Anatomy: The tendons surrounding the ankle joint are connected to the bones in several places by connective tissue strings (retinaculum). Two peroneus muscles are positioned behind the outer ankle knuckle, which are used to stabilise and flex the ankle joint.

Symptoms: Pain at the outer ankle knuckle (malleolus lateralis), where certain movements of the ankle joint can give rise to a painful sense of “slipping”.

Acute treatment: Click here.

Examination: When the painful movement of the ankle joint is performed, normal examination can detect the tendon slip over the outer ankle knuckle. A normal medical examination is usually sufficient in order
to make the diagnosis, however, if there is any doubt concerning the
diagnosis it can be made with certainty by use of ultrasound scanning while the ankle joint is in motion (dynamic ultrasound scanning). Ultrasound scanning will reveal whether there is bleeding in the acute stage. Inflammation of the tendon sheath can develop at a later stage.

Treatment: Treatment is primarily concentrated on providing rest from the painful activities (running). If steady progress from rest and rehabilitation is not achieved, and ultrasound scanning reveals inflammation of the tendon sheath, the treatment can be supplemented by medicinal treatment in the form of rheumatic medicine (NSAID) Alternatively, draining and evaluating fluid can be performed, and injection of corticosteroid into the tendon sheath. Injection into the tendon sheath is best performed if ultrasound guided. Surgical intervention can be attempted in certain cases, if resting, rehabilitation and medicinal treatment do not provide the desired result (article).

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

• Outer ligament injury in the ankle joint
• Rupture of the joint capsule at the front of the ankle joint
• Bone membrane tear (periosteal avulsion)
• Concentration of fluid in the joint (traumatic arthritis/synovitis)
• Inflammation of the bursa
• Arthritis

Possibly supplement with further examinations (x-ray, ultrasound scanning).

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx).

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Examination: X-ray examination will usually, but not always, reveal a stress fracture. The x-ray examination can be repeated after a few weeks as a number of stress fracture are not easily discernible in the early stages. Bone scintigraphy, ultrasound scanning and MRI examination can often diagnose a stress fracture much earlier than x-ray examination (Ultrasonic image), (Scintigraphy-image).

Treatment: Treatment is primarily relief and rest, and possible bandaging. Surgical intervention is only required in very special cases. It is imperative that shoes are equipped with impact absorbing soles (article).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical). Until the pain has subsided, the guidelines under rehabilitation, general should be followed.

Complications: If there is not a steady improvement in the condition a medical examination should be performed once more to ensure that the fracture is healing according to plan. In some cases, a false joint can develop which will require surgical treatment.

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx). Furthermore, the lower part of the shin bone (tibia) and calf bone (fibula) form a part of the ankle joint.

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Acute treatment: Click here.

Examination: X-ray examination will usually reveal the fracture. The fracture can in some cases first be seen after 14 days, thus the x-ray examination should be repeated if there is a continued suspicion of a fracture.

Treatment: Treatment is completely dependent upon which bones are broken, and whether there is a dislocation of the fracture. In some cases relief and rest without bandaging can be opted for, whereas other types of fracture require bandaging and possibly surgical intervention (article) (X-ray picture).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical).
Also read rehabilitation, general.

Complications: If there is not a steady improvement in the condition a medical examination should be performed once more to ensure that the fracture is healing according to plan. In some cases, a false joint can develop which will require (renewed) surgical treatment (X-ray picture).

Special: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.

Anatomy: The shin bone (tibia) and the calf bone (fibula) are held together by a connective tissue membrane (membrana interossea cruris) which is particularly strong at the ankle joint and forms a false joint. This, together with the membrane, is termed syndesmosis tibiofibularis which is strengthened in front and behind with two strong ligaments (ligamentum tibiofibulare anterius & posterius).

Symptoms: Pain in front of the ankle joint between the shin and calf bones. The pain is aggravated when the foot is turned in relation to the shin.

Acute treatment: Click here.

Examination: As the injury is almost always combined with a fracture of the bones in the ankle, an x-ray examination will always be indicative. The x-ray will show the fracture and a possible increase in the distance between the shin and calf bones.

Treatment: Dressing with a bandage and possible surgical intervention dependant upon the presence of a bone fracture.

Rehabilitation: Rehabilitation is dependent upon the course of treatment (conservative/surgical operation), and of possible fractures and their treatment.
Also read rehabilitation, general.

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

• Bone fracture
• Outer ligament injury in the ankle jointt
• Inner ligament injury in the ankle joint
• Bone membrane tear (periosteal avulsion)
• Inflammation of the tendon sheath
• Concentration of fluid in the joint (traumatic arthritis/synovitis)
• Cartilage damage in the joint

Anatomy: The ankle joint is stabilised by a wide fan shaped ligament on the inside (ligamentum deltoideum), and a set of outer ligaments (fore, centre, and at the rear). The ligaments stabilise the ankle joint, especially when twisting and running with sudden directional changes (Photo).

Symptoms: Pain on and under the inner ankle bone (malleolus medialis), swelling due to bleeding, pain when walking.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required for very minor cases (slight sprain) with only minimal swelling and no discomfort when walking. The extent of the swelling is, however, not always a mark of the degree of the injury. Medical examination is recommended with more extensive swelling or pain, in order to eliminate bone fracture in the ankle and a rupture of the ligament between the shin and calf bones (syndesmosis rupture). A normal medical examination is usually sufficient in order to make the diagnosis. X-ray examination should be performed in all cases where there is a suspicion of a bone fracture or syndesmosis rupture. Vigorous twisting of the ankle in the acute stage to appraise the degree of looseness is not indicative, as this has no influence on the choice of treatment (article). Ultrasound examination will give valuable information when the ligament is ruptured (Ultrasonic image).

Treatment: Treatment of ligament injuries is today conservative (rehabilitation). Many patients have earlier undergone operations and setting of plaster cast, however, this course of treatment has practically been abandoned in relation to uncomplicated ligament ruptures (article).

Bandage: It is recommended to use tape in the course of rehabilitation when starting to run on an uneven surface, or with sudden directional change. Nerve cells (proprioreceptors) in the ligaments transmit information to the brain on the position of the ankle joint. The brain sends information to the muscles, which are activated, ensuring that the ankle is held correctly. The nerve paths do not function in an optimal manner when the ligament is injured, and the risk of a new twist of the foot is increased thereby. Use of tape is primarily designed to stimulate the small nerve cells in the skin, thus enabling these to act as a substitute for the nerve cells temporarily damaged in the ligament. The function of the tape is thus not a pure mechanical stabilising of the ankle joint (tape-instruction). In some cases, certain forms of bandaging around the ankle can be used to advantage.

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

• Rupture of the ligament between shin and calf bones (syndesmosis rupture)
• Bone membrane tear (periosteal avulsion)
• Inflammation of the tendon sheath
• Concentration of fluid in the joint (traumatic arthritis/synovitis)
• Cartilage damage in the joint

It is extremely rare that the injury results in a chronically loose ankle joint if rehabilitation is handled sensibly. If the injury does result in a chronically loose ankle joint, intensive co-ordination training must be recommended. Bandages can be tried if this is not sufficient, and if this still does not give the desired effects, surgical intervention to tighten the ligaments can be attempted.

Special: Seesaw exercise is important in the rehabilitation phase, as well as in a preventive capacity. As a preventive measure, seesaw exercises should be performed frequently throughout the rest of the active sporting career if ligament injuries in the ankle joint have previously been experienced. Begin by standing with both feet on the seesaw and use hands for support on the wall. Gradually let go of the support to finally train by standing on only one leg (article). Special bandages have in some studies been shown to reduce the risk of ligament injuries.
(article-1), (article-2).

Anatomy: The ankle joint is stabilised by a joint-capsule as well as a wide fan shaped ligament on the inside (ligamentum deltoideum/mediale), and a set of outer ligaments (ligamentum talofibulare anterius fore, ligamentum calcaneofibulare centre, and ligamentum talofibulare posterius at the rear). There is also a strengthening of the ligaments in front and behind (ligamentum tibiofibulare anterius & posterius). The surrounding tendons are often enclosed by tendon sheaths and joined to the bones with connective tissue strings. The ligaments stabilise the ankle joint, especially when twisting and running with sudden directional changes (Photo).

Symptoms: Pain on and under the outer ankle bone (malleolus lateralis), swelling due to bleeding, pain when walking.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required for very minor cases (slight sprain) with only minimal swelling and no discomfort when walking. The extent of the swelling is, however, not always a mark of the degree of the injury. Medical examination is recommended with more extensive swelling or pain, in order to eliminate bone fracture in the ankle and a rupture of the ligament between the shin and calf bones (syndesmosis rupture). A normal medical examination is usually sufficient in order to make the diagnosis. X-ray examination should be performed in all cases where there is a suspicion of a fracture or syndesmosis rupture. Vigorous twisting of the ankle in the acute stage to appraise the degree of looseness is not indicative, as this has no influence on the choice of treatment (article). Ultrasound examination will give valuable information when the ligament is ruptured (Ultrasonic image).

Treatment: Treatment of ligament injuries is today conservative (rehabilitation). Many patients have earlier undergone operations and setting of plaster cast, however, this course of treatment has practically been abandoned in relation to uncomplicated ligament ruptures, although there is not definitive agreement on this subject (article-1) (article-2).

Bandage: It is recommended to use tape in the course of rehabilitation when starting to run on an uneven surface, or with sudden directional change. Nerve cells (proprioreceptors) in the ligaments transmit information to the brain on the position of the ankle joint. The brain sends information to the muscles, which are activated, ensuring that the ankle is held correctly. The nerve paths do not function in an optimal manner when the ligament is injured, and the risk of a new twist of the foot is increased thereby. Use of tape is primarily designed to stimulate the small nerve cells in the skin, thus enabling these to act as a substitute for the nerve cells temporarily damaged in the ligament. The function of the tape is thus not a pure mechanical stabilising of the ankle joint (tape-instruction). In some cases, certain forms of bandaging around the ankle can be used to advantage. Special bandages have in some studies been shown to reduce the risk of ligament injuries.
(article-1), (article-2).

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

• Rupture of the ligament between shin and calf bones (syndesmosis rupture)
• Bone fracture
• Bone membrane tear (periosteal avulsion)
• Luxation of the peroneus tendon
• Inflammation of the tendon sheath
• Concentration of fluid in the joint (traumatic arthritis/synovitis)
• Cartilage damage in the joint

It is extremely rare that the injury results in a chronically loose ankle joint if rehabilitation is handled sensibly. If the injury does result in a chronically loose ankle joint, intensive co-ordination training must be recommended. Bandages can be tried if this is not sufficient, and if this still does not give the desired effects, surgical intervention to tighten the ligaments can be attempted. The results are usually quite acceptable (article).

Special: Seesaw exercise is important in the rehabilitation phase, as well as in a preventive capacity. As a preventive measure, seesaw exercises should be performed frequently throughout the rest of the active sporting career if ligament injuries in the ankle joint have previously been experienced. Begin by standing with both feet on the seesaw and use hands for support on the wall. Gradually let go of the support to finally train by standing on only one leg (article).