Ankle injuries woes

I thought I might need attention to my left ankle. I just didn't think that it would be giving me problems where it is. I rolled my ankle 'out' an eversion sprain. So basically stretching the ligmanets on the outside of the foot. So why can I now hardly walk down stairs without serious 'sit up and take notice' pain on the inside (medial) and top (dorsal) side of my foot?

I will know more tomorrow when I visit my physio tomorrow. What to do to recover and how long it will take.

I will recover and I will run again.
More tomorrow.

Ankle start of the road to recovery

Physio visit done and I am over the fact that this has happened.
Due to the medial injury the whole joint became unstable. That instability has lead to the other ligaments and tendons compensating and stressing hence the lateral side injury that followed. I must say that the more I look into the ankle and how exactly it functions the more I am amazed.

First the assessment. This involved gripping the foot and expertly manipulating the ankle joint through the various actions. There was a disturbing grinding sound followed by a click or two. After the initial assessment Gary, my physiotherapist (and a sports injury/recovery specialist) put me on the ElctroTherapy machine.

The first 10 min session was 'through' the ankle - medial to lateral - and my my whole foot convulse like a mean pins and needles session. The heated been bag is to keep the muscle warm. It's damn cold in Cape Town at the moment!

After the first 8min session the joint already moved smoother and the clicking was gone. The next ElctroTherapy session was to stimulate the foot to do eversion action. This was very weird, watching your foot move without conscious control!

Gary then tapped the ankle to support the medial ligaments during recover.

 I am also using TransAct patches to manage swelling and inflammation. Gary also gave strict instructions to elevate the foot as often as possible to help move fluid away from the joint.

To help protect the tapping and the TransAct patch the area was covered in a sheath bandage. Below is a video of the nifty way of pulling the sheath on without taking the taping of the patch off.
Also, ensure that the outer sheath ends lower than the inner sheath to not restrict fluid and blood flow.

Ankles Part 2: Anatomy of the problem

The ankle joint is a Synovial joint type. This is the most common and most moveable type of joint in the human body.
The joint is comprised of:
1. Bones and cartilage
2. Ligaments
3. Muscles and tendons

Bones & Cartilage

The important point to consider here is that the ankle is a complex joint - technically 2 joints.
The first joint, the 'True Ankle Joint or Talar Joint' allows you to bend the foot up (Dorsiflexion) and down (Plantar Flexion). Here the joint pivots around the Tibia, Fibia and upper Talus.

The second joint is the "Subtalar Joint" which allows the foot to move or roll sideways. Either the foot moving inwards (Inversion) or out (Eversion). This joint pivots around the bottom side of the Talus (hence subtalar) and the Calcaneus or heel bone.

The True Ankle Joint is kept in place in a kind of 'mortise and tenon' configuration. With the Fibula providing stability on the outside (lateral side) and the hanmer of the Tibia the stability on the inside (medial side).

Cartilage covers all the sections on these joints where bone meets bone and, along with the joint capsule (a water filled like sack), allows for smooth gliding of the joint.

With respect to the bone structure of the joint there are two important points that impact on the effective functioning:

1. Range of motion
The ankle has a limited range of motion in which it can effectively funciton while maintaing the integrity and stability of the joint. This is measured in degrees and is typically in the region of:

• Ankle plantar flexion (movement downward) 0-50
• Ankle dorsiflexion (movement upward) 0-20
• Ankle inversion (turned inward) 0-35
• Ankle eversion (turned outward) 0-25

2. Destabilization
The closer you get to the maximum degree of the flexibility the more unstable the joint will become. It is said that the ankle in full plantar flexion is very unstable.

Ligaments

The ankle joints are kept in place by ligaments. There are fibrous tissues made from bundles of collagen fibers that connect bone to bone and are very different in form and function to tendons which connect the muscle to the bone.
Initially thought to be very basic structures, they have now been shown to perform their function with surprising complexity.

The ligaments in the ankle (or any other joint for that matter) provide three functions:

1. Mechanical strength. They passively align the joint to function within its normal range of motion and thus stabalise the joint.
2. The viscoelastic nature of ligaments help with returning the ankle to its rest position after it has been used
3. Finally, ligaments provide proprioceptive information. This information helps the brain to determine where you foot is in space

There are two sets of ligaments:
A. Lateral Collateral Ligaments
These are the ligaments on the outside of your foot, furthest from your other ankle. The lateral collateral ligament prevents excessive inversion. It is considerably weaker than the larger medial ligament and thus sprains to the lateral ligament are much more common, especially in trail running. It was these ligaments that i damaged. It is made up of 3 individual bands:

Anterior talofibular ligament (AFTL): passes from the fibula to the front of the talus bone.
Calcaneofibular ligament (CFL)- connects the calcaneus and the fibula
Posterior talofibular Ligament (PTFL)- passes from the back of the fibula to the rear surface of the calcaneus.

B. Medial Collateral Ligaments
The medial ligament also known as the deltoid ligament is considerably thicker than the lateral ligament and spreads out in a fan shape to cover the distal (bottom) end of the tibia and the inner surfaces of the talus, navicular, and calcaneus.

Muscles & Tendons

Most of the motion of the ankle is caused by the stronger muscles in the lower leg whose tendons pass by the ankle and connect in the foot. Contraction of the muscles in the leg is the main way that we move our ankle when we walk, run, and jump.
The muscles and associated tendons and their functions are:.

• The peroneals (peroneus longus and peroneus brevis) on the outside edge of the ankle and foot bend the ankle down and out.
• The calf muscles (gastrocnemius and soleus) connect to the calcaneus by the Achilles tendon. When the calf muscles tighten, they bend the ankle down.
• The posterior tibialis muscle supports the arch and helps turn the foot inward.
• The anterior tibialis pulls the ankle upward.

Now that we understand the structure of the ankle, in my next posts I want to take a look at:
Ankle 3: Injuries and treatment
Ankle 4: Preventative measures

References & Copyright

This information provided in this post is not meant for professional diagnostic purposes.  However, I believe that an informed trail runner is a better trail runner. So the information here is to help you understand what is happening inside your body as you run. I hope you find it useful.
Although I referenced a number of websites, the text above is mostly my own. I claim no right to the images above and their copyright remains with the original party. The images are URL references to the original site. The site that I found the most useful, and from which I link to most of the images is:
Advanced Sports Therapy

Other sites referenced are:

Dartmouth Medical School
Wikipedia of course
Excellent article on ligaments at International Society of Musculoskeletal and Neuronal Interactions (ISMNI)
About.com

Ankles Part 1: Injury and initial recovery

I was nearing the end of a short training run along one of my favorite routes in Silvermine reserve, the River Walk. I clearly remember thinking that I was almost near the end and I was running well. In the twinkling of an eye, while stepping down, I rolled my left ankle. Flat.

That was on the19th June. It was such an innocuous little step. I must have run it a few dozen times already.

So I am going to delve into the the world of ankles a little. See you they work, what can and does go wrong, recovery and preventative measures that can be taken.

Home I consulted my physio on the following Saturday as I was entered for a 14.5km trail run on the Sunday. What he had to say further piqued my interest in ankles, but more on that later. He did say that the sprain was such that I could run. I need to strap or brace the ankle and apply a Transact patch. Sunday's race went well and I was surprised how well the ankle held up.

I have given it rest since then, my first training run was today. I again ran with the brace on but no Transact and it held up well.

So I do want to look into the ankle's mechanics, check current research on ankle injuries and maybe even ask some folks in the trail industry on their ankle experiences. Finally, I want to understand if there is benefits (and risks) associated with running with preventative braces.