John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
The difference between doctors who look after mere mortals and those who look
after elite athletes may have to do with how many tests they can order,
regardless of the cost. And when X-ray and
MRI reports lead the news, it makes
it difficult for family doctors to explain why those tests aren't necessarily
appropriate for them (or even the elite athlete).
Ankle sprains are common injuries and historically, patients expected that
if they went to the ER or their doctor's office, they would have an X-ray taken to prove
there were no broken bones. As it turns out, the vast majority of those ankle
X-rays done were normal and, in retrospect, could be seen as expensive, wasteful,
and posed another opportunity to expose a person to unneeded radiation. Ian Stiell
and his colleagues in Ottawa, Canada completed a study that showed it was not
useful to order all those tests, since less than 15% of those ankle X-rays were
positive for a fracture. The results of the study also allowed Dr. Stiell to
develop the Ottawa ankle rule guidelines. They give the doctor and the patient a
starting point for the discussion about care and treatment for ankle injuries.
Ankle injuries are among the most common of the bone and joint injuries.
Often, the degree of pain, the inability to walk, or concern that a bone may be
broken is what usually causes people to seek care for an ankle injury.
The main concern is whether there is a broken bone. Frequently it is
difficult to distinguish a fracture (broken bone) over a
sprain,
dislocation, or
tendon injury without
X-rays of the ankle.
The ankle joint is made up of three bones that articulate together, the
tibia, fibula, and talus (some authors also include the calcaneus bone and
label the joint as the subtalar joint and considerate it part of the ankle):
The tibia, the main bone of the lower leg, makes up the medial, or
inside, anklebone.
The fibula is a smaller bone that parallels the tibia in the lower
leg and makes up the lateral, or outside, anklebone.
The far ends of both the tibia and fibula are known as the
malleoli (singular is malleolus). These malleoli are the lumps of bone
that you can see and feel on the inside and outside of the ankle.
Together they form an arch or mortise (a recess) that sits on top of the
talus, one of the bones in the foot.
A fibrous membrane called the joint capsule, lined with a smoother
layer called the synovium, encases the joint architecture. The joint capsule
contains the synovial fluid produced by the synovium. The synovial fluid
allows for smooth movement of the joint surfaces.
The ankle joint is stabilized by several groups of ligaments, which
are fibers that hold these bones in place. They are the capsule ligament,
deltoid ligament, the anterior and posterior talofibular ligaments, and the
calcaneofibular ligament. Some of these ligaments may be disrupted if the
ankle is fractured.
Broken Ankle Causes
When a person stresses the ankle joint beyond the strength of its elements,
the joint becomes injured.
If only the ligaments give way and tear, the damage is a
sprained ankle.
If a bone gives way and breaks, the damage is an ankle fracture.
Fractures can occur with simultaneous tears of the ligaments. This can
happen in several ways:
Rolling the ankle in or out
Twisting the ankle side to side
Extreme flexing or extending of the joint
Severe force applied to the joint by coming straight down on it as in
jumping from a high level
The body is meant to move. Muscles allow that movement to happen by contracting and making joints flex, extend and rotate. Muscles attach on each side of the joint to bone by thick bands of fibrous tissue called tendons. When a muscle contracts, it shortens and pulls on the tendon, which allows the joint to go through a range of motion.
A strain occurs when the muscle tendon unit is stretched or torn. The most common reason is the overuse and stretching of the muscle. The damage may occur in three areas:
The muscle itself may tear.
The area where the muscle and tendon blend can tear.
The tendon may tear partially or completely (rupture).
Joints are stabilized by thick bands of tissue called ligaments which surround them. These ligaments allow the joint to move only in specific directions. Some joints move in multiple planes; therefore, they need mor...
