Your ankle bone and the ends of your two lower leg bones make up the ankle joint. Your ligaments, which connect bones to one another, stabilize and support it. Your muscles and tendons move it.

The most common ankle problems are sprains and fractures. A sprain is an injury to the ligaments. It may take a few weeks to many months to heal completely. A fracture is a break in a bone. You can also injure other parts of the ankle such as tendons, which join muscles to bone, and cartilage, which cushions your joints. Ankle sprains and fractures are common sports injuries.

Harm or hurt to the ankle or ankle joint usually inflicted by an external source.

Joints

The ankle is the most frequently injured joint in the body, with the most common injury being an inversion ankle sprain. A sprain is the stretching or tearing of the supporting ligaments. Excess inversion causes the talus bone to tilt laterally, thus damaging the ligaments on the lateral side of the ankle. The anterior talofibular ligament is most commonly injured, followed by the calcaneofibular ligament. In severe inversion injuries, the forceful lateral movement of the talus not only ruptures the lateral ankle ligaments, but also fractures the distal fibula.

Less common are eversion sprains of the ankle, which involve stretching of the deltoid ligament on the medial side of the ankle. Forcible eversion of the foot, for example, with an awkward landing from a jump or when a football player has a foot planted and is hit on the lateral ankle, can result in a Pott’s fracture and dislocation of the ankle joint. In this injury, the very strong deltoid ligament does not tear, but instead shears off the medial malleolus of the tibia. This frees the talus, which moves laterally and fractures the distal fibula. In extreme cases, the posterior margin of the tibia may also be sheared off.

Above the ankle, the distal ends of the tibia and fibula are united by a strong syndesmosis formed by the interosseous membrane and ligaments at the distal tibiofibular joint. These connections prevent separation between the distal ends of the tibia and fibula and maintain the talus locked into position between the medial malleolus and lateral malleolus. Injuries that produce a lateral twisting of the leg on top of the planted foot can result in stretching or tearing of the tibiofibular ligaments, producing a syndesmotic ankle sprain or “high ankle sprain.”

Most ankle sprains can be treated using the RICE technique: Rest, Ice, Compression, and Elevation. Reducing joint mobility using a brace or cast may be required for a period of time. More severe injuries involving ligament tears or bone fractures may require surgery.

The ankle is the most frequently injured joint in the body, with the most common injury being an inversion ankle sprain. A sprain is the stretching or tearing of the supporting ligaments. Excess inversion causes the talus bone to tilt laterally, thus damaging the ligaments on the lateral side of the ankle. The anterior talofibular ligament is most commonly injured, followed by the calcaneofibular ligament. In severe inversion injuries, the forceful lateral movement of the talus not only ruptures the lateral ankle ligaments, but also fractures the distal fibula.

Less common are eversion sprains of the ankle, which involve stretching of the deltoid ligament on the medial side of the ankle. Forcible eversion of the foot, for example, with an awkward landing from a jump or when a football player has a foot planted and is hit on the lateral ankle, can result in a Pott’s fracture and dislocation of the ankle joint. In this injury, the very strong deltoid ligament does not tear, but instead shears off the medial malleolus of the tibia. This frees the talus, which moves laterally and fractures the distal fibula. In extreme cases, the posterior margin of the tibia may also be sheared off.

Above the ankle, the distal ends of the tibia and fibula are united by a strong syndesmosis formed by the interosseous membrane and ligaments at the distal tibiofibular joint. These connections prevent separation between the distal ends of the tibia and fibula and maintain the talus locked into position between the medial malleolus and lateral malleolus. Injuries that produce a lateral twisting of the leg on top of the planted foot can result in stretching or tearing of the tibiofibular ligaments, producing a syndesmotic ankle sprain or “high ankle sprain.”

Most ankle sprains can be treated using the RICE technique: Rest, Ice, Compression, and Elevation. Reducing joint mobility using a brace or cast may be required for a period of time. More severe injuries involving ligament tears or bone fractures may require surgery.

A sprain is a stretched or torn ligament. Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting hit can all cause a sprain. Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising, and being unable to move your joint. You might feel a pop or tear when the injury happens.

A strain is a stretched or torn muscle or tendon. Tendons are tissues that connect muscle to bone. Twisting or pulling these tissues can cause a strain. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common. Many people get strains playing sports. Symptoms include pain, muscle spasms, swelling, and trouble moving the muscle.

At first, treatment of both sprains and strains usually involves resting the injured area, icing it, wearing a bandage or device that compresses the area, and medicines. Later treatment might include exercise and physical therapy.

Each of your feet has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. No wonder a lot of things can go wrong. Here are a few common problems:

• Bunions - hard, painful bumps on the big toe joint
• Corns and calluses - thickened skin from friction or pressure
• Plantar warts - warts on the soles of your feet
• Fallen arches - also called flat feet

Ill-fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems.

General or unspecified injuries involving the foot.

Fourteen of the 26 bones in your feet are in your toes. The toes, particularly your big toe, help you move and keep your balance. Playing sports, running, stubbing your toe, and dropping something on your foot can damage your toes. Wearing shoes that are too loose or too tight can also cause toe problems. Certain diseases, such as severe arthritis, can cause toe problems and pain. Gout often causes pain in the big toe.

Common toe problems include

• Corns and bunions
• Ingrown toenails
• Sprains and dislocations
• Fractures

Treatments for toe injuries and disorders vary. They might include shoe inserts or special shoes, padding, taping, medicines, rest, and in severe cases, surgery.

Your legs are made up of bones, blood vessels, muscles, and other connective tissue. They are important for motion and standing. Playing sports, running, falling, or having an accident can damage your legs. Common leg injuries include sprains and strains, joint dislocations, and fractures.

These injuries can affect the entire leg, or just the foot, ankle, knee, or hip. Certain diseases also lead to leg problems. For example, knee osteoarthritis, common in older people, can cause pain and limited motion. Problems in your veins in your legs can lead to varicose veins or deep vein thrombosis.

Heel problems are common and can be painful. Often, they result from too much stress on your heel bone and the tissues that surround it. That stress can come from

• Injuries
• Bruises that you get walking, running or jumping
• Wearing shoes that don't fit or aren't made well
• Being overweight

These can lead to tendinitis, bursitis, and fasciitis, which are all types of inflammation of the tissues that surround your heel. Over time the stress can cause bone spurs and deformities. Certain diseases, such as rheumatoid arthritis and gout, can also lead to heel problems. Treatments for heel problems might include rest, medicines, exercises, taping, and special shoes. Surgery is rarely needed.

Foot drop syndrome describes the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot. As a result, individuals with foot drop scuff their toes along the ground or bend their knees to lift their foot higher than usual to avoid the scuffing, which causes what is called a “steppage gait."

Foot drop can be unilateral (affecting one foot) or bilateral (affecting both feet). Foot drop is a symptom of an underlying problem and is either temporary or permanent, depending on the cause.

Causes include:

• Neurodegenerative disorders of the brain that cause muscular problems, such as multiple sclerosis, stroke, and cerebral palsy
• Motor neuron disorders such as polio, some forms of spinal muscular atrophy and amyotrophic lateral sclerosis (commonly known as Lou Gehrig's disease)
• Injury to the nerve roots, such as in spinal stenosis
• Peripheral nerve disorders such as Charcot-Marie-Tooth disease or acquired peripheral neuropathy
• Local compression or damage to the peroneal nerve as it passes across the fibular bone below the knee
• Muscle disorders, such as muscular dystrophy or myositis

Treatment depends on the specific cause of foot drop. The most common treatment is to support the foot with lightweight leg braces and shoe inserts, called ankle-foot orthotics. Exercise therapy to strengthen the muscles and maintain joint motion also helps to improve gait. Devices that electrically stimulate the peroneal nerve during footfall are appropriate for a small number of individuals with foot drop. In cases with permanent loss of movement, surgery that fuses the foot and ankle joint or that transfers tendons from stronger leg muscles is occasionally performed.

Foot drop caused by trauma or nerve damage usually has partial or even complete recovery. For progressive neurological disorders, foot drop will be a symptom that is likely to continue as a lifelong disability. People with foot drop are more likely to fall.

Each step you take involves a complex network of bones, muscles, tendons, and ligaments. This, combined with all of the weight they carry, explains why feet can have problems. To keep your feet healthy

• Examine your feet regularly
• Wear comfortable shoes that fit
• Wash your feet daily with soap and lukewarm water
• Trim your toenails straight across and not too short

Your foot health can be a clue to your overall health. For example, joint stiffness could mean arthritis. Tingling or numbness could be a sign of diabetes. Swelling might indicate kidney disease, heart disease, or high blood pressure.

Good foot care and regular foot checks are an important part of your health care. If you have foot problems, be sure to talk to your doctor.

The distal extremity of the leg in vertebrates, consisting of the tarsus (ANKLE); METATARSUS; phalanges; and the soft tissues surrounding these bones.

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose can't get into your cells as quickly as usual. The glucose builds up in your blood and causes high blood sugar levels.

How does diabetes cause foot problems?

Foot problems are common in people with diabetes. They can happen over time when high blood sugar damages the nerves and blood vessels in the feet. The nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in your feet.

If you can't feel pain, you may not know when you have a cut, blister, or ulcer (open sore) on your foot. A wound like that could get infected. The infection may not heal well because the damaged blood vessels can cause poor blood flow in your feet.

Having an infection and poor blood flow can lead to gangrene. That means the muscle, skin, and other tissues start to die. If you have gangrene or a foot ulcer that does not get better with treatment, you may need an amputation. This is a surgery to cut off your damaged toe, foot, or part of your leg. It may prevent a bad infection from spreading and could save your life.

But there's a lot you can do to prevent a foot wound from becoming a major health problem.

How can I protect my feet if I have diabetes?

The best way to protect your feet is by controlling your blood sugar levels every day. This will help keep nerve and blood vessel damage from getting worse. The next step is to keep the skin of your feet healthy.

Good foot care for people with diabetes includes:

• Checking your feet every day. Look for cuts, redness, and other changes in the skin and toenails, including warts or other spots that your shoes could rub. Make sure to check the bottoms of your feet too.
• Washing your feet every day. Use warm water and soap. Don't soak your feet because that can dry out your skin. After you dry your feet, you can use talcum powder or cornstarch between your toes. They soak up moisture that can cause infection. If you use lotion, don't apply it between your toes.
• Asking your doctor how to remove corns and calluses safely. Thick skin on your feet can rub and lead to sores. But removing it the wrong way could damage your skin. So you don't want to cut the skin or use medicated pads or liquid removers.
• Trimming your toenails straight across with a clipper. If it's hard for you to trim your own toenails, or if they're thick or curve into the skin, have a podiatrist (foot doctor) do it for you.
• Always wearing well-fitting shoes and socks or slippers to protect your feet when walking. You don't want to walk barefoot, even indoors. And be sure your shoes are smooth inside. A seam or pebble could rub your skin raw.
• Protecting your feet from heat and cold. Use sunscreen on exposed skin and don't walk barefoot at the beach. In cold weather, wear warm socks instead of warming your feet near a heater or fireplace.
• Keeping the blood flowing in your feet. Put your feet up when you're sitting. Wiggle your toes and circle your feet throughout the day. Don't wear tight socks. And get plenty of activity that's not too hard on the feet, such as walking.
• Getting your feet checked at your health care visits. Even if you haven't noticed a problem, it's good to have your health care provider look at your feet.

When should I see my health care provider about diabetic foot problems?

Serious foot problems can develop quickly. See your health care provider right away if you notice:

• A cut, blister, or bruise on your feet that doesn't start to heal in a few days
• Red, warm, or painful skin on your feet
• A callus with dried blood inside
• A foot infection that becomes black and smells bad that could be gangrene

Remember, controlling your blood sugar and caring for your feet every day are the best steps you can take to prevent serious diabetic foot problems.

Ankle Fracture (Broken Ankle)

An ankle fracture is a break of the ankle bones.

PubMed Health Glossary (Source: Wikipedia)

About Ankle Fractures

When people twist their ankle they might sprain it. This means that muscles and soft tissue around the ankle joint are injured. But sometimes the ankle joint is fractured (broken) instead. This is a more serious injury that may affect one or more bones in your ankle. If the ankle joint is fractured, the ligaments are often torn and cartilage damaged too. The foot becomes swollen, is painful and can no longer hold any weight.

Outlook

It takes several days or weeks for the swelling to go down completely, and can take months for the ankle joint to fully recover from the fracture. Until then, the foot cannot be moved much and cannot carry much weight.

If the healing process is disturbed too soon and the fracture does not heal properly, other treatments may be needed. On the other hand, if a person does not move their foot for a long time, it could become less mobile and weaker.

Diagnosis

The doctor will probably first ask how the accident happened, and then examine the foot and ankle to see how severe the injury is. If he or she suspects that the ankle is fractured, an x-ray of the ankle is taken. Sometimes x-rays do not lead to a clear diagnosis. Then a computed tomography (CT) scan, and perhaps also a magnetic resonance imaging (MRI) scan, might be done too. Ligament and cartilage injuries can usually be seen better with MRI scans.

Treatment

Surgery is usually not needed for ankle fractures. Whether or not surgery is done depends on various factors, including how bad the fracture is, where the ankle is fractured, and whether the bone fragments are in the right place. Screws or plates might be used to hold bone fragments in place so they can grow together again. After surgery the ankle will be immobilized (kept still) using a brace, splint or plaster cast. Some braces and splints are removable, making it possible to already start doing gentle exercises during the immobilization phase.

Even if surgery is not needed, the foot and ankle are still immobilized at first in order to protect the joint and avoid disturbing the healing process. Braces, splints or plaster casts are generally used for around six weeks. After a while you can gradually start putting more strain on the joint and strengthening it. The point at which people are advised to start doing gentle exercises or physiotherapy depends on things like how bad the injury is: Some already start a few days after the injury or surgery, and others only start when their splint or plaster cast comes off.

The ankle is formed by the talocrural joint (image). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg (crural = “leg”). The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations with the medial malleolus of the tibia and the lateral malleolus of the fibula, which prevent any side-to-side motion of the talus. The ankle is thus a uniaxial hinge joint that allows only for dorsiflexion and plantar flexion of the foot.

Additional joints between the tarsal bones of the posterior foot allow for the movements of foot inversion and eversion. Most important for these movements is the subtalar joint, located between the talus and calcaneus bones. The joints between the talus and navicular bones and the calcaneus and cuboid bones are also important contributors to these movements. All of the joints between tarsal bones are plane joints. Together, the small motions that take place at these joints all contribute to the production of inversion and eversion foot motions.

Like the hinge joints of the elbow and knee, the talocrural joint of the ankle is supported by several strong ligaments located on the sides of the joint. These ligaments extend from the medial malleolus of the tibia or lateral malleolus of the fibula and anchor to the talus and calcaneus bones. Since they are located on the sides of the ankle joint, they allow for dorsiflexion and plantar flexion of the foot. They also prevent abnormal side-to-side and twisting movements of the talus and calcaneus bones during eversion and inversion of the foot. On the medial side is the broad deltoid ligament. The deltoid ligament supports the ankle joint and also resists excessive eversion of the foot. The lateral side of the ankle has several smaller ligaments. These include the anterior talofibular ligament and the posterior talofibular ligament, both of which span between the talus bone and the lateral malleolus of the fibula, and the calcaneofibular ligament, located between the calcaneus bone and fibula. These ligaments support the ankle and also resist excess inversion of the foot.

Ankle and Foot Joints

The ankle is formed by the talocrural joint. It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg (crural = “leg”). The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations with the medial malleolus of the tibia and the lateral malleolus of the fibula, which prevent any side-to-side motion of the talus. The ankle is thus a uniaxial hinge joint that allows only for dorsiflexion and plantar flexion of the foot.

Additional joints between the tarsal bones of the posterior foot allow for the movements of foot inversion and eversion. Most important for these movements is the subtalar joint, located between the talus and calcaneus bones. The joints between the talus and navicular bones and the calcaneus and cuboid bones are also important contributors to these movements. All of the joints between tarsal bones are plane joints. Together, the small motions that take place at these joints all contribute to the production of inversion and eversion foot motions.

Like the hinge joints of the elbow and knee, the talocrural joint of the ankle is supported by several strong ligaments located on the sides of the joint. These ligaments extend from the medial malleolus of the tibia or lateral malleolus of the fibula and anchor to the talus and calcaneus bones. Since they are located on the sides of the ankle joint, they allow for dorsiflexion and plantar flexion of the foot. They also prevent abnormal side-to-side and twisting movements of the talus and calcaneus bones during eversion and inversion of the foot. On the medial side is the broad deltoid ligament. The deltoid ligament supports the ankle joint and also resists excessive eversion of the foot. The lateral side of the ankle has several smaller ligaments. These include the anterior talofibular ligament and the posterior talofibular ligament, both of which span between the talus bone and the lateral malleolus of the fibula, and the calcaneofibular ligament, located between the calcaneus bone and fibula. These ligaments support the ankle and also resist excess inversion of the foot.

Figure 9.21 Ankle Joint The talocrural (ankle) joint is a uniaxial hinge joint that only allows for dorsiflexion or plantar flexion of the foot. Movements at the subtalar joint, between the talus and calcaneus bones, combined with motions at other intertarsal joints, enables eversion/inversion movements of the foot. Ligaments that unite the medial or lateral malleolus with the talus and calcaneus bones serve to support the talocrural joint and to resist excess eversion or inversion of the foot.

Ankle Sprain

The ankle is the most frequently injured joint in the body, with the most common injury being an inversion ankle sprain. A sprain is the stretching or tearing of the supporting ligaments. Excess inversion causes the talus bone to tilt laterally, thus damaging the ligaments on the lateral side of the ankle. The anterior talofibular ligament is most commonly injured, followed by the calcaneofibular ligament. In severe inversion injuries, the forceful lateral movement of the talus not only ruptures the lateral ankle ligaments, but also fractures the distal fibula.

Less common are eversion sprains of the ankle, which involve stretching of the deltoid ligament on the medial side of the ankle. Forcible eversion of the foot, for example, with an awkward landing from a jump or when a football player has a foot planted and is hit on the lateral ankle, can result in a Pott’s fracture and dislocation of the ankle joint. In this injury, the very strong deltoid ligament does not tear, but instead shears off the medial malleolus of the tibia. This frees the talus, which moves laterally and fractures the distal fibula. In extreme cases, the posterior margin of the tibia may also be sheared off.

Above the ankle, the distal ends of the tibia and fibula are united by a strong syndesmosis formed by the interosseous membrane and ligaments at the distal tibiofibular joint. These connections prevent separation between the distal ends of the tibia and fibula and maintain the talus locked into position between the medial malleolus and lateral malleolus. Injuries that produce a lateral twisting of the leg on top of the planted foot can result in stretching or tearing of the tibiofibular ligaments, producing a syndesmotic ankle sprain or “high ankle sprain.”