The ankle is one of the most commonly injured joints in sports and exercise. Sometimes an ankle injury is not serious. They can resolve with short periods of rest and other non-surgical treatments. Others require surgery, and they can lead to long absences from activities. This article describes some of the common injuries around the ankle that athletes and athletic people often suffer.

Ankle injury #1: Ankle sprain

Inversion injuries (rolling your ankle) to the ankle can injure the ligaments on the lateral side (side away from the midline of the body) of the ankle. The resulting ankle sprain can be a mild injury that causes only a few days or 1-2 weeks out of sports. More severe ankle sprains can keep an athlete out for 4 to 6 weeks. Surgery is usually unnecessary for an acute ankle sprain. Ice, rest, wearing an ankle brace, taping the ankle, and physical therapy are some of the non-surgical treatments used to help an athlete return to play.

Ankle brace after ankle sprain

Ankle injury #2: Achilles tendon rupture

The Achilles tendon connects the calf muscles to the calcaneus (heel bone). In an athlete, an Achilles tendon rupture is usually caused by a noncontact mechanism. Often the patient remembers starting a sprint from a period of standing. Or he might plant his foot to change directions. He feels a pop and sharp pain. Often the event is so painful that he thinks someone kicked him in the back of the ankle. Many active people choose surgery to regain calf strength quickly. The recovery is still lengthy, and return to sports can take up to 6-12 months.

Ankle injury #3: Lateral malleolus fracture

A lateral malleolus fracture is a fracture of the ankle. Specifically, the fracture involves distal aspect of the fibula, or the bony prominence on the outside of the ankle. The athlete will have pain on the bone at the fracture site. A nondisplaced or minimally displaced fracture can be treated in a cast or boot, while a displaced fracture often requires surgery. A medial malleolus fracture involves the bone on the inside of the ankle. Active patients can injure the bones on both sides of the ankle, creating a bimalleolar ankle fracture that usually needs surgery.

Ankle injury #4: Syndesmosis injury (“High ankle sprain”)

A syndesmosis injury is commonly called a “high ankle sprain.” It often occurs in combination with injuries to the ankle ligaments. A syndesmosis injury involves tearing of the ligaments between the ends of the tibia and fibula. A patient feels pain above the ankle in addition to the lateral side of the ankle. This injury takes longer to heal than a traditional ankle sprain. Fortunately, surgery is rarely required.

Ankle injury #5: Jones fracture

A Jones fracture refers to a fracture in a specific location along the fifth metatarsal. This is the long bone on the lateral (outside) side of the foot beneath the little toe. This particular fracture typically occurs at the junction between the base of the bone and the midshaft (long, cylindrical middle portion of the bone). Fractures in these location don’t always heal. Due to that risk of nonunion in athletes, surgeons often offer surgery to fix the fracture. If nonoperative treatment, such as a cast or a boot, is attempted, close observation with regular x-rays is critical to ensure that the fracture is healing appropriately. Surgery usually involves placement of a screw inside the bone across the fracture.

X-ray of Jones fracture, a common ankle injury
The surgeon has inserted a screw down the center of the fifth metatarsal in this professional athlete.

Ankle injury #6: Peroneal tendon subluxation

Peroneal tendon subluxation is an injury that involves the peroneal tendons that travel behind the lateral malleolus on the outside of the ankle. A sheath normally holds them in place behind the lateral malleolus. That sheath can rupture with an inversion injury like an ankle sprain. The tendons can then slide back and forth across the lateral malleolus with ankle motion. Surgery to repair the tissue that holds the tendons in place can prevent these tendons from subluxing.

Ankle injury #7: Lateral process of the talus fracture

This is a fracture of a small portion of the talus. This fracture can also occur with the similar inversion mechanism that causes some of the other ankle injuries listed above. Snowboarders often suffer this fracture. X-rays, or often a CT scan or MRI study, is often required to make the diagnosis.

Some of these ankle injuries are not serious. On the other hand, some ankle injuries require lengthy absences from sports and exercise. Many even require surgery. It can be worthwhile for an athlete or active person to see an orthopedic surgeon or sports medicine doctor for evaluation and treatment.

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