When you think about it, there is no surprise that ankles are frequently injured.
If you consider the ankle as part of the foot, it is the most proximal linkage of a very complicated system that allows us to adapt to the terrain we are moving over, yet efficiently transmits the forces of our muscles’ contraction to propel us.
When standing behind a child running barefoot it is possible to see the heel change angle to the axis of the leg, as the foot strikes the ground and when the toes lift off.
When the foot contacts the ground the heel slopes outward (into valgus), yet when the toes lift off the heel slopes inward (into varus).
With the heel in valgus the linkages of the foot (the midfoot) are loose and the foot more compliant. With the foot in varus the midfoot is more rigid and so a better transmitter of force.
How do ankle sprains occur?
Most ankle sprains are inversion injuries. They occur with the heel in varus (tilted inward) the foot is rigid and so the forces are transmitted to the ankle, most often damaging the ligaments, though sometimes the joint surface and bone.
There are two main ligaments that resist these forces – the Anterior Talofibular ligament and the Calcanoefibular ligament.
There are grades of injury – from stretching of these ligaments to rupture. The vast majority of injuries are treated non-operatively – in a brace with early movement (ice and analgesics are used to help with the pain). Chronic ankle instability is not very common.
There is little evidence that would support the contention that even complete ruptures should be operated on immediately as the results of early brace treatment are usually very good. At times there are problems with the foot that lead to recurrent sprains – these can be difficult to overcome.
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