Q&A: How to Avoid an Ankle Injury

DEAR MAYO CLINIC: I am in my early 50s and lead an active lifestyle. I have recently heard of an increase in ankle sprains and broken ankles, especially in an older population, partly due to activity and aging. How can I avoid these injuries in the first place?

ANSWER: The ankle joint is made up of the ends of the tibia and fibula bones which are connected by multiple ligaments which help stabilize the joints. Collectively, this relationship is essential for ankle stability and movement.

An injury to any of the bones, ligaments, or tendons in the ankle, as well as several types of arthritis, can cause ankle pain. Many people report ankle pain, which can be a precursor to ankle injuries.

The most common problem is a sprained ankle, which is an injury that occurs when you roll, twist, or turn your ankle awkwardly, forcing it out of its normal position. This can stretch or tear the ligaments. Failing to properly treat a sprained ankle, engaging in activities too soon after spraining your ankle, or spraining your ankle repeatedly can lead to ongoing complications.

When it comes to an ankle fracture, the most common area for this to happen is at the fibula, specifically the lateral malleolus. In isolation, lateral malleolus fractures can be treated without surgery if no other ligament injuries are identified with special X-ray views. Fractures of the lateral malleolus, medial malleolus, and posterior malleolus often require a surgery if they occur in combination, as the ankle becomes unstable and prone to arthritis if not treated surgically. These joints are translational joints – allowing a part to move relative to each other – not to rotate. But historically, just 1 millimeter of joint translation has been shown to reduce contact area by 42%. If this stable relationship is not restored, ankle osteoarthritis can progress rapidly.

The incidence of ankle fractures is estimated at more than five million ankles in the United States per year. Fractures can range from tiny cracks in your bones to fractures that pierce your skin. Ankle fractures can be caused by multiple factors, including low-energy rotational injuries in recreational sports or high-energy motor vehicle accidents. Treatment for an ankle fracture depends on the exact site and severity of the bone fracture. A badly broken ankle may require surgery to implant plates, rods, or screws into the broken bone to maintain proper position while it heals.

Preventing these injuries is multifactorial, starting with a healthy diet and daily physical activity. It is estimated that more than one billion people worldwide are deficient in vitamin D, and current guidelines recommend at least 600 international units (IU) for people aged 1 to 70 and 800 IU daily for people over 70 years old.

Additional preventative measures for ankle injuries include ankle proprioception exercises, which optimize both balance and coordination. These exercises strengthen the stabilizing ligaments and muscles of the ankle joint, including the tibialis anterior, tibialis posterior, and peroneal muscles. Additionally, a healthy lifestyle with daily physical activity will help these muscles stabilize the ankle on uneven surfaces.

Supportive shoes with inserts that help with forefoot pronation can also better position the ankle joint for patients with arched feet. Finally, a tight calf, or gastrocnemius muscle, can predispose patients to ankle fractures, as a very arched foot can be more prone to ankle sprains. Stretching the calf muscle daily helps combat imbalance in the ankle joint and may help prevent ankle injuries altogether.

Treatment for ankle injuries may depend on the severity of the problem. Certainly, for a sprain, self-care measures and over-the-counter pain relievers may suffice, but a medical evaluation may be needed to determine the appropriate treatment and prevent repeat injury. It is important to seek out a qualified medical professional, such as an orthopedic, physical medicine, or sports medicine specialist, to help you. Connecting with a physiotherapist can be part of the recovery and prevention program, depending on your specific needs.

In conclusion, ankle fractures can occur as a result of high-energy crashes or low-energy rotational injuries. A healthy diet with an appropriate intake of vitamin D will optimize bone health, and daily exercise will directly activate the stabilizing muscles and ligaments of the ankle. For ankle injury-prone patients with high arched feet, stretching the calf muscles along with wearing supportive shoes with inserts can put the ankle joint in a better position to prevent future injury.

—Dr. Krystin Hidden, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

Mayo Clinic News Network 2022.
Distributed by Tribune Content Agency, LLC.