HY 03/07: Your Complex Ankle Joint | Lehigh Valley Hospital

Ankles deserve special care to avoid injury and keep you active

The ankle is a biomechanical marvel. This intricate system of bones, ligaments, tendons and muscles acts like a hinge, propelling you forward when you run, cushioning jumps and allowing you to pivot quickly.

Your hard-working ankles bear up to eight times your body weight. They’re strong enough to keep you standing steady, yet flexible enough for dancing or tree-climbing.

Not surprisingly, some stability is sacrificed for flexibility—a trade-off that leaves ankles prone to injury.

Most common is the sprain, which occurs when your ankle rolls over your foot (inside or outside), causing a ligament to stretch or tear. “Some sprains are caused by playing sports, others from everyday activities like stepping in a hole in the lawn,” says orthopedic surgeon Barry Ruht, M.D., of Lehigh Valley Hospital and Health Network.

If ligaments don’t heal correctly, the result can be chronic ankle instability—and recurring sprains. “No one is inherently more prone to sprains, but a prior injury definitely increases your risk,” says Ruht’s colleague, orthopedic surgeon Mitchell Cooper, M.D.

Sometimes ligaments need to be repaired surgically. But often, you can avoid surgery through good prevention strategies. If you are at risk for an ankle sprain, here’s what to do:

Control your weight. “For every pound you lose,” Ruht says, “you decrease the burden on your ankle by two pounds.”

Wear a brace or tape your ankles to prevent excessive motion. “Braces come in many styles,” Cooper says. “Ask your doctor about the best kind for you.”

Strengthen your ankles. Muscle-strengthening exercise after a sprain helps prevent further injuries. Always stretch before and after athletic activities.

Wear appropriate shoes made for your sport (in other words, don’t play basketball in running shoes). Avoid high heels that throw off your balance.

Try customized shoe inserts (orthotics) to stabilize your feet and ankles.

When Surgery Becomes Necessary
A lifelong sports enthusiast, 48-year-old Tom Roth of Allentown took occasional ankle sprains in stride. But when they started increasing, he decided to seek help. “Every couple of months I was turning my ankle,” he says.

A visit to orthopedic surgeon Barry Ruht, M.D., showed that a ligament in his right ankle was permanently stretched, causing chronic instability. After physical therapy failed to resolve the problem, Roth had ankle reconstruction surgery to tighten the ligament.

This involves cutting the ligament, overlapping the ends to make it shorter, and reattaching them. The procedure sometimes can be done by inserting a heat probe through a small incision to shrink the ligament. In Roth’s case, Ruht also placed a permanent screw through his heel bone for added stability.

After several months in a cast and physical therapy, Roth could finally play tennis and bike again. “I still wear a brace for tennis, but I don’t worry as much about sprains,” he says. “It was definitely the right thing to do.”

Your Complex Ankle Joint

Ankles deserve special care to avoid injury and keep you active

A brace keeps him on the court