The ankle is one of the most constantly used and one of the most frequently injured parts of the human body. Children and young military service members in particular put the ankle to the test running, jumping, turning sharply and accelerating quickly. One wrong step can end in a sprain or fracture of the ankle, incapacitating the owner for several weeks.
Servicemembers are susceptible to ankle injuries because of the requirements and characteristics of military life. Physical training, field duty and after-work athletic activities on often uneven terrain or ungrooved surfaces put servicemembers’ ankles at greater risk than normal activities.
Softball, in part because of the sheer number of players, seems to take out more ankles than any other activity. Often softball players hit the diamond unprepared, overextend themselves and suffer an ankle injury as a result.
The ankle consists of a single anklebone – the talus – connected to the two bones of the leg like a hinge joint. Between the talus and the leg bones is a padding of cartilage to protect the bones from wear and tear. The bones are connected by ligaments, tendons and muscles that move the foot and strengthen the ankle joint.
The classic ankle injury is a sprain. Sprains occur most often when the foot inverts or rolls over on the side, stretching or tearing the ligaments on the outside of the ankle. One, two or three of the main ligaments may be stretched or torn. Whether an ankle is sprained or fractured depends on the speed and degree of the force and how far the force is carried across the ankle. A sprain can be as debilitating as a fracture because ligaments do not heal well.
A ligament heals by forming scar tissue and may or may not reform a good ligament. If there is too much motion in the ankle during the healing process, the scar tissue will be stretched forming a ligament that is too lax. This can cause chronic pain and instability in the ankle. Treatment of a sprain depends on the degree of the trauma and swelling caused by the sprain and may range from an ace wrap, to a short leg cast to surgery.
Tendonitis – an inflammation affecting the small tendons of the foot – is another common ankle injury. It is caused by overuse of the ankle and foot and is commonly seen in people who participate in repetitive sports such as running and aerobics. Tendonitis is also common in servicemembers who ordinarily have a desk job but intermittently go to the field. While in the field, they may be required to do a lot of hiking or engage in other physical activity for which they are unprepared.
In tendonitis, an inflammation develops along the tendon sheath. Tendons connect muscles to bones. Every tendon is surrounded by a sheath which has a small amount of fluid in it allowing the tendon to glide smoothly when it is pulled by a muscle.
The inflammation of the tissue surrounding the tendon sheath causes pain with motion of the muscle to which it is attached. There is also a creaking sensation in the tendon as it moves.
Tendonitis usually improves with three to four weeks of rest and anti-inflammatory medication such as aspirin. However, even though the pain has subsided, the area is still sensitive and this ankle injury can easily reoccur so one must be careful not to overuse the ankle during this period.
The Achilles tendon, which connects the calf muscle to the heel bone, is subject to tendonitis and tendon rupture. A rupture is a debilitating injury that usually requires six months of treatment either with a cast or surgery before normal activities can be resumed. The type of treatment depends on the individual’s injury and lifestyle.
Sports in which ruptures occur tend to be those calling for sudden bursts of activity, such as basketball, tennis and other court sports. The rupture is instantaneous and has been described by patients as a sharp, scaring or stabbing pain accompanied by an audible snap. The victim is then unable to push off with his foot.
Self-treatment for ankle injuries, as for most sports injuries, is to elevate the ankle above the level of the heart, to immobilize the ankle and to put ice on it for an hour to an hour and a half at a time. These steps should be followed for at least 72 hours. If the pain or swelling persists, the victim should see a doctor for further evaluation and treatment.
Those who experience a pop or snapping sound along with the ankle injury should seek medical treatment sooner so X-rays can be taken to determine if there is a fracture.
Recurrent ankle injuries over many years can wear away the cartilage in the ankle joint and lead to degenerative arthritis.
Ankle injuries can be prevented by warming up before participating in sports or strenuous activity and, above all, by realizing that the older one gets the more essential it is to gradually build into an activity.