If there were a candidate for most overlooked and under-appreciated joint in the body, the ankle would surely be a contender. Although these rather small joints are responsible for connecting us to our feet and play a huge role in keeping us properly upright, they don’t get the kind of attention as do, say, knees or hips with their increasingly common super-modern replacements. Yet the ankle is the site of one of the most common sports injuries — ankle sprain. And unfortunately, after the first sprain often another sprain occurs… and yet another. Eventually this can lead to additional problems, including arthritis.
To get the low-down on this joint, I called ankle expert David I. Zaret, MD, an orthopedic surgeon in Long Island, New York. Dr. Zaret explains that tripping or trying to plant your foot on uneven ground are common causes for ankle sprains. A bad sprain can set the stage for recurring ones if the injured ligaments that connect the bones fail to heal completely or do so in an elongated fashion, leaving the ligament permanently stretched and the ankle bones unsupported.
If you trip or fall and your ankle swells and hurts when you try to put weight on it, it’s probably a sprain. Dr. Zaret suggests the familiar RICE technique — rest, ice, compression and elevation — as your first treatment. Another option: Apply ice initially, then, once swelling subsides, alternate with hot compresses. This technique will help the tissues, particularly the ligaments, to heal with less scarring and elongation, according to Daily Health News contributing editor Andrew L. Rubman, ND. If a few days go by with no improvement, visit your doctor for an X-ray to be sure there is no fracture.
Although some research maintains immobilization is better, Dr. Zaret disagrees, saying it is best to keep the ankle moving after a sprain. He has found that unless the sprain is truly severe — and this is rare — casting or splinting are not helpful and patients do better to start moving the ankle around (though not bearing weight) and rehabbing as soon as possible. Walking while wearing a support brace is fine, once it is comfortable — it will help ligament healing and also prevent ligaments from forming scar tissue, he explains. Patients who develop recurring sprains may need surgery to repair the stretched ligaments that are failing to keep the joint in place, says Dr. Zaret.
Though uncommon, a severely arthritic ankle is extremely painful and limiting and may require surgical correction. Older patients may be good candidates for replacement surgery — perhaps surprisingly, more so than younger, more active people. This is because ankle replacement (unlike some hip and knee replacements) won’t allow the patient to return to high-intensity activities. The surgery’s primary result is to reduce pain sufficiently so that the patient can function better in normal activities of life, i.e. walking but not running, perhaps golfing, but with a cart only. Ankle replacement is a complicated, somewhat uncommon procedure. Dr. Zaret says it is important to locate a surgeon who has been trained and is experienced in it. To find a listing of qualified surgeons around the country, go to the American Orthopaedic Foot & Ankle Society Web site (www.aofas.org).
The other choice for those with severe ankle arthritis is fusion, where patients essentially end up trading their up-and-down ankle motion for pain relief. The surgeon clears out whatever cartilage is left in the joint and, using metal implants, brings the bones together to fuse while healing. Interestingly, fusion is often preferred for younger and more active patients, because ankle replacement prostheses are likely to wear out. That said, there is a huge down side of fusion — it may cause a limp and limit mobility and also causes other joints to take on a different load, putting them at risk for eventually developing arthritis as well, says Dr. Zaret.
In the long run, it’s best to keep your ankles strong and flexible so you can avoid ankle problems altogether. To this end, Dr. Zaret advises doing “alphabet” exercises at least three times a week. Pretend you are holding a pen between your first and second toe. Using only your foot, not the entire leg, draw the letters of the alphabet in the air, making exaggerated motions. This takes only a few minutes, you can do it at your desk or while watching TV, and you can have fun with it, writing in script, in print, with great flourish, and other ways you can think of to change your “handwriting” while also strengthening your ankle joints.
