Dr Alan Griffiths from the English Medical Centre outlines what can go wrong when you hurt your ankle, and explodes a couple of myths at the same time…
Ankle injuries are more common in snowboarders (16% of all boarding injuries) than in skiers (6% of all skiing injuries). This is because boarding boots allow more movement than ski boots. However, it is not true that you cannot seriously hurt your ankle in a ski boot, as the picture shows.The ankle joint is made up of the lower part of the leg bones (tibia and fibula) and the talus bone underneath. The bony prominence at the end of the fibula (the thin bone down the outside of the leg) is called the lateral malleolus. The other knobbly bit on the inside of the ankle is called the medial malleolus, and is a part of the main leg bone (tibia).
Ankle sprains are common. They occur when the foot stretches the ligaments that hold the bones together. The ligament fibres become torn, which causes pain and swelling. In severe cases it can take several weeks for the ligaments to heal. Rest, Ice, Compression and Elevation of the foot are the mainstays of treatment (R.I.C.E.). The healing process can be speeded up by immobilising the joint with strapping or a splint.
When more force is involved, the bones that the ligaments are attached to can snap. Usually it is the end of the fibula that breaks. Treatment depends on the severity of the fracture. In simple breaks all that may be required is a plaster cast. But if there is any displacement of the bone fragment, an operation to insert metalwork becomes necessary. Similarly, if more than one bone is broken an operation is a near certainty.
It is much les common for the talus to fracture, but it is still possible. Minor talar fractures are generally treated with immobilisation in a plaster cast. However, because this bone takes all of the body weight, surgery is sometimes required to stabilise the fragments with metal screws. A part of the talus called the lateral process can snap yet not show up on ordinary X-rays. This fracture is almost never encountered apart from in snowboarders. Pain over the outside of the ankle that is not responding to treatment should prompt your doctor to consider a CT scan to exclude this specific “snowboarder’s fracture”.
Finally, the Achilles tendon should not be forgotten. This tendon attaches the calf muscle to the heel. It is usually injured in a forwards fall. If a few fibres of the tendon are strained it is not too serious, and heals up quickly with the RICE treatment. But if the entire ligament snaps it will take a good three months to recover in a plaster cast. Sometimes it requires an operation to stitch it back together, but this doesn’t really shorten the recovery time. If you hurt your ankle, do not fall into the trap of thinking that “if I can walk on it, there can’t be a break”. This is not the case, but what is true is that if you do walk on a broken ankle you are more likely to displace the bone fragment and increase your chance of needing surgery (see picture).
Mythbuster: this fractured lateral malleolus occured in a ski boot, and after walking around on it for two days the patient did not think it needed an X-ray. It actually required an operation to insert a metal plate.
Tags: S5E12
