Download Cover Story – Ankle Agony

Cover Story – Ankle Agony
Mind Your Body, The Straits Times (Thursday, 28 January 2010)
By Geraldine Ling
Although athletes are more susceptible to ankle injuries, it can easily happen to anyone. After all, we use our
ankles every day when we walk, run or jump.
Retiring national badminton player Ronald Susilo has injured it. So have several international soccer players.
And chances are, you may have injured it too at some point.
That is, the ankle, the most commonly injured joint in athletes.
Said Mr Susilo: 'I sprained my ankle about four times, twice during badminton practice.
'The worst sprain happened while I was playing basketball. It got better in two weeks, but I didn't do a lot of
strengthening exercises after that.
'Then I went and played soccer using running shoes. These did not have enough support for the activity and
the injury worsened,' he said.
The 30-year-old shuttler took another month to recover from the injury and needed crutches to move around
for two weeks.
Nestled between three bones - the tibia, fibula and talus - the ankle joint works together with the other foot
joints to provide mobility as you walk, run and jump.
The ankle is also held together by bands of elastic fibre called ligaments.
Said Dr Tan Ken Jin, an associate consultant at the Division of Orthopaedic Sports Medicine at National
University Hospital (NUH): 'In a sprain, one or more groups of the ligaments are injured, usually those on the
outer side of the foot.'
Said Ms Eleanor Chew, a physiotherapist at Singapore General Hospital: 'Sprains happen when the foot
twists, rolls or turns beyond its normal motions, usually when it is turned inwards.'
Any sport that is weight bearing or involves jumping or direction changes increases the likelihood of ankle
injuries, said Dr Tan. Examples include soccer, basketball and tennis.
Symptoms of a sprain include pain and swelling, said Dr Lim Kay Kiat, a consultant orthopaedic surgeon at
Changi General Hospital. 'In more severe sprains, bruising will be evident and there may even be difficulty in
walking,' he said.
Once a fracture is ruled out, most simple sprains are treated using the Rice method, he said.
Rice stands for rest, ice, compression and elevation. This means letting the joint rest and icing it for 20
minutes every two hours.
'However, you should avoid icing to the point of pain,' he added.
Compression - like a bandage - should be applied and the ankle should be slightly raised to allow blood to
flow away from the injury.
Apart from sprains, other ankle injuries include ligament tears and fractures.
Ligament tears, which can also be caused by falls, inflict significantly more pain and swelling than sprains.
Unlike sprains, which can take up to a week to heal, ligament tears need about 11/2 months to recover and
can have long-term effects on the ankle, said Dr Tan.
'When the ligament heals, it becomes loose. That will make the ankle prone to instability and future sprains.
It's like a rubber band that's overstretched - it's not taut any more,' he said.
The worst ankle injuries are fractures and most have to be treated surgically, said Dr Tan.
Surgery - using screws and metal plates (Picture 2) - is needed to align the cracked bones.
'If the bones heal while they are out of position, it will compromise joint function,' said DrTan.
It is usually unnecessary to place the ankle in a cast after an operation, said Mr Durai Muragan Chinnasamy,
a senior physiotherapist at NUH. But if the fracture is managed conservatively - that is, without an operation
- a cast is needed.
In either case, patients are sent for physiotherapy where they learn to walk without putting weight on the
injured ankle using crutches.
Said Ms Toh Mei Kwan, the principal physiotherapist at the Ang Mo Kio-Thye Hua Kwan Hospital: 'Often, we
focus on the most limiting factor for a patient first. For example, if the joint is too stiff and limits mobility, then
we first restore the ankle's range of motion, in conjunction with mobility training.'
A fractured ankle may need up to three months for complete recovery.
Besides trauma, ankle pain can also be caused by chronic conditions.
'Rheumatoid arthritis is an autoimmune disease which affects multiple joints, including the ankle. Symptoms
include joint pain, stiffness and swelling,' said Dr Lim.
Another condition, osteoarthritis, is a result of cartilage degeneration of the joint, said Dr Lim.
To treat ankle arthritis, activity modification and medication are first recommended, said Dr Tan.
If such a treatment does not help, the next step would be to fuse the ankle bones to eliminate joint
movement, he said.
'But it means that the other joints in the foot would have to work harder,' he said.
A third option would be ankle replacement, which is not the first choice of treatment if symptoms are not
severe, said Dr Tan. In ankle replacement, the worn-out surfaces of the joints are replaced by metal.
'The advantage is that you retain some mobility and the other joints don't work so hard. The downside is that
it's a relatively new procedure, so we don't have good long-term results yet,' said Dr Tan.
FOR YOUR FEET'S SAKE
Footwear is important when it comes to maintaining ankle health. Here are some recommendations:
Wear shoes with laces and a firm heel counter, if you do not have any ankle conditions.
'Such shoes enhance ankle stability,' said Mr Jasper Tong, the head of Singapore General Hospital's
podiatry department.
•
Wear shoes that are right for the sport so that they provide the necessary support.
Dr Tan Ken Jin, an associate consultant in the division of orthopaedic sports medicine at National
University Hospital, said: 'If you are playing basketball, don't use running shoes.'
•
Wear cushioned shoes with soft, conformable arch supports if you have high foot arches.
'People with high-arched feet are more prone to ankle instability and ankle sprains,' said Mr Tong.
•
Wear ankle-high boots with flat, cushioned soles if you experience recurrent ankle sprains.
'Alternatively, you could wear ankle guards with running shoes,' said Mr Tong.
•
Wear heels that are less than 2.5cm in height.
‘Ladies' heels more than 2.5cm high promote ankle instability. If you suspect that your ankle
sprains are caused by your heels, reduce their height.