The upper ankle, or ankle joint, connects the lower leg and foot. This complex area supports up to 1.5 times body weight when walking and eight times when running. Its design allows for broad motion and stability for daily activities and athletic performance.
Anatomy of the Upper Ankle
The upper ankle joint is formed by the meeting of three bones: the tibia, fibula, and talus. The tibia, or shin bone, is the larger lower leg bone, bearing approximately 85% of your body weight. The fibula, a smaller bone parallel to the tibia on the outer calf, forms the ankle’s lateral wall and supports the remaining 15% of body weight.
The talus is a dome-shaped bone in the foot that sits below the tibia and fits into a socket formed by the lower ends of the tibia and fibula. This arrangement allows for upward (dorsiflexion) and downward (plantarflexion) foot movements. Ligaments, strong bands of fibrous tissue, connect these bones and stabilize the joint. For instance, the lateral collateral ligaments on the outside of the ankle include the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), while the thick deltoid ligament supports the inner side. Tendons, like the Achilles tendon, cross the joint, facilitating movement by attaching muscles to bones.
Common Upper Ankle Injuries
Ankle sprains are frequent upper ankle injuries, occurring when ligaments are overstretched or torn by unnatural twisting. Inversion ankle sprains, accounting for 70-85% of all ankle sprains, occur when the foot rolls inward, straining lateral ligaments, particularly the ATFL. Eversion ankle sprains are less common, involving the foot turning outward and affecting the deltoid ligament on the inner ankle.
A “high ankle sprain,” also known as a syndesmotic injury, involves damage to the ligaments connecting the tibia and fibula above the ankle joint. These ligaments, forming the syndesmosis, prevent the tibia and fibula from spreading apart, especially under weight-bearing. High ankle sprains result from forceful outward twisting or upward bending of the foot, often seen in high-impact sports. Fractures, such as malleolar fractures of the tibia or fibula, can also occur in the upper ankle, sometimes with high ankle sprains.
Recognizing and Diagnosing Upper Ankle Issues
Upper ankle injuries often present with noticeable signs and symptoms. Pain or soreness, especially when walking or bearing weight, is common. Swelling and bruising around the ankle may also develop, potentially worsening. Difficulty walking or bearing weight, stiffness, and limited range of motion are also common.
When these symptoms arise, seek medical attention. A healthcare professional will conduct a physical examination, gently touching the area to pinpoint tenderness and moving the foot to assess range of motion. X-rays are the initial imaging test to rule out fractures, as they visualize bone structures. For soft tissue damage, such as ligament tears, magnetic resonance imaging (MRI) provides detailed cross-sectional images.
Treatment and Rehabilitation
Initial treatment for many upper ankle injuries follows the R.I.C.E. protocol for the first two to three days: Rest, Ice, Compression, and Elevation. Rest involves avoiding painful activities. Apply ice packs for 15-20 minutes every two to three hours to reduce swelling. Compression with an elastic bandage helps control swelling. Elevating the ankle above heart level, particularly at night, aids fluid drainage. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can manage discomfort.
Depending on injury severity, medical interventions may include immobilization using elastic bandages, sports tape, ankle support braces, or a cast or walking boot for severe sprains or fractures. Physical therapy plays a significant role in rehabilitation, focusing on exercises to restore the ankle’s range of motion, strength, flexibility, and stability. Balance and stability training, such as standing on one leg, is important to retrain ankle muscles and prevent future injuries. For severe fractures, chronic instability, or significant tibia and fibula separation, surgery might be necessary to stabilize the joint.
Preventing Upper Ankle Injuries
Several proactive steps can reduce the risk of upper ankle injuries. Wear appropriate footwear that offers good support and cushioning. Replace shoes when they show signs of wear, typically every three to six months for runners or after 400-500 miles. Choosing sport-specific shoes can also provide better protection than general cross-training shoes.
Before physical activity, a proper warm-up, such as light cardio or dynamic stretches, prepares muscles and joints. Incorporating strengthening and balance exercises into a regular routine can enhance ankle stability; examples include ankle circles, heel raises, and resistance band exercises. Be mindful of uneven surfaces and gradually increase activity levels to avoid overexertion and sudden twists.