“Oh, my aching ankle.” That’s a common refrain, some version of which we hear frequently at Essex Union Podiatry. Ankles are the source of some of the most common bone and joint injuries. While there are a variety of causes, and subsequently a variety of treatment solutions, it is crucial to understand two important sources of ankle pain: a sprain or a break (or fracture).
How common are these injuries? More than a million people head to the emergency room every year with ankle injuries, and for 25,000 people a day, they are ankle sprains. And ankle fractures are numbered at approximately 187 annually for every 100,000 people, a number that is on the rise.
Sprains and breaks can occur in a variety of ways—from stepping awkwardly off a curb or falling, and increasingly, from all levels of fitness and sports activities.
Sprain Versus Break
These two injuries can result in similar symptoms and can be hard for people to differentiate. It is important to understand the differences.
The ankle joint is made up of bones, muscles, cartilage, ligaments and tendons. An ankle sprain occurs when the ligaments, a strong band of tissue that support and stabilize the ankle bones, are stretched or torn. This happens when the ankle is moved in awkwardly with a twist, turn or roll.
A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. This can stretch or tear the tough bands of tissue (ligaments) that help hold your ankle bones together.
Lateral ligament sprain-This is the most common ankle sprain, one which causes a throbbing pain on the outside of the ankle. This sprain may also cause swelling and bruising. With a tear, you may also have a distinct feeling of the joint giving out.
Medial and high ankle sprains-These are less frequent that lateral ligament sprains and usually occur if the ankle rolls outward. Pain is present on the inside of the ankle. If the foot rotates out in relation to the leg, it can cause a high ankle sprain (commonly seen in football players), characterized by pain above the ankle.
Symptoms of an Ankle Sprain
- Discolored skin
- Inability to bear weight
- Tender to the touch
An ankle fracture occurs when one or more of the related bones is broken. These include the lower leg bones
- Fibula—smaller bone of the lower leg, sometimes referred to as the calf bone
- Talus—foot bones
The injury can range from a simple, single break, to fractures of several bones at once. While you may still be able to walk on a single fracture, multiple fractures—which may also include ligament damage—may prevent you from walking, and require no weight bearing for several months to heal. People often have misconceptions about ankle fractures that can impede treatment and healing.
Symptoms of an Ankle Fracture
Depending on the severity of the break(s), you may experience:
- Ankle deformity
- Inability to bear weight
- Immediate, severe pain
- Tenderness to the touch
If pain is severe or prolonged (beyond five to seven days), your first step should be medical care. While a mild sprain can heal with self-treatment (see R.I.C.E. below), if symptoms persist you should seek medical care. In addition, sprains can be tricky, as weakened ligaments tend to result in vulnerability to future injury or problems, such as ankle instability.
A visit to a physician for ankle injury begins with the doctor taking a medical history and doing a physical exam of the injured area. Before ordering an imaging test, healthcare practitioners may use a set of diagnostic guidelines called the Ottawa Ankle Rules to determine if an X-ray is necessary. Tests for sprains or breaks may include:
- X-ray stress test
- CT (computed tomography) scan
- MRI (magnetic resonance imaging)
Doctors will usually start with an X-ray, because these types of imaging tests are particularly useful in diagnosing (or ruling out) fractures. The calcium in bone absorbs the X-rays, making bone stand out on the image. Fractures can often be seen clearly on an X-ray. If the X-ray shows no fracture or proves inconclusive, other imaging tests may be used.
The primary remedy for ankle injury is the classic R.I.C.E. This stands for rest, ice, compression, elevation. In addition, over-the-counter anti-inflammatories can be used if they do not conflict with other medications you may be taking. In addition to R.I.C.E. and anti-inflammatories, a sprain may be treated by:
- Keeping weight off with the use of crutches
- Elastic bandages
Depending on type and severity, a fracture may be treated by:
- Immobilization—requiring a cast, brace, boot or stiff-soled shoe
- Reduction—used to manipulate misplaced bones back into proper position
- Surgery—in the case of a severe fracture(s) and/or ankle instability, surgery may be performed. This includes the use of instrumentation (pins, screws, plates) to properly position bones for healing. These implements may or may not be removed.
If you experience an ankle injury, request an appointment with an Essex Union Podiatry specialist. We have decades of combined experience diagnosing the type of injury (sprain or break), and we will tailor a treatment plan for you as well as provide education on preventive measures to hopefully keep these injuries from recurring.