Ailments of the Ankle

Anyone who has ever had an elevated blood sugar level is at risk for foot complications. It may be as simple as knowing that once in your life, even during pregnancy, you have had an elevated blood sugar level. If so, you are at risk and must monitor your feet.

Diet-controlled diabetics, whether diagnosed as an adult or as a child, have feet at risk for diabetic complications. The simple rule: If you have ever been told that you are at risk of developing diabetes, you need to monitor your feet closely to prevent complications.

The Achilles tendon is the largest tendon in the body. It connects the upper calf muscles to the back of the heel bone. Achilles tendinitis is an injury to this tendon that causes pain in the back of the leg. Typically this injury results from inflammation of the surrounding sheath (paratenonitis), degeneration within the tendon (tendinosis), or a combination of the two.

The Achilles tendon is the largest tendon in your body. It connects the upper calf muscles to the back of the heel bone. Achilles tendinosis is a condition in which the Achilles tendon degenerates and becomes inflamed. Sometimes, it may also be called Achilles tendinitis. If you have Achilles tendinosis, your tendon can swell and become painful. This condition is common in athletes, runners, and people who have calf tightness. Achilles tendinosis may occur in the middle of the tendon (known as midsubstance Achilles tendinosis) or at the point where the tendon connects to the heel bone (known as insertional Achilles tendinosis).

The goal of ankle arthrodesis (also known as ankle fusion) is to relieve pain and maintain or improve function for patients with ankle arthritis. Ankle arthritis is degeneration of the cartilage that covers the ends of the bones that form the ankle joint. These bones are the tibia, the fibula, and the talus. Pain typically is made worse with movement of the arthritic ankle. In ankle arthrodesis the ankle bones are fused into one bone. This eliminates the joint motion and reduces pain coming from the arthritic joint. 

The ankle is made up of three bones:

• the tibia (shin bone), which forms the inside, front, and back of the ankle
• the fibula, which forms the outside of the ankle
• the talus, a small bone that sits between the tibia and fibula and the heel bone

The ends of these bones are called malleoli. The tibia has a medial (inside) malleoli and a posterior malleoli. The fibula forms the lateral (outside) malleoli.

An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral (outside) part of the ankle. There's a good chance that while playing sports as a child or stepping on an uneven surface as an adult you sprained your ankle—some 25,000 people do it every day. It can happen in the setting of an ankle fracture (i.e., when the bones of the ankle also break). Most commonly, however, it occurs in isolation.

The pain and stiffness you feel in your feet and ankles as you age could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances. Severe arthritis can restrict your mobility, but with proper treatment, you can minimize the pain and maximize your quality of life.

Arthritis is a broad term for a number of conditions that destroy the workings of a normal joint. Arthritis may occur in your back, neck, hips, knees, shoulders or hands, as well as your feet and ankles. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle, but not all of them have symptoms.

Osteochondral lesions of the talus (OLTs) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. Foot and ankle orthopaedic specialists call this type of injury an OLT. Since the ankle joint moves while walking, the rough spots may cause pain, swelling, stiffness, and decreased motion. It is kind of like having a pothole in the joint surface.

Bulk allograft transplantation takes bone and cartilage from a human cadaver and places it into the damaged talus. This surgery is reserved for severe cases of OLT that have either failed previous surgical treatment or involve a very large part of the talus. These types of OLTs may not respond to lesser surgeries.

Charcot arthropathy, also known as Charcot foot and ankle, is a syndrome in patients who have peripheral neuropathy, or loss of sensation, in the foot and ankle. Patients may experience fractures and dislocations of bones and joints with minimal or no known trauma.

Chronic lateral ankle pain is recurring pain on the outer side of the ankle often develops after an injury such as a sprained ankle. However, several other conditions also may cause chronic ankle pain.

Clubfoot is an abnormal inward curving of the foot. One of the most common nonmajor birth defects, clubfoot affects a child's foot and ankle, twisting the heel and toes inward. The clubfoot, calf and leg are smaller and shorter than normal. Clubfoot is not painful, the deformity is correctable, and your baby is probably otherwise normal. Approximately one in every 1,000 newborns has clubfoot. Of those, one in three have both feet affected. Two out of three clubfoot babies are boys. Clubfoot is twice as likely if the baby’s parents or their other children also have it. Less severe infant foot problems also are common and sometimes mislabeled as clubfoot.

Every day, the average person spends several hours on their feet and takes several thousand steps. Walking puts pressure on your feet that's equivalent to one-and-a-half times your body weight. No wonder your feet hurt!

Actually, most foot problems can be blamed not on walking but on your shoes. Corns, for example, are calluses that form on the toes because the bones push up against the shoe and put pressure on the skin. The surface layer of the skin thickens and builds up, irritating the tissues underneath. Hard corns usually are located on the top of the toes or on the side of the small toe. Soft corns may resemble open sores and develop between the toes as they rub against each other.

The high ankle ligaments are located above the ankle, as opposed to the more commonly injured ligaments on the outside of the ankle. These high ankle ligaments connect the tibia to the fibula. It is important to have stability between the tibia and fibula at this level because walking and running place a tremendous amount of force at this junction.

A high ankle sprain occurs when there is tearing and damage to the high ankle ligaments. These injuries are much less common than a traditional ankle sprain. 

Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. Foot and ankle orthopaedic specialists call this type of injury an OLT. Since the ankle joint moves while walking, the rough spots may cause pain, swelling, stiffness, and decreased motion. It is kind of like having a pothole in the joint surface.

One way to treat the damaged ankle cartilage is through surgery. One type of surgery is called mosaicplasty (MP), which is the transplant of small amounts of bone and cartilage. The primary goal of this procedure is to smooth out the surface of the ankle joint by replacing the unhealthy spots with healthy, smooth cartilage. By reconstructing the surface, pain and other symptoms should decrease or stop all together.

Osteochondral lesions, sometimes called osteochondritis dessicans or osteochondral fractures, are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. Throughout this article, these injuries will be referred to as osteochondral lesions of the talus (OLT).

The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. Peroneal tendinosis is enlargement and thickening with swelling of these tendons. This usually occurs with overuse, such as a repetitive activity that irritates the tendon over long periods of time. 

The tibia (shin bone) and the fibula are the bones of the lower leg. Pilon fractures are injuries that occur at the lower end of the tibia and involve the weightbearing surface of the ankle joint. The fibula also may be broken. These injuries were first described more than 100 years ago and remain one of the most challenging problems for orthopaedic surgeons to treat. Common causes of pilon fractures are falls from a height and car accidents.

Rheumatoid arthritis (RA) is a systemic disease that attacks multiple joints throughout the body. About 90 percent of people with RA eventually develop symptoms related to the foot or ankle. Usually symptoms appear in the toes and forefeet first, then in the middle and back of the foot, and finally in the ankles. Other inflammatory types of arthritis that affect the foot and ankle include gout, ankylosing spondylitis, psoriatic arthritis, and Reiter's syndrome.

The exact cause of RA is unknown but there are several theories. Some people may be more likely to develop RA because of their genes. However, it usually takes a chemical or environmental trigger to activate the disease. In RA, the body's immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame the joints.

A talus fracture is a broken ankle bone. The talus is the bone in the back of the foot that connects the leg and the foot. It joins with the two leg bones (tibia and fibula) to form the ankle joint and allows for upward and downward motion of the ankle.

The talus (ankle bone) sits within the ankle mortise or hinge, which is made up of the two leg bones, the tibia and fibula. There are three joints:

• the ankle, which allows the up-and-down motion of the foot with the leg
• the subtalar joint, which allows for side-to-side movement
• the talonavicular joint, which has a complicated biomechanical function that controls flexibility of the foot and the arch of the foot.

The talus has no muscular attachments and is mostly covered with cartilage, which makes injuries difficult to heal.