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The Ankle Joint - Don't Get it Twisted

The Ankle Joint 

There are many different joints that make up the ankle/foot, each playing a vital role in the biomechanics of the ankle and the foot.  For now, we are going to focus on the primary joint of the ankle; the talocrural joint.

The talocrural joint is made up of the distal tibia and fibula articulating with the talus.  Dorsiflexion and plantar flexion, or bringing your foot up, and pushing your foot down, are the primary motions that occur at this joint.  Other motions you may have heard of that occur at this joint are, pronation and supination.  Pronation and supination each required 3 different motions to occur at the talocrural joint.  Pronation requires dorsiflexion, external rotation, and eversion; this happens when you bring your feet up and all the way out, or when you’re standing, and your arch flattens out.  Supination requires plantarflexion, internal rotation, and inversion; so when you point your foot down and in, or when you stand on the outsides of your feet.  Both pronation and supination are very important movements required for walking and running.

There are many surrounding ligaments that attach to the talocrural joint to protect this area and stabilize the joint.  These ligaments consist of the deltoid ligament on the inside of your ankle, and the lateral ligaments on the outside of your ankle.  The deltoid ligament is composed of 4 different ligaments, the tibionavicular, anterior tibiotalar, tibiocalcaneal, and the posterior tibiotalar. The lateral ligaments consist of the anterior talofibular, posterior talofibular, and the calcaneofibular.  These ligaments are the only structures that attach directly onto the talus, so if these ligaments become injured, there aren’t any other structures to directly stabilize this joint.  We are able to stabilize the joint using the surrounding muscles and decrease the risk of injury. 

Types of Ankle Sprains 

There are 3 different types of ankle sprains; a lateral ankle sprain, a medial ankle sprain, and a high ankle sprain.  The most common being the lateral ankle sprain.  A lateral ankle sprain occurs when your ankle goes into supination, stressing the lateral ligaments of the ankle, the anterior talofibular, posterior talofibular, and the calcaneofibular ligaments. A medial ankle sprain is when the deltoid ligament is stressed.  A high ankle sprain is when the area between the tibia and fibula is stressed, usually resulting from planting and twisting at your ankle and typically requires a longer recovery period. 

What happens after an ankle sprain 

Following an ankle sprain, what tends to happen immediately is the ankle begins to show signs of inflammation, swelling, warmth, and some pain and redness.  During this time, it is important to apply the RICE principle to decrease the inflammation; Rest, Ice, Compression, and Elevation.  In addition to this, you can perform some range of motion (ROM) exercises in a pain free range to decrease swelling and to help maintain motion and strength surrounding the joint.  Some ROM exercises can consist of performing circles in both directions with your ankle and simply moving your ankle up and down, and side to side. 

When the inflammation begins to improve, usually in about a week or so, this is when it can be beneficial to seek physical therapy. Physical therapists are trained to progressively load the area in order to facilitate healing, and strengthen the surrounding structures to provide stability and protect from future injury.  During this process, the physical therapist assists in helping the individual return to their normal activities. 

Additionally, seeking treatments that will expedite this process and help to boost the healing of the injured ligaments and tendons are highly suggested. These types of treatments are prolotherapy and platelet rich plasma (PRP), and they work exceptionally well with physical therapy for ankle sprains. The combination of these two services is what we are known for at Alliance Regen and Rehab - which leads to faster healing times, results you can feel, and results that last! 

How it can cause knee and hip issues 

Following an ankle sprain, the ankle joint tends to become more unstable due to the increased laxity of the ligaments that were injured.  If the injury is not treated and rehabilitated correctly, or at all, this can increase the risk of injury or cause further problems for the knee and/or the hip.  Due to the injury, the surrounding musculature may have also been injured causing the muscles to not function properly.  Therefore, what tends to happen is that the muscles that support the arch of your foot become weaker and cause you to over pronate and develop a “flat foot.”  This over pronation can cause a valgus stress on the knee and cause injury to the inside of the knee.  Traveling up the lower extremity, this valgus position of the knee can also have an effect on the hip, and alter the mechanics of the individual.

Take Home Points 

  • There are 3 different types of ankle sprains with the lateral ankle sprain being the most common. 
  • The talocrural joint is the main joint of the ankle and it is made up of the talus, distal tibia, and distal fibula.  
  • There are many ligaments in your ankle that provide static stability; if injured or torn, the ankle relies on the surrounding musculature to help provide dynamic stability. 
  • After any type of ankle injury, it’s important to control the inflammation through ice, compression, and elevation, while also performing pain free ROM.  
  • During or following the inflammatory phase, you should seek out treatment from a physical therapist so they can assist you in the proper strengthening and recovery program in order to ensure the proper structures are being addressed to decrease further risk of injury to your ankle, knee, or hip.  

Special Thanks

A special thanks goes out to one Alexys Lynch, a former and amazing physical therapy intern of ours. Alexys spent 12 weeks with us while finishing up her Doctorate in Physical Therapy at the University of St. Augustine for Health Sciences. As the main contributor and writer of this blog, she invest lots of time and energy in putting together a very informative blog for our readers. Thank you Alexys!

Pictures

  • https://www.earthslab.com/wp-content/uploads/2017/07/Ankle-joint.jpg 
  • https://previews.123rf.com/images/vonuk/vonuk1802/vonuk180200002/95926562-foot-deformation-valgus-and-varus-defect-normal-human-foot-and-the-foot-with-pronation-or-flatfoot-w.jpg 
  • https://musculoskeletalkey.com/wp-content/uploads/2016/12/B9780323089449000113_f011-011ab-9780323089449.jpg 
  • https://s3.amazonaws.com/classconnection/643/flashcards/13611643/png/knee_varus_valgus-165F4215BEB6ABB07C6-thumb400.png

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