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Ankle injuries: Causes and treatments

Ankle injuries are common among people taking part in sport, but can also happen in falls and accidents around the home.

Sprains and fractures are the most common ankle injuries, but strains and tendon tearing is also possible.

Ankle sprains account for up to 1.5 million visits to A&E in the UK every year.

What kinds of ankle injuries are there?

Ankle injuries are defined by the kind of tissue - bone, ligament or tendon - that's damaged. The ankle is where three bones meet - the tibia and fibula from your leg and the talus from your foot. These are held together at the ankle joint by ligaments, which are elastic bands of connective tissue. These keep the bones in place while stretching to permit normal movement. There are also muscles and tendons that protect the ankle joint, do the work of making the foot move and help to hold the joint in place.

A fracture occurs when there is a break in one or more of the bones. A sprain is the term that describes damage to ligaments when they are stretched beyond their normal range of movement. A sprain can range from microscopic tears in the fibres that comprise the ligament to complete tears or ruptures of the ligament. A strain refers to damage done to muscles and tendons, which connect muscles to bones, as a result of being pulled or stretched too far.

Muscle sprains are more common in the legs and lower back. There are two tendons at the ankle that stabilise the ankle and foot and protect them from sprains. These are the peroneal tendons. They can become inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, rupture or slip out of place.

Acute tears result from repetitive activity or trauma. If the tears are degenerative, meaning they occur over a long period of time as a result of being overstretched, the condition is called tendonosis. The tendons can slip out of place - subluxation - as a result of either a trauma or a variation in the shape of the bone or muscle.

What causes ankle injuries?

Fractures and sprains can result from the ankle joint being twisted too far out of its normal position. This can happen as a result of:

  • Tripping or falling
  • Landing awkwardly after a jump
  • Walking or running on uneven surfaces
  • A sudden impact such as a car crash
  • Twisting or rotating the ankle
  • Rolling the ankle

Most ankle injuries occur either during sports activities or while walking on an uneven surface that forces the foot and ankle into an unnatural position.

Are there different signs for different ankle injuries?

The signs of a sprain and the signs of a fracture are very similar. In fact, fractures can sometimes be mistaken for sprains. That's why it's important to have an ankle injury evaluated by a doctor as soon as possible. The signs include:

  • Pain, often sudden and severe
  • Swelling
  • Bruising
  • Inability to walk or bear weight on the injured joint
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