Many of the movements we make every day are made possible by the ankle, a complex set of joints that allows our foot to move up and down and to turn.
The ankle can easily be injured during sports such as football, or by walking or running on uneven surfaces, so it's worth knowing a little about how to prevent and treat ankle injuries, and when to seek expert advice.
Anatomy of the ankle
The ankle is a set of two joints which allow the foot to move in four directions.
- The main ankle joint is made up of the bottom of the leg bones (the tibia and fibula), one of the larger bones in the foot (the talus), and multiple surrounding ligaments. It allows you to move your foot up and down
- The subtalar joint, meanwhile, is made up of the talus and the heel bone (the calcaneus) together with other ligaments. It allows you to turn your ankle in and out
How to help keep your ankles healthy
You can help prevent injury to your ankle by keeping it well supported. If you're going to be walking a lot (especially on uneven surfaces) or playing sports, consider footwear which offers built-in ankle support.
Many styles of sports shoes and walking or hiking shoes extend up beyond the ankle, providing a little extra protection while still allowing the foot to move.
Ankle injuries
Injury to any of the ligaments, muscles or bones of the ankle joint can cause pain and stiffness in the joint, and may make it unstable, leading to restricted movement.
An unstable ankle injury also affects your ability to bear weight on the affected side, which can cause you to experience pain on the other side of your body as it has to support the extra weight.
If you injure your ankle, you should go to the nearest accident and emergency (A&E) department or call 999 for an ambulance if:
- Your ankle looks obviously deformed
- You have any pins and needles, or loss of sensation in the foot
- Your foot looks pale compared to the non-injured side
These may be signs of an emergency requiring prompt treatment.
Although you may not need to call an ambulance if your injury is less severe, it's advisable to attend your local minor injuries unit for an X-ray if you experience either of the following:
- You're unable to walk on the affected side for more than three steps
- Pressing on any part of the foot is painful
Ankle strain or sprain
Muscle strain is the least severe form of ankle injury, but it can still be very painful. If you move the joint further than usual, or put more weight on it than you normally do, the muscle can strain and bruise. This often triggers swelling in the muscles around the ankle, which in turn causes more pain when you move it.
A sprain is an injury to the ligaments around the ankle joint. Sprains often occur when landing awkwardly on the ankle, or when walking on uneven ground. They're more likely to occur when the ankle isn't supported properly. Common symptoms of a sprain are tenderness and swelling around the ligaments of the ankle, bruising, and difficulty weight-bearing. The knee may also be affected in a sprained ankle.
In the first 72 hours after spraining or straining your ankle it's important to remember PRICE and HARM:
- Protect the ankle with a support
- Rest the joint with only minimal weight-bearing for the first 48-72 hours
- Ice the joint as soon as possible after the injury for up to 20 minutes every two to three hours, but do not apply ice directly to the skin
- Compression with bandages can help reduce swelling
- Elevation of the foot also helps reduce swelling
- Avoid HARM (Heat, Alcohol, Running and Massage), for the first 72 hours, as these can make the injury worse
If your sprain or strain is more severe, you may need help from a physiotherapist to manage your rehabilitation. Occasionally, surgery is also needed. A sprain or strain may start feeling better after a couple of weeks. But, as a general rule, you should avoid vigorous exercise such as running for at least eight weeks after your injury. Visit a minor injuries unit if the injury isn’t getting better after you’ve tried to treat it yourself or if the pain or swelling is getting worse.
Ankle fracture
Fractures are breaks in the bones of the ankle joint. It's often difficult for doctors to tell without X-rays whether patients have an ankle sprain or an ankle fracture. Some things that may indicate a fracture rather than a sprain are deformity in the joint (if it looks misshapen) or hearing a snap on injuring the joint (although this is not reliable).
The management of ankle fractures depends on which parts of the bones are affected. Some fractures require surgery within a few days in order to heal properly, and some can be managed without surgery. If your doctor suspects you have a fracture, you'll need an X-ray or possibly a scan. If you have a fracture, you’ll usually be referred to a specialist.
Achilles tendon rupture
This is breakage of the tendon at the back of your heel. It is common with this kind of injury to experience a 'snap' accompanied by sudden pain at the back of the heel. You may be unable to stand on tiptoes after this injury. If you suspect an Achilles tendon rupture, you should go to your local emergency department, as you may need surgery or application of a plaster cast.
Pain management
Simple painkillers can be used to help keep the pain of an ankle injury under control. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be purchased from your local pharmacy either as tablet or a cream that can be applied to the ankle, and may help reduce the inflammation and pain at the injury site. NSAIDs aren't suitable for everyone – always consult your pharmacist before taking any new medicines, especially if you take any other over-the-counter or prescription medicines.
An ankle support may also help with pain management, as it helps to support the ankle while it heals. Whether or not you should wear one depends on the type of injury, so have a chat to your pharmacist or Doctor about it.
Next steps
- You can treat minor ankle injuries, such as sprains and strains, at home by using PRICE therapy and avoiding HARM for the first 72 hours
- Consider an NSAID painkiller such as ibuprofen to keep the pain under control. Bear in mind that these aren’t suitable for everyone – your pharmacist will be able to advise you
- Seek medical advice if you have any of the warning symptoms mentioned above