Justin T. Smith, MD
Orthopaedic Sports Surgery & Shoulder Reconstruction Specialist
Example of Ankle Injuries Treated:
Anterior ankle impingement
High ankle sprain
Low ankle sprain
5th metatarsal stress fracture
Examples of Ankle Treatment Options:
Arthroscopic lysis of adhesions
Modified Brostrom repair
Fracture reduction and internal fixation
The ankle is a series of joints made up of different structures - bones, tendons, ligaments, and muscles. They all work together to maintain the ankle's normal function and provide stability to the knee during movement.
Having a well-functioning healthy ankle is essential for our mobility and ability to participate in various activities. Understanding the anatomy of the ankle enhances your ability to discuss and choose the right treatment procedure for ankle problems with your doctor.
Bones of the Ankle
The most proximal (towards the body) joint of the ankle is known as the tibiotalar joint formed by the shinbone (tibia) and the talus. The end of the tibia has a bony shoulder the forms the inside bony prominence of the ankle known as the medial malleolus. The outer bony prominence is from the long skinny bone in the leg, called the fibula. These two prominences help to stabilize this tibiotalar joint in rotation so that it may function properly in its main range of motion, dorsiflexion and plantar flexion (up and down motion). This joint functions to lift your foot so that don't trip when you walk or run.
The joint just below the talus is known as the sub-talar joint. It is a joint formed by the talus and the calcaneous (heel bone). This joint provides the side to side motion of the ankle and allows for stability when walking on uneven ground.
Articular Cartilage of the Ankle
Movement of the bones causes friction between the articulating surfaces. To reduce this friction, all articulating surfaces involved in the movement are covered with a white, shiny, slippery layer called articular cartilage. The articulating surface of the tibia, fibular, talus and calcaneous are covered with this cartilage. The cartilage provides a smooth surface that facilitates easy movement.
To further reduce friction between the articulating surfaces of the bones, the tibiotalar and sub-talar joints are lined by a synovial membrane that produces a thick clear fluid called synovial fluid. This fluid lubricates and nourishes the cartilage and bones inside the joint capsule.
Ligaments of the Ankle
Ligaments are tough bands of tissue that connect one bone to another bone. The ligaments of the knee stabilize the ankle joints. There are important ligaments that hold the bones of the tibia, fibula and talus that are commonly injured during sports activities.
The primary ligaments that hold the tibia and the fibula together are known as the syndesmotic ligaments. These are comprised of the anterior inferior tibiofibular ligament (AITFL), posterior-inferior tibiofibular ligament (PITFL), interosseous membrane, interosseous ligament, and inferior transverse ligament (ITL). These ligaments are typically damaged during high ankle sprains.
The ligaments that hold the talus to the tibia on the inside (medial) part of the ankle are known as the deltoid ligament complex. The ligaments that hold the talus to the fibula are known as the anterior talofibular ligament (ATFL). There is also another important stabilizer on the outside (lateral) of the ankle in-addition to the ATFL that travels from the fibula to the calcaneous known as the calcaneofibular ligament (CFL). These two groups, inner part (medial) and outer part (lateral), of ligaments stabilize the ankle from excessive sliding, rotation, and titling.
Muscles of the Ankle
There are three major muscles groups in the ankle - the dorsiflexors, plantar flexors, and peroneal muscles - which enable movement of the ankle joint. The dorsiflexors (upward motion of ankle) begin in the front of the leg and travel down to various attachments in the foot/ankle. The plantar flexors (downwards motion of the ankle) begin in the back of the leg and travel to various attachments in the foot/ankle. The peroneal tendons begin in the outside (lateral) part of the leg and cross the ankle to attach in the foot to control side to side motion and foot biomechanics during the gait cycle.
Tendons of the Ankle
A tendon is a tissue that attaches a muscle to a bone. The most notable tendon that can be injured in the ankle is the achilles tendon. The achilles tendon is formed from the gastrocnemius muscles and the soles muscle converging into a single tendon that attaches on the back side of our heel bones (calcaneous). This tendon is the primary plantar flexor (downward ankle motion) of the ankle joint.