Your ankles are a vital player in your ability to move, as it is the junction point at which the bones, muscles, ligaments, and tendons of the leg connect to the foot.
Unfortunately, all those intersecting parts make the ankle vulnerable to injury, especially if you participate in sports. Physical activity and repetitive movements can overexert the connective tissues holding your skeletomuscular system together or damage the bones making up the ankle joint.
Let’s explore some of the most common ankle injuries, including the tissues they affect, how they occur, and possible treatments to help you get back on your feet.
Basic Ankle Anatomy
Before we discuss common ankle injuries, it’s essential to understand the different elements that come together to form the ankle. It gives context to the injuries and explains why some tissues are more prone to damage than others.
The ankle consists of two joints, four bones, three ligaments, and six tendons:
True Ankle Joint and Subtalar Joint
The tibia, fibula, and talus form the true ankle joint. The tibia is the long bone that forms the ankle's interior, while the fibula is the shorter bone that includes the outer ankle.
These lower leg bones meet at the talus, a small bone just above the calcaneus (heel), forming the primary ankle joint.
The smaller of the two ankle joints, called the subtalar joint, is the junction of the talus and the calcaneus bones.
Ligaments connect bones to other bones, and the ankle area depends on these strong connective tissues for stability and movement.
- The syndesmotic ligaments attach the tibia to the fibula.
- The lateral collateral ligaments stabilize the outside of the ankle by connecting the fibula to the heel bone.
- The deltoid ligaments stabilize the inside of the ankle as they connect the talus and heel.
Tendons are also connective tissue, but they attach bones to muscles.
- The anterior tibialis tendon makes up the front of the ankle, connecting the front leg muscles to the midfoot bones.
- The posterior tibialis tendon creates the foot’s arch by attaching the leg muscles to the bottom of the foot bones.
- The three peroneal tendons stabilize the outer foot, running from the outer ankle to the bottom of the foot and pinky toe.
- The Achilles tendon is the large connective band at the back of the ankle, attaching the heel to the calf muscle.
5 Common Ankle Injuries
Now that we’ve explored the various components that make up the ankle let’s dive into the possible culprits behind your pain.
If you’ve ever accidentally stepped in a hole or landed incorrectly after jumping, there’s a good chance you’re familiar with the pain of an ankle sprain. They are among the most common ankle injuries, with 2 million cases annually in the United States alone.
These occur when ankle ligaments stretch too far or, in extreme cases, tear due to hyperextension. The sprain’s severity can range from slight discomfort when putting pressure on the affected foot to permanent instability.
Sprain classifications depend on the specific direction of the hyperextension:
- Inversion sprains occur when the ankle rolls inward, affecting the lateral collateral ligaments.
- Eversion sprains are caused by overextending the ankle outward, stressing the deltoid ligaments.
- Syndesmotic sprains, or high ankle sprains, are the rarest type, caused by the foot and shin forcefully bowing forward.
An essential tool for healing a sprained ankle is giving the stretched ligaments time to rest by using the affected leg as little as possible. During that time, you can use hot compresses to encourage circulation to the area and ibuprofen to reduce inflammation.
For those who cannot stay immobilized for a few days, an active brace can help stabilize the joint and take pressure off the weakened connective tissue.
Achilles tendonitis is when the Achilles tendon or the shaft around the connective band becomes inflamed.
Athletes who suddenly increase their training schedule are most prone to the condition, as are those who pick up a new physical activity that requires more ankle movement than they usually do.
Often, the pain starts in the calf and moves down the back of the leg into the heel. As the tendonitis persists, the ankle feels stiffer and more painful when you wake up in the morning, then loosens up after moving around.
It is very rare for Achilles tendonitis to require treatment beyond OTC pain relievers and slowing down for a couple of days. Once the pain eases, gentle stretching and gradual strength training can help the connective tissue move and stretch more comfortably.
People with chronic tendonitis may benefit from a compression sleeve that takes the pressure off the Achilles tendon and supports the arch.
Because the ankle is a joint, extreme trauma can cause the tibia, fibula, or talus to move out of place, causing intense pain. They often occur alongside a break but can coincide with more extreme sprains, particularly those in which one of the ligaments tears.
Dislocated ankles can look deformed, as the bones are out of alignment, and make it nearly impossible to walk. The area may also be bruised, swollen, and sore to the touch.
Dislocations require medical intervention to reset the bones.
In some cases, doctors can move the bones back into their proper place in a process called closed reduction, but more severe dislocations might require surgery called internal fixation. This procedure utilizes metal plates to hold the bones in place as they heal.
Anterior Ankle Impingement
Aptly known as “footballer’s ankle,” anterior ankle impingement occurs when multiple minor injuries cause scar tissue or bone spurs on the front of the ankle. It’s one of the most common ankle injuries in athletes, who are more prone to ankle trauma like sprains and stress fractures.
As the bones and connective tissues heal over and over, they thicken, limiting the ankle’s range of motion and pinching muscle between the growths.
This condition becomes more severe over time and may start as a minor ache that eventually escalates to decreased flexibility and stability at the ankle joint.
Treatment for anterior ankle impingement usually involves taking a break from the activity in question and stretching exercises that help maintain ankle flexibility.
OTC anti-inflammatories can address the swelling, while alternating hot and cold compresses help loosen the muscles and increase circulation to the area.
Repetitive movements, a sudden increase in physical activity, and weakened bones due to aging can cause stress fractures, which are tiny cracks in the ankle bones.
They most frequently happen to people who neglect to rest following a connective tissue injury, as these supportive bands rely more on the bones to support your weight while they heal.
Stress fractures are most painful during exercise, particularly those that mimic the movement that caused the injury in the first place. Still, it can also affect your ability to put weight on your foot during everyday activities.
Unlike a complete break, this microscopic damage heals on its own as new bone cells replace older ones, so long as you don’t compound the issue by continuing the repetitive motion that caused it in the first place.
A walking boot helps support the ankle while allowing freedom of movement without putting additional pressure on the affected bones.
Ankle injuries can be painful, frustrating, and slow-healing, as we rely on these important joints for normal movement. Unfortunately, it’s not always possible to immobilize the area. Braces and compression sleeves can help by taking pressure off the bones, ligaments, and tendons without taking you off your feet.
Before beginning any treatment for these common ankle injuries, you should always speak with your doctor to ensure that there isn’t a more severe issue at play.