In the next few minutes, we’re going to take a look at common ankle injuries experienced by athletes.
Foot and ankle injuries are no stranger to athletes. Some of the most common ankle injuries, which we’ll talk about today, are sprains, chronic lateral ankle instability, peroneal tendon tears, and Achilles tendon tears.
Let’s first take a look at ankle sprains. These injuries occur so frequently that they send more than 150,000 people to the emergency room or urgent care center each year.
As common as ankle sprains are, many people don’t know what exactly they involve. A sprained ankle is an injury to one or more ligaments in the ankle. Ligaments are bands of tough, flexible tissue—like rubber bands—that connect two bones or hold a joint together. The ankle has three lateral ligaments, which give you stability by restricting wobbly, side-to-side movement. The ankle also has medial ligaments, which also help stabilize the ankle. In a sprained ankle, the injury involves either a stretching out of the ligament, or a tear.
Not all ankle sprains are the same—some are much worse than others. The severity depends on whether the ligament is stretched, partially torn, or completely torn. Severity also depends of the number of ligaments injured. In some severe cases, a piece of bone may have broken off, or there may be some other type of fracture.
The symptoms of a sprained ankle can vary. Typically there will be pain and swelling, although some people who have had previous sprains might just feel wobbly instead. Bruising typically occurs, and it may be difficult—or in some cases impossible—to walk. Stiffness in the joint is another symptom for some people.
What should you do if you think you’ve sprained your ankle? Prompt medical attention is critical, for several reasons. For example, if the sprain isn’t treated properly, you could develop a troublesome condition called chronic lateral ankle instability. The ER or urgent care center will give you an initial diagnosis and temporary treatment, but be sure to follow up and make an appointment with a specialist—a foot and ankle surgeon who specializes in treating ankle sprains and other related conditions. In the meantime, be sure to ice your ankle, keep it elevated, and stay off your foot as much as possible.
After the foot and ankle surgeon thoroughly evaluates your injury, which might include more advanced diagnostic imaging, you’ll receive a treatment plan aimed at your specific injury. Many sprained ankles are treated with splinting or casting, rest, ice, compression, medication such as a nonsteroidal anti-inflammatory drug, and physical therapy. Doing physical therapy as soon as possible, as advised by your doctor, is important to rehabilitate the ankle. In more severe cases, surgery may be needed to repair the damage.
Now let’s take a look at another common ankle injury in athletes—chronic lateral ankle instability, or chronic ankle instability. I mentioned this condition earlier as a potential consequence of a sprained ankle sprain that didn’t heal adequately or wasn’t completely rehabilitated.
Chronic lateral ankle instability is a weakness of the ankle that’s described as a recurring “giving way” of the outer—or lateral—side of the ankle. This can occur while walking or doing other activities, but it can also happen when you’re just standing.
This “giving way” can lead to spraining your ankle. And just as this condition can result in an ankle sprain, it also is often caused by previous ankle sprains. That’s because when you sprain your ankle, the injured ligaments can weaken and affect your sense of balance.
This highlights the importance of proper rehabilitating a sprained ankle, through physical therapy. Rehabilitation will strengthen the muscles and “retrain” the ankle for better balance—and thereby help prevent chronic ankle instability from developing. In contrast, failing to undergo proper rehabilitation can result in repeated ankle sprains.
How do you know if you have chronic ankle instability? People with this condition often say their ankle feels wobbly or unstable, and may have a repeated turning of the ankle, especially on uneven surfaces or when participating in sports. There may also be persistent swelling and discomfort, as well as pain or tenderness. And, of course, instability can easily lead to additional ankle sprains.
If you have chronic ankle instability, your foot and ankle surgeon will determine the best treatment for your case.
Conservative treatment begins with physical therapy, which will include various modalities and exercises to strengthen the ankle, improve balance and range of motion, and retrain your muscles. You’ll also receive training that relates specifically to your sport. Some patients are also given an ankle brace to support the ankle. Nonsteroidal anti-inflammatory drugs are often prescribed to reduce the pain and inflammation.
For some people, surgery is necessary because of the degree of their ankle instability or because they didn’t improve enough with conservative treatment. Surgery will serve to repair or reconstruct the damaged ligament or ligaments.
The third category of common ankle problems among athletes consists of peroneal tendon injuries. We’ll concentrate on two types of these injuries: acute (or sudden) tears and subluxation.
The foot has two peroneal tendons. Tendons are bands of tissues that connect muscle to bone. The peroneal tendons run side-by-side behind the outer ankle bone. The main function of these is to stabilize the foot and ankle and protect them against sprains.
Acute tears of the peroneal tendons are very common in sports, especially those that involve repetitive ankle motion. Symptoms include pain, swelling and weakness or instability of the foot and ankle. As time goes on, these tears could lead to a change in the shape of the foot and the arch may become higher
Subluxation—another common peroneal tendon injury—occurs when one or both tendons have slipped out of their normal position. For athletes, this can occur following trauma, such as an ankle sprain. It’s very important to have this promptly treated, because a tendon that continues to move out of position is more likely to tear.
One classic symptom of a peroneal tendon subluxation is a snapping feeling of the tendon around the ankle bone. You may also have pain, on and off, behind the outside ankle bone. Some people also have ankle instability or weakness.
Treatment depends on the specific type of peroneal tendon injury. The foot may be placed in a splint or cast, and medications—either oral or injected nonsteroidal anti-inflammatory drugs—may be given. Physical therapy is also an option, and may run the gamut from ice, heat, and ultrasound therapy to exercises once symptoms start to improve. Bracing may also be used. In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot.
Now let’s look at the final type of common ankle injuries in sports: Achilles tendon tears.
The Achilles tendon—also called the “heel cord”—runs down the back of the lower leg and connects the calf muscle to the heel bone. It helps to raise the heel off the ground, thereby facilitating walking.
An Achilles tendon tear, which can be a complete or partial tear, occurs when the tendon is stretched beyond its capacity. This often happens with forceful jumping or pivoting, or sudden accelerations in running. It’s very common among “weekend warriors.”
People who have torn their Achilles tendon typically have sudden pain in the back of the ankle or calf. It will feel like a kick or a stab, and then is often subsides into a dull ache. Many people also describe a popping or snapping sensation. There may be swelling on the back of the leg between the heel and the calf, and it may be difficult to walk, especially upstairs or uphill, and difficult to rise up on your toes.
If you’ve had this kind of injury, prompt medical attention is needed. Once the foot and ankle surgeon evaluates your injury, treatment based on the extent of the tear and your particular situation can begin.
Non-surgical treatment is usually reserved for minor tears, less active people, and those who cannot undergo surgery. A higher rate of re-tearing occurs when non-surgical treatment is undertaken. Non-surgical options include wearing a cast, walking boot, or brace to allow the tendon to heal.
Surgery offers important potential benefits over non-surgical treatment, including decreasing the likelihood of another tear occurring. Also, surgery often increases push-off strength and improve muscle function and ankle movement.
I hope this has given you some useful information about common ankle injuries among athletes. Knowing what to do if these injuries occur will do much to put you on the road to effective treatment and good outcomes.