Ouch! Common Ankle Injuries

By: Rebecca Webb, PA-C

Hello friends! It is time to learn about some new orthopedic injuries. It’s play-off time in the professional basketball world, so my topic this week is basketball injuries.  Hands (or should I say feet) down, ankle injuries are the most common injury in basketball. A journal article looking at injuries that occurred in the NBA across a 17-year period reported that injuries to the ankle joint accounted for 14.7% of all injuries sustained. However, professional athletes aren’t the only people to hurt their ankles. According to the American Academy of Orthopedic Surgeons, 25,000 people sprain their ankle each day. That would mean 9,125,000 people could sprain their ankle each year… yikes! I don’t know about you, but I have hurt my ankles more than a handful of times, some while playing sports and others while just walking down the street.

Before we get into some specific injuries, let's spend a little time reviewing ankle anatomy. The ankle joint is made up of three bones; the tibia and fibula which are in the lower leg or calf, and the talus which is in the foot. You know those little bumps on the inside and outside of your ankle? Well, the one on the inside is called the medial malleolus, and it is the bottom portion of the tibia. The lateral malleolus is on the outside of your ankle, and likewise is the bottom of the fibula. There are many, many ligaments and tendons supporting the ankle, but the most commonly injured and most important ones to mention are located on the lateral, or outside, and the medial, or inside, of the ankle. The ligaments on the inside are known as the deltoid ligament, and their job is to prevent the ankle from moving too far outward. On the outside, there are three separate and distinct ligaments, and they work to prevent the ankle from rolling inward. Alright, now that we talked a little bit about the anatomy of the ankle joint we can get into some common injuries that occur.

 Ankle Sprains - Let’s talk about ankle sprains! A sprain is a partial or complete tear of a ligament and occurs when excess force is applied. The ligaments on the outside of the ankle are most commonly injured for two reasons: the lateral ligaments are weaker and they protect the ankle against rolling inward. We call this an “inversion injury” because the foot is moving in towards the midline of the body. Ankle sprains can also happen to the ligaments on the inside of the ankle, but occur with an “eversion injury”, or when the foot moves away from the midline. As some of you know first-hand, it is remarkably easy to roll your ankle! This can happen while landing from a lay-up in basketball, stepping in a hole outside, or even missing a step in your house. 

Signs and symptoms of an ankle sprain include pain, swelling and bruising in the foot and ankle, and it is usually more painful when bearing weight on the affected side. Treatment is based on how badly the ligament is damaged but typically involves RICE -  Rest, Ice, Elevation, and Compression. Sometimes crutches, ankle braces or physical therapy are needed to help with healing.

Ankle Breaks - The same mechanism of injury, or traumatic event, which can cause an ankle sprain can also result in a broken bone. Depending on the location and severity of the fracture, sometimes they can be treated non-surgically with immobilization in a cast or walking boot. Other times, a surgery called an Open Reduction Internal Fixation (ORIF) is needed to repair the broken bone. Broken down, this procedure involves opening up the skin with a surgical incision, placing the broken pieces of bone back together, and securing them with plates and screws to maintain their position. The pictures below can be found at the American Orthopaedic Foot and Ankle Society site here. They show the before and after of an ORIF. The yellow arrow is pointing to the medial malleolus of the tibia, while the red arrow is pointing to the lateral malleolus of the fibula. You can see the plates and screws used in the after image that are holding the fracture pieces together!

That’s all I have for you guys today, but I hope to have shed a little light on some common ankle injuries. For more information regarding the topics discussed above, visit OrthoInfo.org  from the American Academy of Orthopedic Surgery. See you next time!

Sources:

1. Drakos MC, Domb B, Starkey C, Callahan L, Allen AA. Injury in the National Basketball Association: A 17-Year Overview. Sports Health. 2010;2(4):284-290. doi:10.1177/1941738109357303.
2. Maughan KL. Ankle sprain. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2018. www.uptodate.com. Accessed April 28, 2018.
3. Koehler SM, Eiff P. Overview of ankle fractures in adults. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2018. www.uptodate.com. Accessed April 29, 2018.
4. Ghiroli B. (2017 December 22) Britton has surgery to repair right Achilles. Retrieved from https://www.mlb.com/news/orioles-zach-britton-has-achilles-injury/c-263808464
5. Jones O. The Ankle Joint. Retrieved from http://teachmeanatomy.info/lower-limb/joints/ankle-joint/
6. Ankle Fracture Surgery. Retrieved from http://www.aofas.org/footcaremd/treatments/Pages/Ankle-Fracture-Surgery.aspx

Rebecca Webb, PA-C is a Physician Assistant at The Centers for Advanced Orthopaedics, OrthoMaryland Care Center. Rebecca is a member of our Joint Team, working closely with Dr. Peter Jay and Dr. Barry Waldman, treating hip and knee conditions, sports injuries and basic fractures.