is usually more severe. You may have heard of basketball players with high ankle sprains that required several weeks for healing.
TENDINITIS: As with other tendinitis syndromes such as tennis elbow and runner’s knee, ankle tendinitis is often associated with repetitive movements resulting from training or competitive activity. Even though the process is long term, the inflammation and pain may come on suddenly with no obvious cause.
Achilles tendinitis involves the long band of tissue that connects the calf muscle to the back of the heel. Two less common types of ankle tendinitis are:
- posterior tibial tendinitis, occurring on the inner side of the foot and ankle, just above the arch; and
- peroneal tendinitis, affecting two tendons – one that runs along the outer part of the foot and another that runs under the foot and attaches at the arch.
For any of these types of tendinitis, symptoms usually include severe pain with intense or prolonged exercise and mild but unremitting tenderness or stiffness at other times. Sometimes it may be difficult to bend the ankle without pain.
The key with tendinitis is to note symptoms early when self-treatment is possible. Stop the activity that causes the pain and use RICE: rest, ice, compression and elevation. Then ease back into the activity very gradually, being careful not to bring on symptoms. When self-treatment fails, a physician can inject anti-inflammatory medication directly into the site or prescribe oral medications.
Future problems can sometimes be prevented with a change of shoes plus orthotic shoe inserts to reduce the repetitive stress.
FRACTURES: When an ankle injury is severe or when the pain and swelling persist, it may be a sign of a fracture.
A fracture of either the calcaneum or the talus usually occurs as a result of significant trauma. In either case, the patient can expect considerable pain over an extended period and sometimes loss of normal motion.
A stress fracture, or small crack in the outside covering of the bone, can occur either as a result of trauma or repetitive activity such as long distance running.
ARTHRITIS is not as common in the ankle as in the knee, hip or other joints, but persons who have suffered fractures or severe sprains are at increased risk.
When part of the bone is injured enough to impede proper blood flow, the result is osteonecrosis, or deterioration of bone, which eventually leads to arthritis.
Symptoms include pain and stiffness around the joint; bone spurs causing a lumpy appearance; deformity of the joint; and instability -- a feeling that the ankle may give way.
Pain or other symptoms, particularly in the front of the ankle, could also be caused by pinching of the sciatic nerve near its root in the lower back. Swelling of the foot and ankles could be caused by fluid retention related to the heart or kidneys rather than the joint itself.
It’s fortunate that ankles are less vulnerable than knees and hips to the severe joint deterioration of osteoarthritis. Replacement of the ankle joint can be performed, but results so far have not been impressive, with more complications than for total hip or total knee replacement. For some problems, fusion surgery is effective, but it results in permanent loss of some ankle mobility.
The ankle is a complex joint that plays an important role in much of what we do every day. It’s a good idea to take care of the ankles you have by wearing the right shoes and treating injuries promptly.
Dr. Lindsay is a podiatrist with Saint Anthony’s Physician Group, specializing in the prevention, diagnosis and treatment of foot and ankle conditions. For an appointment with Dr. Lindsay or for more information, call 618-463-0227.