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Anatomical features

According to its structure, the ankle joint is a trochlear joint: between a kind of “fork” of two ankles, a block of the articular surface of the talus is inserted. Stability is provided by numerous ligaments: they are arranged in several layers, powerful and durable.

Fig.1. Ankle structure

Freedom of movement is somewhat limited: the joint allows the foot to flex and extend with good amplitude only in one plane.

The ability to move the foot to the right and left is small, but the supporting ability allows it to cope with loads reaching ten times the body weight. True, sometimes even such a safety margin is not enough.

Mechanism of injury

Fractures of the ankle joints occur under the influence of multidirectional forces:

• Axial force perpendicular to the sole (causing wedging of the talus between the ankles).
• Excessive bending (flexion) and extension (extension).
• Turning inward (supination) and turning outward (pronation).
• Rotation of the foot inward (inversion) and outward (eversion).

If a sufficiently large amount of energy is applied in any of these directions, the joint structure may fail and break.

Varieties and types

The classification of ankle fractures is quite complex. Separately classified:

• Fractures of the fibula (outer malleolus).
• Tibial (inner malleolus).
• Damage to the tibiofibular syndesmosis.
• Talus.

Each of these categories has sub-items. In case of injuries, they are combined and rarely occur in isolation. Knowing all the nuances of each type of fracture and understanding the mechanism of injury allows you to eliminate the damage as completely and effectively as possible.

Usually, ankles break off: external (lateral, - the process of the fibula) or internal (medial - part of the tibia). Both can break at once.

Rice. 2. a. displaced fracture of both ankles; b. fracture of the ankles and posterior edge of the tibia.

The peculiarity of such fractures is that sometimes the ankles seem to be torn off from the bones of the leg: when the leg is twisted, strong ligaments may not break, but pull the ankle along with them, tearing it off completely, or causing a breakage and displacement of a small fragment of the bone.

Severe high-energy injuries may not be limited to the ankles and are accompanied by fracture of the articular surface of the tibia.

The talus fractures noticeably less frequently. But if it is damaged, intra-articular fragments may occur. They do not always produce pronounced symptoms and often end in the development of false joints.

We have to deal with fracture-dislocations: when one or both ankles of the leg are broken off, they lose the ability to fix the block, the talus dislocates and shifts, complicating treatment.

Fig3. A. fracture of the outer malleolus, rupture of the syndesmosis and deltoid ligament, subluxation of the foot outward. b. fracture of the talus.

Such injuries are dangerous due to disruption of the blood supply to bone tissue, which causes aseptic necrosis (talus bone) and greatly complicates the work of doctors.

A frequent complication is rupture of the external and deep ligaments and displacement of bone fragments.

Diagnostics

The doctor will discuss with the patient the medical history (how long the pain has been, what happened before the injury) and symptoms. He will also ask how the injury occurred and examine the affected area. If your trauma surgeon thinks you may have broken your ankle, he or she will order a series of tests to more fully understand the injury.

X-rays : X-rays can show whether the ankle bone has been broken and how many pieces of broken bone are there. They can also determine if there is displacement (a gap between broken bones). The doctor may also take X-rays of other parts of the leg or foot to make sure nothing was damaged as a result of the injury.

Stress test : A stress test is performed to determine whether surgical procedures are necessary to heal the injury. The doctor will apply some pressure to the ankle and take a special x-ray to determine the severity of the injury.

CT scan (computed tomography): If the fracture extends beyond the ankle, a CT scan may be needed to further examine the injury. A CT scan allows you to obtain a series of images in different planes, from which the doctor can determine the severity of the injury. Source: Comprehensive diagnosis of ankle joint injuries. Kim L.I., Dyachkova G.V. Genius of Orthopedics, 2013. p.20-24.

MRI (Magnetic Resonance Imaging) Scan: If your doctor suspects ligament damage has occurred, he or she may order an MRI scan to get a better look at the affected area. MRI can look deeper into bones, soft tissues, and ligaments to create higher-resolution images than most other tests.

Symptoms

Certain aspects of external manifestations depend on the type and extent of injury. Attention should be paid to the following symptoms:

• Pain in the injured joint.
• Swelling in one or both ankles.
• Atypical foot orientation.
• Joint deformity.

The tricky part is the risk of low-symptomatic variants. You may encounter a break-off of a small fragment of bone, which does not lead to gross external manifestations, which means there is a delay in seeking medical attention after a fracture and, accordingly, treatment.

First aid for an ankle injury

For any injuries, immediately consult a doctor who can accurately diagnose and recommend effective treatment. For bruises and small tears of ligaments, the RICE protocol has proven itself:

R (rest): stop stepping on your foot and give it complete rest.

I (ice – ice, cold): for the first few days it is useful to apply a bottle of ice or a cold accumulator to the damaged area. This should be done for 10-20 minutes every 2-3 hours. A small layer of tissue should separate the cold object from the skin to prevent frostbite.

C (compression): to prevent swelling during the day, you can wrap your foot and lower leg with an elastic bandage (not tight!). Compression socks are even better.

E (elevation - elevated position): for the first few days, lie down more, placing your leg on pillows to give it a slightly elevated position. This way it will swell and hurt less. Serious ruptures and fractures require immediate fixation of the limb; sometimes surgery may be used.

Modern solutions for treatment and rehabilitation

Special orthoses can help treat typical bruises and ligament tears. Ankle braces significantly reduce pain and swelling, speed up healing and allow you to return to active life earlier. At Medtekhnika Orthosalon stores, experienced consultants will help you choose the best orthosis for your case. Depending on the indications, modern clamps in our network can perform:

• gentle compression for a noticeable reduction in pain and swelling,
• delicate support to stimulate your own muscles and receptors,
• moderate fixation for rapid healing of ligaments and maintaining mobility,
• rigid fixation to stabilize severe damage.

If postoperative fixation is necessary, convenient and comfortable splints are always available. Modern plastic splints are lighter than outdated plaster casts; they allow active movement and hygienic treatment of the skin, changing the angle and degree of fixation. It is important to understand that even after successful healing, the damaged area remains quite vulnerable. Patients after fractures, tears and ligament ruptures during periods of increased stress should be “insured” with the help of lightweight and modern orthoses. This way you will be able to lead a healthy and active life without fear.

Author of the article: Eduard Svitich - orthopedic traumatologist

Diagnostic measures

Questioning and inspection cannot provide the necessary information. The key role is played by x-ray methods. As a rule, a radiograph of the injured limb is required in two projections.

Moreover, for better visualization of individual parts of the joint, different techniques are used (displacement, rotation, tilt of the foot). When necessary, a photo of the healthy leg is taken for comparison. There may be a need for CT or MRI.

Fractures of the talus require a more careful choice of diagnostic technique, as they are more complex in terms of treatment.

Fig4. A. CT scan shows a fracture of the talus and tibia, b. MRI revealed a fracture of the talus

Therapeutic measures

Uncomplicated ankle fractures without significant displacement allow conservative treatment. Manual closed reduction is performed, the details of which depend on the type of injury.

The basic principles are:

• Carrying out the most accurate reposition before applying a plaster immobilization bandage.
• Rehabilitation after removal of the cast, restoration of movement and joint function.

After this, a plaster-based fabric bandage is applied: immobilization is necessary, its duration depends on the degree of the defect and ranges from 4 weeks.

We will help you restore bone integrity, joint function and return to your usual active lifestyle. We have an individual approach to each patient.

Dietary recommendations

Recovery after a fracture is a long process, which can be accelerated by organizing proper nutrition. The diet includes calcium-containing foods:

• poppy;
• sesame;
• various nuts;
• dairy and fermented milk products;
• legumes (beans, soybeans);
• different types of fish;
• green apples and vegetables (white cabbage, Peking cabbage, etc.);
• jellied meat (eating this dish will speed up the restoration of cartilage tissue).

Ground eggshells, which are highly digestible, perfectly compensate for calcium deficiency. It can be added to dishes or consumed in its natural form.

The balance of vitamins and microelements will be maintained in optimal condition by a mixture prepared from a glass of raisins, walnuts, honey, dried apricots and 2 lemons. Thoroughly washed raisins and dried apricots are briefly soaked in water, after which they are rolled through a meat grinder along with the nuts. Next, the mixture is mixed with honey and lemon juice. The tasty medicine should be taken 3 teaspoons three times a day.

Surgical measures

If it is obvious that closed reduction will not be effective, plaster is not used: they resort to open osteosynthesis surgery and installation of metal structures directly on the bone tissue.

Violations of the integrity of the talus are preferable to be treated surgically due to the risk of aseptic necrosis. Reduction and reposition of her fracture-dislocations must be carried out by repeating the mechanism of injury in the opposite direction.

Fig.5 a. osteosynthesis of the talus and calcaneus with screws, b. fracture of both ankles; osteosynthesis with plate and screws.

Time required for recovery

To confirm some types of fractures, it is necessary to take a stress x-ray

The table shows how long it takes for an ankle and foot fracture to heal. Duration is indicated in weeks. The time corridor takes into account the age limit, as well as the profession of the patient, namely, after discharge from sick leave, what kind of work he will have to do - mental or physical.

Important. Widely advertised chondroprotective tablets and ointments do not have a therapeutic effect either for fractures or for degenerative-dystrophic or inflammatory diseases of the skeletal system.

It is better to spend this money on the necessary components of dietary nutrition for damage to bone tissue - fatty fish, seafood, cottage cheese and fermented milk drinks, nuts, dried and fresh fruits, mineral water.

Consequences

If you do not consult a doctor in time, even a simple ankle fracture can complicate your future life.

A common consequence of delayed treatment is ankle pseudarthrosis, fusion in the wrong position, post-traumatic arthrosis.

Insufficiently thought-out treatment leads to impaired ankle stability and deformation. In old cases, eliminating such consequences is not easy.

Gross defects are much more dangerous:

• Persistent impairment of the supporting function of the foot.
• Due to blood supply disorders, aseptic necrosis of bones occurs.
• Infectious complications in the affected area.

The loss of physiological gait affects the entire human skeleton, primarily the spine. In some cases, ankle replacement may be required. .