Ankle Injuries

The ankle, a hinge joint, is made up of three bones, the tibia, fibula, and talus.  The ankle must be stable in order to withstand 1.5 times the body weight when walking and up to 8 times when running.

ANKLE INJURIES

A broken ankle is also known as an ankle “fracture.” This means that one or more of the bones that make up the ankle joint are broken. More broken bones mean increased ankle instability.

Symptoms

  • Immediate and severe pain
  • Swelling
  • Bruising
  • Tender to the touch
  • Cannot tolerate any weight
  • Deformity

Diagnostic procedures

If symptoms suggest a fractured ankle, seek qualified orthopedic medical treatment. Treatment will include encompass a thorough examination which could include diagnostic procedure(s) such as X-rays, stress test,  MRI, and/or a CT scan in order to determine proper non-operative or operative treatment.
Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments of the ankle hold the ankle bones in position and stabilize the joint. If there is a complete tear of the ligaments, the ankle may become unstable.

Symptoms

  • Swelling
  • Bruising
  • Tenderness to touch
  • Instability
  • Hear or feel a “pop” at time of injury

Diagnostic procedures

After a possible ligament tear injury, seek qualified orthopedic medical treatment. Treatment will include encompass a thorough examination and diagnostic procedures which may include palpate and range of motion tests, X-rays, an MRI, and/or an ultrasound in order to determine proper non-operative or operative treatment.
Sprained ankles are common injuries. Approximately 25,000 people experience sprained ankles each day. High ankle sprain injures ligaments connecting the two bones of the lower leg, the tibia and fibula, at the ankle joint. Medial ankle sprain injures the inside ligaments or collectively the deltoid ligament. Low ankle sprain involves the ligaments supporting the subtalar joint which enables the foot to turn to the inside and outside.

Symptoms

  • Pain
  • Swelling
  • Bruising
  • Joint instability

Diagnostic procedures

If symptoms suggest an ankle sprain, seek qualified orthopedic medical treatment. Treatment will encompass a thorough examination, which could include diagnostic procedure(s) such as X-rays, an MRI, and a CT scan in order to determine proper non-operative or operative treatment.
Arthritis is inflammation of one or more of joints. It can cause pain and stiffness in any joint in the body, and is common in the small joints of the foot and ankle.  An ankle injury or degenerative arthritis can cause the cartilage in the joint to wear away and bone to rub against bone. Rheumatoid arthritis is an autoimmune disease that damages the bones and cartilage. Arthritis can make it difficult to walk and remain active.

Symptoms

  • Pain with motion or activity
  • Tenderness with pressure to joint
  • Swelling, warmth and redness
  • Increased pain and swelling after inactivity
  • Difficulty walking

Diagnostic procedures

If ankle inflammation is causing pain and stiffness, seek qualified orthopedic medical treatment. Treatment will encompass a thorough examination, which could include diagnostic procedure(s) such as gait analysis, X-rays, an MRI, CT scan, and laboratory tests in order to determine proper non-operative or operative treatment.

Ankle Pain Testimonials

I am a DOC patient, but was treated like a guest.

This year I climbed Acatenango, a volcano in Guatemala. It’s a two-day climb, steep and treacherous because of slippery volcanic ash. I summited at dawn as the sun came up to highlight all of the volcanoes in the distance above a low cloud cover. The closest active volcano, Fuego, erupted every hour day and night during our trek. On the 6,000 foot descent, I slipped and fell about 15 minutes from the trailhead. I heard and felt a pop and could no longer walk. Our guide carried me on his back to the waiting van and used the ice, which was cooling beers, to reduce the swelling on my ankle and foot.

I flew back from Guatemala the next day for an examination, X-rays and treatment at Direct Orthopedic Care. The upper part of the ankle joint comes from the tibia (shin) and the fibula (outer leg). The ends of these two bones are the malleoli. I fractured both sides of the ankle, tibia and lateral malleolus and tore multiple ligaments. I had no stability to enable me to walk without displacing the fractures. My only option was surgery to keep the bones in alignment while healing and ultimately regain normal movement.

The broken bones were held in the correct position with a metal plate and screws. I was non-weight-bearing in a boot for six weeks. Then I put weight on the ankle, but in the boot, for another six weeks.

I learned that plates and screws used to fix an ankle fracture are not removed if they don’t cause problems and most people do not have problems. Ankle hardware can remain in place permanently. According Kaiser Permanente statistics, 80% of patients never have the standard hardware removed. So about 20% of Kaiser’s patients notice hardware prominence that is irritating enough to warrant surgery.

I climb mountains all over the world. I snow ski. I go to high-impact aerobics every day. In my situation, the hardware needed to be removed because I could feel it, especially after a big hike or ski day. DOC removed the screws with a local anesthetic and two tiny incisions. Nearly 68% of patients improve after hardware removal. I improved with the screws gone.

The plate is still on the outside of my ankle hugging the malleolus. A plate is a flat piece of metal made of titanium or stainless steel that has holes in it for the screws. The plate fits on the surface of a fractured bone. All the plate does is hold the fractured bone pieces together while they heal. After the bone heals, the screws and plate serve no function at all.

I will have DOC remove the plate at the end of ski season and before serious hiking begins. The incision is the same as the original surgery. My fractures are healed. I am told that the risk of surgery is slightly higher because of the scar tissue present over the plate. However, I implicitly trust my DOC surgeon.


Foot Pain Treatment Testimonials

nancy's foot pain and treatmentNancy felt like she was walking on a pebble and endured fiery pain in the ball of her foot. She has a condition called Morton's neuroma. The digital nerve passes under the ligament connecting the toe bones in the forefoot. Morton’s neuroma is a thickening of the tissue that surrounds the digital nerve. It usually develops between the third and fourth toes in response to irritation, trauma or excessive pressure.

Symptoms include burning pain in the ball of the foot that may radiate into the toes, intensified pain with activity and numbness in the toes. The incidence of Morton's neuroma is 8 to 10 times greater in women than in men. High-heeled and tight, narrow shoes can aggravate the condition by compressing the toe bones and pinching the nerve. Sports that require tight fitting shoes, such as skiing, are more likely to cause Morton’s neuroma. High impact activities, hiking or running, can put pressure on the ligament and cause thickening of the nerve.

Nancy did not wear pointed-toed, high-heels, but she did wear ski and hiking boots in Colorado. During an 11-mile hike close to Vail called Two Elk, her Morton’s neuroma was excruciatingly painful. In order to finish the hike, she hobbled in her sock over the rocky trail. She relieved the symptoms temporarily by removing her boot, massaging her foot and soaking it in a mountain stream.

The best time to see your orthopedic specialist at DOC is early in the development of symptoms because early diagnosis of a Morton’s neuroma lessens the need for surgery. After the Colorado hike, Nancy went to DOC. During the examination, the DOC physician felt for a palpable mass between the toe bones. Range of motion tests ruled out arthritis or joint inflammation and X-rays eliminated a stress fracture or arthritis of the joints diagnosis. Nancy definitely has Morton’s neuroma.

Her initial treatments were nonsurgical: Changes in footwear. Shoes with low heels and a wide toe-box. Nancy prefers Danskos. Icing. Icepack on affected area or cold mountain stream if available. Orthotic devices. Custom shoe inserts. Anti-inflammatory drugs. Ibuprofen to reduce pain and inflammation. Injection therapy. One or more injections of a corticosteroid medication.

Nancy benefited from the DOC suggestions, including injection therapy. “DOC gave me an injection before I backpacked for 21 days in Nepal and another injection prior to a three-week trek in Patagonia. A cortisone shot was the perfect solution for me to be pain free and continue my active lifestyle.”

Nonsurgical treatments provide relief in over 80 percent of people with Morton's Neuroma. If conservative treatment does not relieve your symptoms, your DOC orthopedic surgeon may discuss surgical treatment options with you.

Sources:
https://www.mortonsneuroma.com/mortons-neuroma/
http://orthoinfo.aaos.org/topic.cfm?topic=a00158
https://www.foothealthfacts.org/conditions/morton-s-neuroma-(intermetatarsal-neuroma)

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