Ankle injuries are often associated with sports, but you don’t need to be an athlete—or even a weekend warrior—to hurt your ankle. Simply stepping on an uneven surface can lead to a painful and limiting sprain.
These injuries can happen to anyone, regardless of age. That said, certain groups are more prone to them. Men between the ages of 15 and 24 experience higher rates of ankle sprains, while women over 30 are more likely to sprain their ankles than men of the same age group.
Athletic activities account for about half of all ankle sprains, but they’re surprisingly common in everyday life, too.
The most frequent ankle injuries include sprains and fractures, which affect the ligaments and bones. However, tendons in the ankle can also be strained or torn, adding to the list of potential complications.
What Types of Ankle Injuries Can Occur?
Ankle injuries are categorized based on the type of tissue that’s damaged—whether it’s bone, ligament, or tendon. The ankle is a complex joint where three bones come together: the tibia and fibula in the lower leg and the talus in the foot.
Ligaments, which are strong, elastic bands of connective tissue, hold these bones in place and allow for normal ankle movement. Tendons, on the other hand, connect muscles to bones. They not only help move the ankle and foot but also play a key role in stabilizing the joint. When any of these structures are injured, it can affect both movement and stability.
A fracture refers to a break in one or more of the bones. A sprain occurs when ligaments are stretched beyond their normal range of motion, causing damage that can range from tiny tears in the ligament fibers to a complete tear or rupture. A strain, on the other hand, involves damage to muscles or tendons caused by overstretching or pulling.
Muscle and tendon strains are more common in areas like the legs and lower back. In the ankle, two tendons frequently affected by strain are the peroneal tendons. These tendons play a crucial role in stabilizing and protecting the ankle. Overuse or trauma can cause these tendons to become inflamed, a condition known as tendinitis.
Sudden trauma or force can lead to acute tendon tears, while repetitive overstretching that doesn't heal properly can cause tendinosis, which involves microscopic tears that accumulate over time. In more severe cases, tendons can rupture entirely. Another condition, subluxation, occurs when a tendon slips out of its normal position, further destabilizing the joint.
What Causes Ankle Injuries?
Ankle injuries happen when the joint is twisted or forced out of its normal position. This often occurs during sports or while walking on uneven surfaces that cause the foot and ankle to move unnaturally. Faulty footwear, such as high heels or loose-fitting clogs and sandals, can also increase the risk of injury by placing the ankle in an unstable position.
Common causes of ankle injuries include:
- Tripping or falling
- Landing awkwardly after a jump
- Walking or running on uneven surfaces
- A sudden impact, such as during a car accident
- Twisting or rotating the ankle
- Rolling the ankle
These scenarios can strain the bones, ligaments, or tendons, leading to sprains, strains, or fractures.
Are There Different Signs for Different Ankle Injuries?
The symptoms of an ankle sprain and a fracture can be very similar, which is why it’s crucial to have any ankle injury evaluated by a doctor promptly. Some common signs of an ankle injury include:
- Sudden and severe pain
- Swelling
- Bruising
- Difficulty walking or bearing weight on the affected joint
There are subtle differences between a sprain and a fracture that can help identify the type of injury. In the case of a sprain, the ankle may feel stiff. A fracture, however, often causes tenderness in the area and may result in the ankle appearing deformed or out of place. A proper medical evaluation is essential to determine the exact nature of the injury and ensure appropriate treatment.
If the sprain is mild, pain and swelling are usually minimal. However, a severe sprain typically causes significant swelling and intense pain.
Tendinitis and acute tears of the peroneal tendon share symptoms like pain and swelling. Tendinitis often makes the ankle feel warm to the touch, while an acute tear can lead to noticeable weakness or instability in the foot and ankle.
Tendinosis, a condition that develops over years, presents with symptoms such as:
- Sporadic pain on the outside of the ankle
- Weakness or instability in the ankle
- A noticeable increase in the arch of the foot
With subluxation, signs include ankle instability or weakness, sporadic pain behind the outside ankle bone, and a distinct "snapping" sensation around the ankle bone. These symptoms indicate underlying tendon issues and should be evaluated by a healthcare professional.
What to Do After an Ankle Injury
Treating an ankle injury starts with the R.I.C.E. method: Rest, Ice, Compression, and Elevation.
- Rest: Avoid putting weight on the injured ankle to prevent further damage. Use crutches or a supportive device if needed.
- Ice: Apply ice to reduce swelling and numb the pain. Ice should be used within 48 hours of the injury. Avoid leaving it on for more than 15-20 minutes at a time to prevent frostbite. Allow a 40-45 minute break between icing sessions to let tissues return to their normal temperature. Use a freezer bag filled with ice and water, or a frozen bag of peas or corn (don’t refreeze or consume the vegetables after use). Place a towel between the ice and your skin for protection.
- Compression: Wrap the ankle with an elastic bandage or a compression wrap to provide support and reduce swelling. Be careful not to wrap it too tightly; if your toes become cold, blue, or numb, loosen the bandage.
- Elevation: Keep the injured ankle raised to at least heart level to help reduce swelling and discomfort.
Following these steps promptly can help manage pain and swelling and promote recovery. If symptoms persist or worsen, seek medical attention.
It’s essential to avoid putting any weight on an injured ankle until a doctor has evaluated it. Prompt medical attention is crucial, as untreated or improperly managed fractures and sprains can lead to long-term issues, such as chronic ankle weakness, repeated injuries, or arthritis.
How Is an Ankle Injury Diagnosed?
When diagnosing an ankle injury, the doctor will first ask about how the injury happened to understand the mechanism of the damage. Next, they will perform a physical examination, checking for swelling, bruising, and tenderness.
This exam might involve moving the ankle to assess the range of motion and pinpoint areas of pain or instability. While this part of the evaluation may be uncomfortable, it is necessary to determine the severity of the injury and guide the appropriate treatment plan. Once diagnosed, the doctor might advise appropriate treatment for the ankle injury. Ankle sprains, tendon injuries, and fractures require different treatment approaches.
Can Ankle Injuries Be Prevented?
Yes, ankle injuries can often be prevented or minimized through flexibility, strengthening, and balance exercises. These exercises help protect your ligaments and improve the overall stability of your ankles, reducing the risk of injury or re-injury.
Tips to Protect Your Ankles
Here are some simple precautions to help prevent ankle sprains:
- Rest when needed: Avoid exercising or playing sports if you're feeling tired or in pain.
- Warm up properly: Always do ankle stretches before engaging in sports or exercise to prepare your muscles and ligaments.
- Watch your step: Be cautious when walking on uneven surfaces or cracked sidewalks to avoid misstepping and twisting your ankle.
- Run on flat ground: Running on smooth, even surfaces reduces the likelihood of twisting or injuring your ankle.
- Strengthen your body: Tailor your workouts to build strength specific to the sport you're involved in, helping to support your ankle and prevent injury.
- Choose the right footwear: Wear shoes that fit well and suit the activity you're doing. For walking or running, opt for athletic shoes with cushioning in the heel and arch. For court sports, choose shoes that are wider and flatter. Hiking boots with ankle support are essential for uneven terrain. Consider shoe inserts to maintain proper alignment and support for your arch.
- Avoid worn-out shoes: Don’t wear shoes with heels that are worn down on one side, as they can lead to imbalance and increase injury risk.
- Ditch the stilettos: High heels are a leading cause of ankle sprains, especially for women. Consider more supportive footwear to reduce the strain on your ankles.
