Your ankles connect your leg bones to your foot bones, but many people don't realize there are bones and muscles inside the ankle too.
Arthritis, sprains, contractures and fractures are some of the most common ankle problems. The soft tissue, muscle and bones are all in such close proximity to one another that ankle conditions and injuries can become a serious problem.
Treatment for ankle pain is dependent upon the diagnosis.
Tendonitis, the abnormal stretching of a tendon, may require physical therapy.
Tendonosis, a partial tear of a tendon, may require immobilization and then therapy.
A chronic condition, one which gets worse over time but which is not due to a specific injury, may be treated with support such as a brace or orthotic shoe insert.
The two most common ankle injuries are sprains and fractures. Ankle sprain involves stretching the ligaments that support the ankle, either on the inside (medial) of the ankle, or the outside (lateral) of the ankle, which is more common. Pain and swelling are normal. A very severe sprain can cause instability in the ankle. Most sprains are treated conservatively with bracing and physical therapy. Very severe sprains that do not heal well may require surgery if the ankle is unstable. However, that is the exception rather than the norm. Surgery may also be necessary if the ankle ligaments are completely torn or disrupted.
If the sprain is chronic, not something that happens acutely, but over time, certain stress x-rays may be taken to determine if there is any instability, then the ligaments can be reconstructed.
Ankle Fractures
An ankle fracture is an injury that results in an actual break. Fractures can be treated either with a cast or with surgery involving plates and screws.
An ankle fracture that is not significantly displaced can usually be treated with a cast, the theory being that you can reduce it in a cast. Once the swelling is down it will probably re-displace. An injury with any significant displacement, especially with disruption of the ankle mortise, which is basically the stability of the ankle joint, will be repaired surgically. There are very good ways to fix ankle fractures so that the healing process is better, more predictable, and sometimes a little quicker.
Delayed healing is not too common with ankle fractures but it can happen in patients who have had very severe injuries at the outset or patients that are not healthy, such as diabetics or smokers. When healing is not progressing the way that it should, something needs to be done to speed it along.
Healing can be impacted by different factors such as "fracture factors," "patient factors," and "doctor factors."
How well a fracture will heal is affected by the location in the bone, how badly it is displaced, and how good the blood supply is to the bone.
Patient behavior is also critical in the healing process. It is important that patients cooperate with the treatment protocol. The patient must keep the weight off the fracture as instructed. Patient health is important to the healing process Metabolic diseases such as obesity and diabetes, or smoking can impede healing.
Fractures at the end of the tibia, the tibial plafond or the distal tibia, can be very severe injuries, and difficult to heal. It is not unusual to have to use something to facilitate healing, especially if the fracture is open where bone is exposed to the outside. The more severe the injury, the greater the risk that it will not heal easily.
Bone Stimulation for Ankle Fractures
Some ankle fractures heal more slowly than others. In these cases, the healing process must be helped along. Electrical bone growth stimulation can be used in cases where healing is slower than expected such as in a more severe type of injury.
Ankle Fusions
Ankle degeneration, such as degenerative arthritis, is often repaired using ankle fusion, also known as arthrodesis. The ankle joint includes the ends of the tibia and fibula, the leg bones, and the talus, one of the foot bones. The talus sits on top of the calcaneus, which we call the heel bone. The talus acts like a hinge as you walk. Ligaments and muscles hold everything together and allow your foot to move.
The insides of the joints are covered in cartilage, which allows for smooth movement. As this cartilage degrades, a process known as osteoarthritis, joint movement can become painful.
As in the spine, ankle fusion joins two or more bones to prevent movement and the associated pain. With surgical treatment, a part of the talus bone is removed and the tibia and fibula are joined with the calcaneus. Although the ankle joint becomes more rigid than before, the severe pain is often relieved. However, an ankle fusion may cause pressure to be exerted on other bones of the foot, resulting in arthritis developing over time. Other risks include a nonunion due to poor bone healing. To treat a nonunion in the ankle, a second operation may be required to insert bone graft material, as well as an external fixator. Electrical bone growth stimulation is often used to enhance healing.
Malunion means that the bones heal, but in an undesired configuration. If the malunion is debilitating, surgery may be required to correct it.