The ankle

Ankle pain? Solutions and treatments to restore your mobility!

The ankle is a stable joint formed by three bones (the tibia, the fibula, and the talus) assembled in a mortise-and-tenon configuration known as the talocrural joint. This stability is reinforced by capsular, ligamentous, and tendinous structures, particularly at the level of the syndesmosis (the joint between the tibia and the fibula), which is maintained by three ligamentous bands. The interosseous membrane completes this arrangement by binding the tibia and fibula together along the entire length of the leg.

The different zones of the ankle

The talocrural joint is highly solicited and subjected to significant mechanical stress.

With each step, at a normal cadence, the ankle joint bears up to five times the body weight. The cartilage is thin but remarkably resilient. For this reason, following an articular trauma to the ankle(a fracture, for example) painful decompensation may not appear until 30 or even 40 years later.

The syndesmosis

The syndesmosis allows adaptive mobility of the malleolar mortise. The talus is wider at its anterior portion; dorsiflexion of the ankle positions the wider part of the talus into the mortise, causing the syndesmosis to widen.

Syndesmosis injuries can go undetected; for this reason, it is essential to systematically assess the syndesmosis during the clinical examination of an ankle. Ankle arthroscopy is the most reliable method for examining the syndesmosis and subsequently verifying the quality of any stabilization procedure.

Common Ankle Pathologies

Ankle sprains are a very common reason for consultation in emergency departments as well as in outpatient clinics. Management varies depending on the severity of the sprain and the history of the injured ankle.

It is important to distinguish between a patient presenting with a first-time sprain and a patient with recurrent sprains, which are often associated with constitutional joint hyperlaxity.

Ankle fractures involve variable combinations of injuries. These are most often articular fractures, with a potential progression towards osteoarthritis. It is therefore essential to perform a thorough assessment using multiple radiographic views and, where appropriate, a CT scan,  particularly for syndesmosis and tibial plafond injuries.

Treatment is predominantly surgical, with the goal of repairing all lesions.

  • Ankle impingement syndromes are less well known but relatively common.
  • Anterior impingement is caused by the presence of bony spurs, known as osteophytes, and fibrous scar tissue.
  • Posterior impingement is more commonly caused by an accessory bone called the os trigonum, muscular ectopia, or soft tissue thickening.

Bone and cartilage injuries of the ankle frequently present as osteochondral lesions of the talar dome (OLT), also referred to as osteochondral lesions of the talus. Treatment depends on the size and presentation of the lesion. These lesions may be:

  • Fracture-related
  • Cystic (geodic)
  • Osteochondritis-type

Peroneal tendinopathies are less common. They involve damage to the stabilising tendons of the ankle. The lesions may be:

  • Inflammatory
  • Fissural
  • Peroneal instability
  • Tendon ruptures

Both acute and chronic Achilles tendon pathologies fall within the scope of ankle conditions. Other pathologies can also affect the ankle, notably ankle cysts, which may cause pain and functional impairment.

The Ankle Specialists

Ankle surgeons treat all mechanical pathologies of the ankle. Inflammatory ankle conditions associated with chronic inflammatory diseases are managed medically by the rheumatologist. Sports medicine physicians manage non-surgical ankle injuries.

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