Missteps can lead to injuries of important joint

By: BRADLEY J. FIKES - Staff Writer | Saturday, February 10, 2007 8:10 PM PST ∞

A lot is riding on the ankles: nearly the entire weight of your body. Ankles regularly bear the most weight and stress of any major joint. And it shows in the numerous strains, sprains, tears, fractures and other damage inflicted on them.

Ankles somewhat resemble wrists. Both are near an extremity. The appendages they connect to, feet and hands respectively, greatly resemble each other. Both are also junctures of two large, long bones with a smaller bone. In the case of ankles, the long, large bones are the tibia and fibula of the lower leg, which meet up with the talus, or ankle bone. Where these three bones meet is the joint.

When the joint moves, different sides of the talus are brought close to the ends of the tibia and fibula. These surfaces meet smoothly because they are covered with slippery cartilage and lubricated with a substance called synovial fluid.

The tibia and fibula are bound to the talus with ribbons of tough connective tissue called ligaments. These ligaments stretch or shorten depending upon how the ankle joint moves. When the toe-end of the foot moves down, the front ligaments lengthen and the back ligaments shorten. When the toe-end is moved up, the reverse happens. These muscle motions are respectively called plantar flexion and dorsiflexion.

Because the ankle bears so much weight, a false step can easily stress the ligaments beyond their capacity, stretching it or breaking it, causing a sprain. The most common sprain occurs when the foot slips inward, toward the center. This "inversion sprain" injures the outer ligament. The opposite kind of misstep, when the foot slips outward, causes an "eversion sprain."

Pain is the most obvious symptom of a sprain, along with swelling and bruising. Minor sprains, called "Grade I", are the least serious, caused by some excessive stretching. However, the ligament itself is not torn or broken. It's possible to walk with such an injury, provided care is used not to repeat the sprain. Crutches may be required.

Moderate, or "Grade II" sprains, are caused by greater stretching and damage, perhaps including partial tears. The pain is greater, and mobility is very limited.

Severe, or "Grade III" sprains, result from complete tears of the ligament. Not only is the ankle painful, but the tear reduces the joint's stability. It may become unstable or wobble under stress.

Self-treatment usually works for minor sprains. The Mayo Clinic recommends a treatment plan called PRICE, that is Prevent further injury, Rest the injured joint, Ice the injury, Compress the injury with an elastic wrap or bandage, and Elevate the injury when possible.

Obviously major injuries, such as severe sprains or fractures, require a trip to the doctor. This is also true for apparently minor injuries that don't improve after two or three days of self-care. More information on sprains is available at tinyurl.com/24nhsu.

Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.