Dr. Ebraheim’s educational animated video describes the anatomy of the anterior compartment of the foot, and the injuries and conditions associated with the ankle.
There are many structures present at the anterior aspect of the ankle. These structures are often susceptible to injury.
Common injuries and conditions around the anterior ankle
1-Anterolateral impingement: Painful limitation of full range of ankle motion due to soft tissue or osseous pathology. Soft tissue thickening commonly seen in athletes with prior trauma that extends into the ankle joint. Tibial bone spur impinging on the talus can become a source of chronic ankle pain and limitation of ankle motion in athletes.
2-Arthritis of the ankle joint: Commonly the result of a prior injury or inflammation to the ankle joint. Can be usually diagnosed with an examination and x-ray.
3-Osteochondritis dissecans of the talus: Chip type fracture that usually occurs with severe ankle sprains. Causes pain, swelling, and stiffness of the ankle joint. X-rays, Ct scan or MRI are commonly used for the diagnosis.
4-Tibialis anterior tendonitis
5-Anterior tibialis tendonitis: It is an overuse condition common in runners. Common injury that usually accompanies anterior shin splints. If this tendon is strained, pain and tenderness will be felt upon active dorsiflexion or when the tendon is touched.
There are many structures present at the medial aspect of the ankle. These structures are often susceptible to injury.
Common injuries and conditions around the medial ankle
1-Posterior tibial tendonitis or rupture: Posterior tibial tendon problems can occur from overuse activities, degeneration and trauma. The posterior tibial tendon is one of the major supporting structure of the foot. The tendon helps to keep the arch of the foot in its normal position. When there is insufficiency or rupture of the tendon, the arch begins to sag and a flatfoot deformity can occur with associated tight achilles tendon. This occurs distal to the medial malleolus. This area is hypovascular. It presents with painful swelling on the posteromedial aspect of the ankle. Patient is unable to perform a single leg toe raise.
2-Tarsal tunnel syndrome: It is compression of the tibial nerve in the tarsal tunnel. The flexor retinaculum covers the nerve. Tarsal tunnel syndrome is similar to compression of the median nerve in the carpal tunnel. Causes include ganglia, accessory muscle and soft tissue mass.
3-Flexor hallucis tendonitis: Pain, swelling, weakness posterior to the medial malleolus. Dorsiflexion of the big toe may be reduced when the ankle is placed in dorsiflexion. Triggering and pain along the tendon sheath may also occur with toe flexion. It often occurs in activities such as ballet dancing, in which plantar flexion is necessary.
4-Rupture of the deltoid ligament: The deltoid ligament are the primary stabilizers of the ankle joint. The deltoid ligaments provide support to prevent the ankle from everting. An isolated eversion sprain with tear of the deltoid ligaments is a rare injury.
There are many structures present at the posterior aspect of the ankle. These structures are often susceptible to injury.
Common injuries and conditions around the posterior ankle
1-Posterior ankle impingment (os trigonum): It is nonunited piece of accessory bone seen posterior to the talus. It is common among athletes such as ballet dancers. Tenderness in the posterolateral aspect of the ankle posterior to the peroneal tendon especially with passive plantar flexion. May be seen in association with flexor hallucis longus tenosynovitis.
2-flexor hallucis longus tenosynovitis: It is a condition associated with ballet dancing, in which extreme plantar flexion is necessary. Swelling and pain posterior to the medial malleoulus. Triggering with toe flexion. Dorsiflexion of the big toe is less when the ankle is dorsiflexed.
3-Achilles tendonitis: Irritation and inflammation due to overuse. Pain, swelling and tears within the tendon. Usually treated with therapy and injection. Do not inject inside the tendon, rarely treated with surgery.
4-Achilles tendon rupture: Achilles tendon can become prone to rupture with age lack of use, or by aggressive exercise. Rupture is diagnosed by the Thompson test and MRI. Treatment may be conservative without surgery by using a cast or a boot , however the rerupture rate is high. Surgery is done by approximation of the torn ends, however there is a risk of infection, skin and wound complications with surgery.
There are many structures present at the lateral side of the ankle. These structures are often susceptible to injury.
Diagnosis of these injuries can be confusing and many of these injuries can be missed.