Ankle Injury and Ankle Pain Relief Guide

How Your Ankle Works

The ankle joint is a hinge type joint that participates in movement and is involved in lower limb stability. There are 2 types of motions that take place at the ankle joint: dorsiflexion and plantar flexion. Dorsiflexion involves bringing the dorsum of the foot towards the anterior surface of the leg. Such movement is necessary in order to have the foot contact the ground heel first during heel strike and to allow the foot to clear the ground during the swing phase of gait. Plantar flexion occurs when the toes are in contact with the ground and the heel is raised off of the ground (toe raises). This movement provides the propulsive force necessary to lift the limb off the ground and start it swinging forward during the toe off portion of gait. During midstance, when the lower limb supports the weight of the torso, the ankle is in its most stable configuration, which is the dorsiflexed position.

Suffering from Ankle Pain?

At some time in your life you may experience foot, heel, or ankle pain. There are an estimated 25,000 people who sprain an ankle every day in the United States. Even with this high frequency, ankle sprains are not always minor injuries. About one quarter of these will result with the person developing long-term joint pain and weakness. This handbook will allow you to understand the basic anatomy of your foot and ankle so you can get on to healing your body.

Severity of an ankle sprain varies from the ligament being simply stretched, slightly torn, or completely ruptured. In more severe sprains, you are often unable to walk or even put weight on your foot, and your ankle may feel unstable. You usually have a lot of pain at first , but it can significantly decrease after the first hour. If your ankle sprain does not get treated and heal properly you may be more susceptible to re-injury.

Your physician may use the following grading system to determine your injury level:

Grade I: Injury involves only a mild stretch of the ligament. Patients are usually able to bear weight on the ankle immediately following injury.
Grade II: Injury involves some ligament tearing and patient generally experience more significant pain and swelling. They can usually bear some weight.
Grade III: Injury involves a complete tear of one or more ligaments. Significant pain, swelling, and bruising are usually present. The patient will demonstrate clinical, as well as functional instability. Weight bearing for this person is usually difficult.

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Inversion Ankle Sprain

An ankle sprain occurs when the ligaments that connect the bones in the foot, ankle, or lower leg, are stretched or torn. Inversion ankle sprains happen most frequently. During an inversion ankle sprain the anterior talofibular ligament (ATFL) is most commonly injured followed by the calcaneofibular ligament.

Eversion Ankle Sprain

Eversion ankle sprains occur less often and are usually more severe. Damage to the deltoid ligament occurs with this type of sprain, however due to the deltoid's strength it can often result in an avulsion fracture of the medial malleolus rather than damage to the ligament.

High Ankle Sprain

A high ankle sprain injures the large ligament above the ankle that joins together the two bones of the lower leg. These two bones, the tibia (shin bone) and fibula, run from the knee down to the ankle. They are joined together by this ligament, called the "syndesmosis" or sydesmotic ligament.

Patients who sustain a high ankle sprain injure this syndesmotic ligament. The ligament can also be associated with more common low ankle sprains, and even ankle fractures.

Achilles Tendonitis

Achillies Tendonitis is an overuse injury usually characterized by a gradual onset of posterior ankle pain. Achillies Tendonitis may be associated with some increase in activity level. The pain is made worse by wearing lower-heeled shoes and by running, jumping, and climbing activities. It is improved by wearing higher heeled shoes which takes stress off of the achilles.

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Achilles Bursitis (Retrocalcaneal bursitis)

This is a common condition in athletes, particularly in runners. It can often be mistaken for Achilles tendonitis or can occur in conjunction with Achilles tendonitis.

A bursa is a small sack of fluid that goes between a tendon and a bone to help the tendon move smoothly over the bone.

The retrocalcaneal bursa lies between the Achilles tendon and the calcaneus (heel bone). With repeated trauma the bursa can become inflamed.

It is possible for the athlete to have both Achilles tendonitis and bursitis at the same time (Haglund's syndrome).

Plantar Fasciitis

Plantar fasciitis is an inflammation of the plantar fascia and the perifascial structures. If not treated properly chronic stress to the origin of this fascia on the calcaneus may cause calcium to deposit, forming a spur.

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Ankle Sprain Treatment

After a medical professional has determined the severity of the ankle injury, initial treatment can follow the RICE principle:

Rest: Crutches and/or some type of ankle support should be used until walking is not painful.

Ice: After the compression bandage has been applied, use ice packs or an ice wrap to decrease the temperature of the injured area. Ice should be applied for 20 minutes every 1 to 2 hours for the first 24 to 72 hours, or until swelling goes down. Do not expose the area to prolonged cold.

Compression: An elastic pressure bandage or wrap can be applied around the ankle at the site of the sprain. This will help decrease swelling and should be worn for the first 24 to 36 hours. Compression wraps do not offer protection, and a protective brace should be used if you try to bear weight on your injured ankle. Don't apply the wrap too tightly. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage.

Elevation: Promptly elevate the injured limb. If possible, it should be raised above the level of the heart for at least 2-3 hours a day for the first 24 to 36 hours to help reduce swelling and bruising. The easiest way to achieve this is to lie on your back and prop the injured limb up on some pillows.