We will explain the anatomy of the ankle joint, how it works and how it can get injured, as well as how we can help you recover!
Anatomy of the Ankle:
The ankle is the joint located between the foot and the leg. Its rigidity helps maintain the body’s balance while allowing for smooth and flexible movement. It is so stable that it can hold 1.5 to 8 times your weight when you move.
The Ankle Joint Complex
The ankle consists of a 3 joint complex that joins the lower leg to the remainder of the foot.
Inferior Tibia-Fibular Joint
This is a joint between the lower end of two long bones in your lower leg (Tibia and Fibula). It forms the roof of the ankle joint complex. The two lower leg bones, the tibia abs fibula, have bony ends on each side of the ankle called malleoli. These are where you can touch your “ankle” bones on the inside abs outside of your ankle, the medial malleolus and the lateral malleolus.
Talo-Crural Joint
This joint connects the inferior tib- fibular joint to the talus bone. This is the primary ankle joint that moves when you point your foot down as if to push on the gas pedal. This is what most of us would consider the ankle joint.
Subtalar Joint
This joint is the heel joint and attaches the talus bone to the underlying calcaneus bone.
These three joints work together to help stabilize us to impact through our ankles/feet in conjunction with the midfoot and forefoot, but they also provide mobility to allow for adaptation to different surfaces and environment. We also rely on our balance system to help ensure we remain stable on our feet.
The ankle joints are lined with articulate cartilage and have a complex ligamentous, fascial and muscular support system to help the joints move well, as well as control how we accelerate and decelerate movement. They work very closely with the midfoot and forefoot, as well as relate to the knee mechanics.
Common Ankle Injuries:
Ankle Sprains
Among the various ankle injuries, the most common is an ankle sprain. Sprains occur when a ligament stretches (mildly, moderately or more severely) or breaks effectively tearing into two. Ligaments are connective tissues that keeps the joints from moving too far from each other and thus help to stabilize or control movement in the ankle joints. You may sprain your ankle when you accidentally twist or turn your ankle out of its normal range of motion. While it is most common in our favourite sports, something as simple as stepping on a tree root wrong or misjudging a sidewalk can cause us to sustain an ankle sprain.
Sometimes if you sprain the ligaments strongly, a small piece of bones can be pulled off where the ligament attaches. This is called an avulsion fracture. This is sometimes treated like a ligament injury but may also require more bracing support while healing to ensure that it heals properly. If you do have to restrict your ankle movement to heal an avulsion fracture, then you can develop stiffness in your ankle after being immobilized. This definitely could be helped with physiotherapy treatment.
Tendon Injury – Achilles Tendonitis & Rupture
The Achilles tendon is located in our ankles and is the largest tendon in the body. Primarily, it connects the calf muscles to the heel bones. The Achilles tendon may be injured by excessive and unguided exercise or by sudden trauma, resulting in Achilles tendonitis. If you leave Achilles tendonitis unattended, you may make yourself prone to a worse injury, such as an Achilles rupture or more significant Achilles’ tendon tear. If you have ruptured your Achilles’ tendon, it may require surgical repair or some can also be treated non-surgically. You can have other tendon injuries in the foot and ankle, such as the tibial is posterior tendon orthe peroneal tendons. These are less common but do occur and are largely resolve with treatment and exercise.
Ankle Fracture
When we sustain an ankle injury our bones can also get injured, just like we can injure ligaments, tendons and muscles. If one or more of the ankle bones break, an ankle fracture occurs and this can occur in conjunction with a torn ligament, as noted above. Similar to the other ankle injuries, ankle fractures are usually due to sudden rotational movements, such as twisting or rolling the ankle, or direct trauma.
Other types of bone injuries are stress fractures.
Stress fractures are caused by repetitive stress or trauma to the ankles over time and are often caused by poor movement patterns or altered alignment of the hours in the foot and ankle leading to too much stress occurring in one part of the foot ankle. Stress fractures are seen more commonly on the mid foot more than the ankle joints themselves. Other causes of stress fracture can be Introducing a new strenuous activity to ones fitness regime or overdoing it in an already existing activity.
Ankle Cartilage Injuries
When someone injures the ankle by sustaining a sprain then can sometimes also sustain an injury to the underlying articulate cartilage which lines the surfaces of the joint. When we “go over” on our ankle, the cartilage can get pinched and suffer from an impact force to the cartilage inside the joint which results in an injury like a bruise – sometimes called a bone bruise or cartilage bruise. If someone sustained an injury such as this, they could also have sustained an osteochondral lesion injury which is a more severe impact injury to the cartilage. There are varying degrees of this type of injury from mild to more severe.
These types of injuries tend to include more swelling in the joint and a slower recovery overall. The more severe osteochondral injuries can sometimes require surgery.
Ankle Arthritis
Out of the above common ankle injuries we mentioned, ankle arthritis is a longer-term condition that slowly progresses over time. Unlike other forms of arthritis, ankle arthritis is rare; nonetheless, the condition poses a significant challenge to mobility.
Arthritis is a degenerative disease that affects the joints, causing pain, swelling, deformity and immobility. The articular cartilage tends to wear down over time with load. The type of arthritis that occurs at the ankle can be classified based on is causes.
Learn More about Treatment for Ankle Pain
Check out our Physiotherapy Treatment Videos and our Informational Videos about ankle pain.