The ankle is a "hinged"joint capable of moving the foot in two primary directions: away from the body(plantar flexion) and toward the body (dorsi-flexion). It is formed by three bones. The end of the shinbone of the leg (tibia) and a small bone in the leg(fibula) meet a large bone in the foot, called the talus, to form the ankle.The end of the shin bone (tibia) forms the inner portion of the ankle, while the end of the fibula forms the outer portion of the ankle. The hard knobs on each side of the ankle are called the malleoli. These provide stability to the ankle joints, which function as weight-bearing joints for the body while standing and walking. Ligaments on each side of the ankle provide stability by tightly strapping the outside of the ankle (lateral malleolus) with the lateral collateral ligaments and the inner portion of the ankle (medial malleolus) with the medial collateral ligaments. The ankle joint is surrounded by a fibrous joint capsule. Tendons that attach the large muscles of the leg to the foot fit around the ankle both from the front and rear. The large tendon (Achilles tendon) of the calf muscle passes behind the ankle and attaches at the back of the heel. A large tendon of the leg muscle (posterior tibial tendon) passes behind the medial malleolus. The peroneal tendon passes behind the lateral malleolus to attach into the foot.
The ankle has the ability to move the foot, from the neutral position to right-angle position to approximately 50degrees of plantar flexion and to approximately 25 degrees of dorsi-flexion. The powerful muscles that move the ankle are located in the front and rear of the leg. These muscles contract and relax while in motion.
Ankle sprains and fractures: Causes and Injuries.
Ankle sprains are the most common musculo-skeletal injuries. Sprains are injuries to the ligaments of the ankle,causing them to partially or completely tear as a result of sudden reaching or stretching. They can occur on either or both of the inner and outer portions of the ankle joint. Ankle sprains more commonly happen when there is a preexisting muscle weakness in the ankle area or a history of previous ankle injuries. The typical injury occurs when the ankle is suddenly "twisted" in a sports activity or by stepping off an uneven surface. The pain is initially severe and can be associated with a "popping" sensation. Immediate swelling in the area of injury often occurs as the injured blood vessels leak fluid into the local tissue. Examination of the area may cause extreme pain when the ankle is moved. The level of pain may not necessarily indicate the level of damage to the ligaments. Ligament injuries are often assessed from Ito III, ranging from partial to complete tears. Partial tears retain some or little ankle stability, whereas complete tears lose stability because the strapping ligaments no longer brace the ankle joint. After an examination,significant ankle sprains are commonly evaluated with an x-ray X-rays can determine whether there is a break or (fracture) of the bone.
Ankle sprains are initially treated with ice, rest, and limiting the amount of walking and weight-bearing on the injured ankle. The leg can be elevated to reduce swelling, and crutches are often recommended to avoid further trauma to the injured ligaments.Anti-inflammatory medications can be given to reduce local inflammation. Ice packs help decrease further swelling of the area and can reduce pain. Cold laser therapy is now available for accelerated healing. Patients with severe injuries are placed in immobilization casts. Surgical repair of some injuries is considered, especially for those patients contemplating future athletic participation. Physical therapy programs are part of the rehabilitation process, incorporating strengthening exercises of the lower leg muscles. Fractures are repaired with casting to immobilize the bone for healing. Depending on the severity, fractures can require orthopedic casting,surgical procedures including pinning, and open repair of the fractured bone.
Treatment of Tendinitis.
Tendinitis is an inflammation of the tendon. Tendinitis of the ankle can involve the Achilles tendon, the posteriortibial tendon, or the peroneal tendon. This condition usually results from trauma but can result from underlying inflammatory diseases or illnesses such as reactive arthritis (formerly called Reiter's syndrome), rheumatoid arthritis, and ankylosing spondylitis. All forms of tendinitis cause pain,swelling, and tenderness in the tendon area involved. The onset may be rapid,such as with an athletic injury. Immediate treatment involves immobilizing the area, elevation, and limiting weight-bearing, applying ice, and using cold laser therapy. To decrease inflammation To the hip joint Participation in sport should be limited when the tendon is still inflamed, as there is a significant risk of rupturing or tearing the tendon, especially in the Achilles area,. A rupture of the Achilles tendon is more frequent in patients who have had previous Achilles inflammation.
Causes and Treatment.
Inflammatory types of arthritis(inflammation of the joint) that can involve the ankle area include rheumatoid arthritis, reactive arthritis, gout arthritis, ankylosing spondylitis, and proriatic arthritis, among others. They generally are not induced by trauma injuryand develop gradually. These types of arthritis are associated with pain,swelling, stiffness, and warmth in the afflicted area. Other conditions of the ankle which can cause ankle pain include tarsal tunnel syndrome. This is a result of nerve compression at the ankle as the nerve passes under the normal supportive band surrounding the ankle called the flexor retinaculum. Tarsal tunnel syndrome. Infections of the ankle joint are rare. They most commonly occur as a result of bacteria being introduced into the ankle joint through a wound or trauma. They also occur with a breakdown of the skin over the ankle as a result of ulcerations or abrasions.
Ankle
sprains / ligament damage
One of the most common
ankle injuries we treat are inversion ankle sprains. The term inversion applies when the ankle is forced inwards usually
when the ankle rolls over on the outside.
If the ankle sprains
due to rolling the ankle inwards then it is known as an eversion ankle sprain.
Inversion ankle sprains
most commonly occur as a result of trauma in sport, landing from a jump or
falling off a pavement curb or something similar.
Depending on the
severity of the sprain will determine how much bruising and swelling is present. Pain is felt on the outside of the ankle joint and can spread over the whole foot and up into the Achilles tendon area.
It is important to
note that ankle sprains are one of the most recurring injuries. It is therefore vital that the appropriate
treatment is started early. It is not just a case of resting and icing the joint. Specific rehabilitation and in particular balancing and co-ordination exercises are crucial.
Pain in the
Achilles tendon
Achilles
tendonosis / tendonitis
Pain in the Achilles
tendon is almost always due to tendonitis or tendonitits.
Tendonitis suggests
there is inflammation present within the tendon and tendonosis suggests that
there is degeneration due to wear and tear.
Typical symptoms
include thickening around the tendon which is tender to touch, stiffness and
pain when getting out of bed in the morning, pain usually after exercise, a
general ache throughout the day and pain with sport participation.
The majority of people
who suffer pain in the Achilles tendon tend to leave it as pain is usually not
that bad in the beginning. Over a period of time it slowly gets worse. The
quicker treatment is started the quicker the injury will heal.
Treatment will usually
involve deep tissue massage, correction of foot biomechanics, specific
strengthening exercises and joint mobilisations.
Pain on the
inside of the ankle
Ankle
sprain / ligament damage
Just like an inversion
sprain, ankles can be forced into an outward position known as eversion.
Tendon
injuries
There are many tendons
coming from the calf muscles that run directly around the inside of the ankle bone. These tendons are
commonly injured in runners as they are responsible for the raising and lowering of the inside of the foot during running.
Repetitive use can
cause irritation, mild tearing and pain.Pain is often felt around the inside of the ankle joint and can be referred into the inside of the shin area.
Deep tissue massage is
usually the treatment of choice in order to free up the movements of muscles and tendons. Strengthening exercises and correction of walking/running gait is also important.
Pain on the
bottom of the foot
Plantar
fasciitis
Plantar fasciitis
involves inflammation of the plantar fascia tissue. The plantar fascia
attaches to the bottom of the heal bone and connects to the toes.
It acts like an
elastic spring during walking and running. As we walk the plantar fascia
stretches. Excessive wear and tear can cause tiny tears and lead to
inflammation.
Pain is usually felt
on the bottom of the heal that can radiate into the toes. Factors that may lead
to plantar fasciitis include; poor footwear, high foot arches, tightness in the
Achilles tendon and other surrounding muscles, trauma.
Treatment is focused
on addressing the underlying causes of the pain. This usually involves
correcting walking gait, joint mobilisations and deep tissue massage.
