Tricky Business Series: Ankle

Not all sports injuries are straight-forward, occasionally they can be quite tricky to repair. Luckily there are highly experienced consultants such as Dr Catherine Spencer-Smith, on hand to help.

Introducing our new mini-series in troublesome sports injuries, from Dr Catherine Spencer-Smith, Physician in Sports & Exercise Medicine – we start with tricky ankles; looking at when you should be concerned, and how you can get back on track.

 Part 1: Tricky Ankles

Ankle Sprains: When should you be concerned?

The majority of active people have experienced an ankle sprain, and yet a staggering 32% of those ‘sprains’ are still causing significant problems seven years later.

The ankle joint is an arch shape, formed by the tibia and fibula bones. The talus bone sits like a square shaped ‘key’ within the arch’s ‘lock’. The arch is reinforced with ligaments and a tough fibrous band called the syndesmosis. On the inside (or ‘medial’ side) of the ankle, a strong fan shaped structure, called the deltoid ligament links the ankle to the foot below. Similarly, three smaller ligaments (the  anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL)), form the outside or ‘lateral’ link between the ankle and the foot.

So what happens when we twist an ankle? The commonest injury mechanism is called an ‘inversion’ injury, which occurs when we roll the ankle, so that the sole of the foot is facing inwards. The lateral ligaments can all be partially or completely torn during an inversion injury, but it’s the AFTL that is most commonly affected.

Sometimes, the inversion can twist the talus bone in the arch, scuffing up the hard shiny articular cartilage, or creating a small fracture in its surface. This kind of damage can lead to long-term swelling and pain.

10% of ankle sprains involve damage to the syndesmosis at the top of the ankle arch, and this injury can occur if you fall forwards over the ankle, with the toe pointing towards the ground. It’s known as a high ankle sprain, and a ring of swelling frequently develops around the top of the ankle. This injury is less well recognised, but it’s important not to miss it, as prompt treatment (consisting of immobilising the ankle in a boot device) can prevent long term problems.

If the ankle remains mechanically unstable because of lateral ligament damage, a person may find that they repeatedly go over on the ankle, or it becomes swollen with exercise.

Thankfully, most sprains will settle with first aid, physio and exercises to improve proprioception (balance) and strength.

An ankle not improving after six weeks needs assessment by a clinician and may need investigation (e.g. with an MRI scan). Some injuries can be settled with a cortico-steroid injection.

Occasionally keyhole surgery is need to repair cartilage damage, or in the case of a ‘floppy ankle, a procedure to reconstruct torn ligaments.

If you find yourself unable to get back to sport, or are concerned about the progression of your rehabilitation, do seek expert help.  A proper diagnosis, supported by medical imaging if necessary, will ensure you get the right treatment, especially if you are not back to your sport by three months.

Look out for part two in the tricky business series, coming early November.

If you’d like to arrange an consultation with Dr Spencer-Smith please contact the Enquiry Helpline on 0207 483 5148