What to do If you Have an Ankle Injury?

In Germany alone, more than 22 million people regularly engage in sports. That’s when injuries or signs of wear and tear to the joints sometimes occur. Ankle injuries are particularly common. We spoke with Stuttgart orthopedist Dr. Christian Mauch about causes, risks and consequences.

Ankle injuries are particularly common among athletes. Why?

Dr. Mauch: Because the joint is subjected to stress in many sports and has an additional complicated structure: it consists of the lower and upper ankle joint and is stabilized by three outer and two inner ligaments. A typical injury is the torn ligament. Incidentally, the outer ligament tear is the most common ligament injury in humans and usually occurs after a twisting ankle. Predominantly, the foot bends inward in the upper ankle joint.

How do I recognize an ankle joint injury?

First, of course, by the sharp pain in the outer ankle area. After that, a crescent-shaped bruise forms and the foot can hardly be moved.

Now it has happened. What next?

In any case, go to the doctor! Even seemingly harmless injuries must be treated by an orthopedist. Compression cooling is recommended as initial treatment. This means that the affected joint should be cooled with ice and stabilized with a pressure bandage. This prevents the ankle from swelling. And, of course, the joint should be stressed as little as possible.

How is an ankle injury usually treated?

The external ligament tear is always treated conservatively, that is, without surgery. The two simplest measures are also the most important: relieving the foot and sparing it. Through a special bandage with a removable splint (Aircast) and simultaneous physiotherapy, the ligaments usually heal completely within four to six weeks.

But what if you still complain of instability in the ankle and pain after an extended period of time?

This can have several causes. Either the ligaments have not grown together optimally, the ligaments are simply looser and thus the ankle joint is unstable or scar tissue has formed in the joint. In any case, the first choice is special physiotherapy. If this does not lead to the desired success, a surgical reconstruction of the ligaments by means of the so-called periosteoplasty is recommended, especially for competitive athletes.

And what happens during this operation?

In this special surgical technique, a strip-shaped portion of periosteum is separated from the lower leg through an incision in the skin. This strip is then cut in half, folded over, and anchored as a ligament replacement at the lower attachment sites of the stretched or torn ligaments. Thus, the ligamentous structure of the ankle joint is restored.

Sounds complicated…

… But it isn’t. Periosteoplasty is a rather routine and very effective treatment for instability in the ankle joint. Even patients who have suffered from chronic ligament injuries for a long time are fit again in a few weeks thanks to this technique. After surgery, the joint must be immobilized for three weeks. After another six weeks of exercise therapy, the new ligament is firmly healed and the joint is stable again.

You warn against not taking a torn ligament seriously. What are the risks?

In the worst case, instability of the joint leads to cartilage damage associated with osteoarthritis. In addition, the joint remains restricted in its movements for a long time and can also only be fully loaded with pain. This is particularly bitter for athletes. After all, this is always associated with longer breaks from training.

So what would you recommend for athletes with such an injury?

People often take an ankle injury lightly. But people often forget that the joint is hugely important in almost every sport. That’s why it’s crucial to fully heal the torn ligament. The rule of thumb here is that the ankle joint cannot be fully loaded again until four weeks after the injury.