Ankle Injuries

ACHILLES TENDINITIS

Achilles tendinitis occurs when your Achilles tendon becomes irritated or inflamed.  This often occurs when an athlete puts a lot of stress on the Achilles tendon and calf muscles.  It can also be the result of a quick increase in the frequency and intensity of exercise.  When Achilles tendinitis is treated quickly, it usually doesn't last long, but if it is untreated, it can cause pain that lasts or can even cause the tendon to rupture or tear, and this may require surgery to correct this damage.  Over the counter medicines and rest can reduce the inflammation and pain from Achilles tendinitis.

Symptoms of Achilles Tendinitis

The symptoms of Achilles tendinitis often develop slowly over time.  One of the symptoms is a dull ache or a painful feeling when pushing off of your floor when you walk or rise up on your toes.  Another symptom is a tenderness located over your Achilles tendon.  There may also be a little swelling or a bump over your tendon as well as stiffness that does lessen as you warm up.  Finally, you may notice a creaking or crackling sound when you touch or move your Achilles tendon.  The Achilles tendon may also feel sore when you rise in the morning and may improve a bit when you start to move around as you start your day.  If you are feeling sudden pain and swelling near the heel of your foot and you cannot bend your foot downward or walk in  normal way, your Achilles tendon may have been ruptured.  Once it has been ruptured, you will not be able to rise up on the toes of your injured leg.

Causes of Achilles Tendinitis

Your Achilles tendon is the big band of tissues that connect the muscles in the back part of your calf to the bone of your heel.  You need your Achilles tendon to jump, walk, run, or push up.  When you put a lot of stress on this tendon, it can become inflamed because of many small tears that happen while active.  This may occur because there is a sharp increase in repetitive activity that involves the Achilles tendon.  There are other factors that can be to blame.  One is improper conditioning.  This condition is most common with athletes who have not become properly conditioned for their activity.  If the calf muscles are not flexible and strong enough, the tendon can be overloaded.  Additionally, sports like basketball and tennis have many starts and stops and repeated jumping which can lead to Achilles tendinitis.  A second cause for this condition is from trying to do too much too soon.  When you are starting a new exercise program, you should make sure you stretch before and after you exercise and you should increase the amount over time.  If you try to do too much, you can cause injury.  A third possible cause is a flattened arch.  When you have a flattening of the arch of your foot, you are at a higher risk of developing the condition of Achilles tendinitis.  Therefore you should wear shoes that have the appropriate support.  Finally if you have had trauma or infection near the tendon, inflammation of the Achilles tendon can occur.

Treatment of Achilles Tendinitis

If you suspect you have Achilles Tendinitis, you should of course try some home self-care treatments, such as ice, over the counter pain relievers, and rest, but if these home care remedies are not working, then your doctor may suggest other treatments to improve your condition.  First, a temporary foot insert called an orthotic device may be recommended.  This will elevate your heel in your shoe to relieve strain on your stretched tendon.  Additionally your doctor may prescribe heel pads of cups to wear in your shoes in order to cushion and support your heel or even a splint to wear at night in order to keep the Achilles tendon stretched out while you are asleep.  In more severe cases, the physician may recommend a walking boot or have you utilize crutches in order to help the tendon heal.  Nonsurgical treatments, such as physical therapy and changing your exercise program may also allow the tendon to heal itself over time.  In some cases, if there is no improvement from any of these treatments, surgery may be necessary in order to remove the inflamed tissue from the tendon, but this is normally a last resort.   

Prevention of Achilles Tendinitis

There are some actions you can take to try to reduce your chances of developing Achilles Tendinitis.  First, you need to increase your level of physical activity slowly rather than fast to avoid overuse of the tendon.  Second, avoid activities that will put too much stress on your tendons.  Third, make sure that the shoes you are wearing when you are exercising will provide your foot with enough of a cushion for your heel and do not have excessive wear.  Arch supports may also help, especially if you have flat feet.  Fourth, when you are ready to exercise, be sure to stretch every day.  It is important to take time to stretch your calf muscles and Achilles tendon in the morning before you exercise and after you exercise.  Fifth, strengthening your calf muscles is also helpful.  Daily exercises such as toe raises will help to train your tendons to be able to withstand more force.  Finally, cross-training your body with low impact activities can help you to strengthen your body without excessive force on the muscles and tendons, such as swimming and cycling. 

BROKEN ANKLE

A broken ankle or a broken foot is fairly common.  You have over two dozen bones in each foot and three bones in each joint of your ankle.  Every time you walk or run, these bones must withstand a pounding.  Fractures can be tiny cracks or shattering breaks, so the severity of the condition depends.  The treatment will depend on the exact location and the severity of the fracture.  A severely broken ankle or foot can need surgery in order to place screws, rods, plates, or wires into the bone for proper healing.

Symptoms of a Broken Ankle or Broken Foot

A broken ankle or broken foot can lead to many signs and symptoms.  The immediate feeling may be immediate pain that throbs, swelling, bruising, tenderness, deformity, possible protrusion of bones or bone fragments, cuts, punctures, and pain that increases with activity and decreases with rest. 

Causes of a Broken Ankle or Broken Foot

There are a number of reasons why someone might have a broken ankle or a broken foot.  First, a car accident may cause a crushing injury that may require surgery to repair the bone.  Second, tripping and falling may cause bones in your ankles or feet to break.  Additionally, jumping from high levels and landing on the foot can crush it, causing broken bones.  Third, dropping heavy items on the foot can break the bones.  Sometimes just walking and putting your foot down wrong can cause a broken bone, such as stubbing the toes.  Finally, stress fractures are common, which are actually tiny cracks that are caused over time by overuse or repetitive force, like running long distances.  This can also be caused when the bones have become weakened over time, such as in the case of osteoporosis.

There are several risk factors that may lead you to be at an increased risk for a broken ankle or broken foot.  Some of these risk factors include participation in high-impact sports such as hockey, football, tennis, gymnastics, ballet, and soccer, using improper or faulty sports equipment, and being overweight.  Other risk factors include working in certain occupations, such as construction sites.  Keeping your home poorly lit or cluttered can also lead to accidents or falls.  Certain conditions, such as osteoporosis, in which your bones are fragile, or neuropathy, in which you have poor sensation in your feet can put you at a higher risk of injury to your ankle bones and feet.

There are some complications that can occur as a result of a broken foot or a broken ankle, and although these are uncommon, they can include bone infection, arthritis that shows up much later, nerve or blood vessel damage, and compartment syndrome, which is a neuromuscular condition that causes swelling, pain, and disability in the affected muscles of the arms and legs. 

Treatment of a Broken Ankle or Foot

Treatments for broken ankles or feet may vary depending on the severity of the injury and which bone has broken.  Over the counter pain relievers may be necessary.  Therapy may also be prescribed in order to loosen up any stiff ligaments and muscles after the bone has healed.  One surgical procedure is called reduction, in which your physician may need to manipulate the pieces back into their proper position.  You may need a muscle relaxant, sedative, or general anesthetic before completing the procedure.  Immobilization must occur so that the bone can come back together.  This normally requires a cast, but in some cases, minor foot fractures may just need a removable brace or a shoe that has a stiff sole.  If a toe is fractured, it is usually taped to the next toe and a piece of gauze is placed between the two.  Finally in some cases, surgery may be necessary in which plates, screws, or pins will be needed in order to place the bones in the right position for proper healing.  After the fracture has healed completely, the screws, plates, or pins can be removed. 

Prevention of a Broken Ankle or Foot

In order to prevent a broken ankle or foot, there are some actions you can take to decrease your risk.  First, wearing proper shoes is important.  This means you should wear the right athletic shoes with enough support, wear hiking boots on rough terrain, and steel-toed boots when working in a construction environment.  Athletic shoes should be replaced regularly.  When starting a new fitness program, take it slowly instead of trying to do too much, too soon.  Alternating activities can help decrease the strain on your bones, such as rotating running with cycling or swimming.  Be sure to eat enough foods with calcium so that you have strong bones.  Finally, it may be helpful for you to use night lights and avoid walking in the dark so you don't stumble, fall, or run into anything. 

SPRAINED ANKLE

A sprained ankle occurs commonly, as sometimes all it takes to sustain this type of injury is to roll, turn, or twist your ankle in an awkward way which can stretch or tear the ligaments in your ankle that help keep it together.  The ligaments of your ankle are tough, elastic bands of fibrous tissue that are responsible for connecting bones to each other.  The ligaments stabilize your joints.  A sprained ankle will occur when the ligaments of your ankle are forced past their typical range of motion.  Treatment for this condition depends on the severity of the injury. 

Symptoms of a Sprained Ankle

Symptoms of a sprained ankle include swelling and bruising, pain, particularly when you put weight on it, and an inability to move your ankle as you normally would.  Some people experience a popping sound when the injury occurs. 

Causes of a Sprained Ankle

A sprain occurs when your ankle has to move out of its normal position, forcing one or more ligaments out of its usual range of motion, forcing it to stretch or tear.  Some situations causing a sprain include landing on your foot awkwardly after pivoting or jumping, walking or exercising on an uneven surface, and falling which causes your ankle to twist. 

Risk factors for an ankle sprain include participating in sports, especially sports that require the rolling or twisting of your foot.  Some of these sports may include football, soccer, running, tennis, volleyball, and basketball.  If you are playing sports on an uneven surface, you are also at greater risk.  If you have had a prior ankle injury, you are also more likely to sprain your ankle again.  When the condition is not treated or you engage in activities too soon after the injury, the result can be chronic joint instability, chronic pain, and early onset of arthritis in that joint.  Therefore it is important to get treatment and rest.

Treatment of a Sprained Ankle

Treatment for the condition of a sprained ankle depends on how severe the injury actually is.  In many cases, over the counter pain relievers are sufficient to handle the pain from a sprained ankle.  After the swelling has gone down after a few days following the injury, you should be able to begin physical therapy.  Physical therapy is important to improve the balance, flexibility, strength, and range of motion of your ankle.  Stability and balance training is important so that the joint has enough support.  If you were playing a sport when you injured your ankle, you should speak to your doctor about when it is appropriate for you to return to the sport.  You may need to wear an ankle brace or have your ankle wrapped in order to protect it from becoming reinjured.  If the joint of your ankle is unstable, you may need a cast or a walking boot in order to immobilize your joint so it is able to heal properly.  In very rare and serious cases, surgery may be needed to repair the damage. 

Home remedies are important while your ankle is healing.  First, you need to make sure your ankle remains protected, so you should use a splint or elastic wrap or brace to keep it from further injury.  If the sprain is severe, your doctor may put a cast or a brace around your ankle to protect it.  Rest is also an important home remedy because pain, swelling, and discomfort should be avoided.  Ice is important, and immediately when the injury occurs, the area should be iced immediately.  For the first forty-eight to seventy-two hours, ice should be used for 15 to 20 minutes for every two to three hours while awake.  The cold will help to reduce the swelling, pain, and inflammation in the injured muscles, connective tissues, and joints.  If a tear has occurred, the bleeding in the tear may slow because of ice.  However, if you have diabetes, vascular disease, or decreased sensation, you should speak to your doctor first before applying ice.  In order to stop swelling, you should compress the ankle with an elastic bandage until the swelling ceases, but be careful not to wrap it too tightly.  Also, elevate your ankle above your heart level, particularly at night. 

Prevention of a Sprained Ankle

To prevent a sprained ankle, there are some actions you can take.  First, be sure to warm up prior to exercising or playing sports.  Second, try to avoid playing on uneven areas of ground as these are risk factors for losing your footing.  Be sure to wear shoes that fit well and are well suited for your activity.  Avoid high heeled shoes.  Do not participate in sports or activities without proper conditioning and stretching.  Maintain good flexibility and strength to avoid problems.