Ankle Injuries

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Fractures

Fractures of the ankle are serious because they involve an important weight-bearing joint. They are intensely painful, heal slowly, and present a significant risk for later complications, such as traumatic arthritis and chronic pain.

Types

Ankle bones can fracture in various ways. A stress fracture is a crack in the outer shell of the bone, necessitating limited weight bearing and possibly a cast. Continued activity can cause even a small stress fracture to worsen until a complete, larger fracture occurs.

A simple fracture is more serious than a stress fracture and involves a complete break of the bone into two pieces. In a comminuted fracture, the bone is shattered into several fragments.

Fractures may be displaced, in which the broken bones are moved out of their normal position, or nondisplaced, in which the bones are minimally misaligned. Fractures also may be open, in which a portion of the broken bone protrudes through the skin, or closed, involving no skin breakage.

Complications

The goal of the attending physician is to restore the damaged ankle joint to as close to its original position as possible. This is important because any displacement of the bones can cause problems in the future.

The most common complication is traumatic arthritis, which occurs as a result of damage to the cartilage. Normally, the cartilage in the ankle allows the bones to articulate without friction. When cartilage breaks down and wears away, the bones grind against each other. Pieces of cartilage may break away and migrate into the ankle joint. This causes painful inflammation and fluid buildup in the joint lining (synovial tissue), resulting in swelling and stiffness.

As more layers of cartilage wear away from the ankle joint, the space within the joint becomes narrower. This produces imbalances in other joints in the body and can lead to problems in the knees, hips, back, and neck. It also brings the exposed, cartilage-depleted ends of the anklebones into painful, grinding contact. Over time, leg and foot deformities can develop, causing severe, disabling pain.

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