11 February 2009

Your ankles

The ankle is a mechanical miracle. It is flexible and resilient, serves as a foundation and propels you forward. But ankles can also become swollen, strained or sprained.

The ankle is in many ways a mechanical miracle. It is flexible and resilient, is a good shock absorber, serves as a foundation and propels you forward. It carries the weight of the entire body. It can sustain huge pressure, while providing the body with mobility, balance and support.

The ankle is made up of two joints, namely the subtular joint and the true ankle joint. The latter is composed of three bones, the tibia (the inside portion of the ankle), the fibula (which forms the outside portion of the ankle), and the talus underneath. The true ankle joint makes it possible for you to move your foot up and down and the subtular joint makes sideways movement possible. The ends of these bones are covered in cartilege and there are nine different ligaments in the ankle.

Together with the muscles and tendons of the lower leg, these different parts of the ankle make jumping, walking and running possible.

The weight the ankle carries, is precisely the reason why ankles are so susceptible to injury, not only for those taking part in sport, who are overweight or are wearing high-heeled shoes, but also in people who do little exercise. Slipping on pavements, stepping in potholes or falling over the cat can cause serious ankle injuries.

If you want to see how important a role your ankle plays in your life, see the effect it has when you fracture or strain it. And this happens to many people – ankle fractures, strains and sprains are of the most common injuries treated by orthopaedic doctors.

The most serious injuries or conditions affecting the ankle are swelling, sprains, strains and fractures.

Ankle swelling
Most people have swollen ankles at some time in their lives, especially if they've been sitting up for hours on long flights.

Swollen ankles can be caused either by injuries or by fluid retention.

This fluid retention, also called oedema, occurs when fluid is retained between the cells of the body. This can be caused by serious conditions involving the heart, liver, kidneys or blood vessels, but is often also caused by inactivity, such as when you are sitting up all night on an overnight flight. Inactive muscles do not help pump fluid back up toward the heart.

Other causes include pregnancy and PMS, abuse of laxatives, drugs or diuretics, sodium retention, allergic reactions and neuromuscular disorders, to name but a few.

Many people who have high blood pressure, diabetes and circulatory problems, suffer from oedema.

Treatment by a doctor is advisable, but there are things, which can be done at home to reduce the swelling. These include leg elevation, increasing muscle activity through exercise, limiting salt intake, avoiding standing for long periods, drinking plenty of water (water retention is often a sign that you may be dehydrated), finding long-term alternatives for contraceptive pills and hormone replacement therapy. Wearing support stockings when standing or inactive for long periods can also prevent oedema.

Read more about easing your oedema, or swelling, as it is more generally referred to.

But fluid retention is not the only cause of swollen ankles – bruising, strains and sprains can have the same effect. Bruises can cause contusions of the ankle tissues resulting in tenderness and discoloration. The body sends extra fluid to an injured area to increase the healing rate . These usually heal by themselves.

Ankle sprains and strains
Strains and sprains can, however, be more serious. So what's the difference between them?

A sprain occurs when the ligaments, which hold the bones together around a joint are damaged or torn as a result of overstretching or twisting.

A strain occurs when a muscle or tendon is damaged by overstretching or an excessive contraction and is also partially torn or "pulled".

Few people do not experience a strain or a sprain at least once during their lives. These are very common injuries, in people who take part in sport, in children who play, in people who slip and fall, for whatever reason – in short, everybody is at risk.

If you have sprained or strained an ankle, you will feel pain, there could be bruising and movement could be limited. It is advisable to get to a doctor, as it is often difficult to distinguish between sprains, strains and fractures, especially in children.

Treatment for sprains include the following:

  • Rest for the injured part of the body. Use crutches if the leg, foot or ankle is injured. Support an injured wrist, arm or shoulder with a sling. An injured finger can be rested by taping it to the healthy finger next to it (the same applies to toes). A broken leg can be tied to the other leg.
  • Ice packs or cold compresses applied for 20 minutes a time every few hours in the first two to three days to lessen the swelling and reduce pain.
  • Compression bandages for at least two days, also to reduce swelling. Don't wrap the injured area too tightly – loosen the bandage if the area feels cool or numb or if it tingles.
  • Elevation of the injured area above the level of the heart as much as possible. This also reduces swelling and bleeding.

Read more about Sprains and strains.

South African Podiatry Association (SAPA)



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