Common ankle injuries in sports and exercise

Ankle injuries are some of the most common injuries in sports and exercise. Some ankle injuries are minor, and you recover with only short periods of rest. Other ankle injuries can require you to undergo surgery. They might even keep you out of sports for a long period of time. Here are some of the common ankle injuries that athletes and athletic individuals often suffer.

Ankle sprain

Almost every sport presents a risk for the most common injury – ankle sprains. Inversion injuries to the ankle can injure the ligaments on the lateral side (side away from the midline of the body) of your ankle, causing an ankle sprain. The injury can be a mild sprain that causes you to miss only a few days or 1-2 weeks of your sport or exercise. On the other hand, more severe sprains might keep you out for 4 to 6 weeks. You rarely need surgery for an acute ankle sprain. An orthopaedic surgeon might prescribe ice, rest, a brace or taping, and physical therapy to help you return to play.

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Ankle sprains

High ankle sprain

A syndesmosis injury involves tearing of the ligaments between the ends of the tibia and fibula. This ankle injury is commonly called a “high ankle sprain.” It isn’t necessarily a separate injury but rather one that often occurs in combination with injuries to the ankle ligaments. You will feel pain above your ankle in addition to the lateral side of the ankle. This injury often takes longer to heal than a traditional ankle sprain. Seeing a doctor or orthopaedic surgeon can be important, as proper diagnosis can help you plan a longer absence from sports. Fortunately
surgery is rarely required.

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High ankle sprain

High ankle sprain, one of the common ankle injuries

Lateral malleolus fracture

This is a fracture of the 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 instead of the lateral ligaments below the bone. Orthopaedic surgeons treat nondisplaced or minimally displaced fractures in a cast or boot. We usually fix displaced fractures surgically with a plate and screws.

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Ankle Fractures

Jones fracture

The metatarsals are the long bones of the foot. The fifth metatarsal refers to the long bone on the lateral (outside) side of the foot beneath the little toe. A Jones fracture refers to a fracture in a specific location along the fifth metatarsal. This particular fracture typically occurs at the junction between the base of the bone and the midshaft (long, cylindrical middle portion of the bone). A fracture in this location has a real risk of not healing – nonunion. Due to the risk of nonunion in athletes, orthopaedic surgeons often treat these fractures surgically. Surgery usually involves placement of a screw inside the bone across 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.

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Jones fracture

Achilles tendon rupture

The Achilles tendon connects the gastrocsoleus (calf) muscles to the calcaneus (heel bone). Rupture of the Achilles tendon is one of the more painful and difficult ankle injuries in sports. A noncontact mechanism usually causes the tear. You might remember starting to sprint suddenly from a period of standing. Or you might plant your foot to change directions. You feel a pop and sharp, stabbing pain. Often the injury is so painful that you think someone kicked you in the ankle or leg. We often perform surgery for athletes and active people, although non-surgical treatment can get the tendon to heal. Return to sports can take up to 6-12 months.

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Achilles tendon rupture

Peroneal tendon subluxation

The peroneal tendons are two tendons that travel behind the lateral malleolus on the outside of the ankle. The sheath that holds them in place behind the lateral malleolus can rupture with an inversion injury, like those that cause ankle sprains. The tendons can then slide back and forth across the lateral malleolus with ankle motion. Surgery is usually needed to repair the tissue that holds the tendons in order to prevent these tendons from sliding out of place while you are performing physical activities.

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Peroneal tendon subluxation

Location of the peroneal tendons, site of common ankle injuries

Fracture of the lateral process of the talus

This fracture is a less common ankle injury, often afflicting snowboarders. You could fracture a small portion of the talus (bone under the ankle) with the same inversion mechanism that occurs in an ankle sprain. X-rays, or often a CT scan or MRI study, is often required to make the diagnosis.

Take home message

Some of these ankle injuries are not serious, while some require extensive absences from your sport or exercise and even surgery. If your ankle injury keeps you out for any period of time, it can be worthwhile to see an orthopaedic surgeon or sports medicine doctor for evaluation and treatment.

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