The ankle is a complex joint it is not made up of only 1 joint like many other joints in the body. In fact, there are 4 joints that work together to support our lower body. The ankle is connected to our lower body with 2 main bones, the tibia and the fibula as pictured on the right.
1. Tibiofibular joint is a syndesmotic joint, which means there is extremely limited movement. This joint connects the tibia and fibula. The main stabilizers of this joint are the anterior and posterior tibiofibular ligaments. Since this joint is not moveable, it takes a high amount of force for it to be injured and is very uncommon.
2. Talocrural joint is made up of the tibiotalar and tibiofibular complexes. It is a synovial hinge joint, which means it’s responsible for bringing the foot up and pushing it down. The talocrural joint forms the ankle hinge point. This joint is the most common location referred to as the “ankle joint”.
3. Subtalar joint. It is a plane synovial joint which is similar to many other joints the body. It is supported by multiple ligaments that binds the talus and calcaneus (heel) together. This joint is very important in allowing your foot to adjust to uneven terrain while moving by shifting from side to side. It is also very important in athletic movements such as pivoting or turning with a fixed foot. This movement is essential for proper gait, but can lead to increased risk of injury if due to hypermobility and over rotation.
4. Tarsal joint. This joint is located near the midfoot. It combines bone articulations and ligaments. It is the furthest joint within the “ankle”. This is also a synovial joint and assists the subtalar joint in raising or lowering the foot.
The ankle consists of multiple muscles, due to the size and complexity of the ankle joints. It is often easy to strain these muscles. There are many groups of small and muscles, we aim to list the muscles that perform bulk of the movements below.
The peroneal muscles run on the outside edge of the ankle and foot. These muscles allow the ankle to bend downward and outward.
The calf muscles (gastrocnemius and soleus), connect to the Achilles tendon. These muscles work in tightening and relaxing of the calf. They allow the ankle to bend downward and upward.
The posterior tibialis muscle, which supports the arch of the foot and enables the foot to turn inward.
The anterior tibialis muscle, which enables the ankle and foot to turn upward. The complexity of the ankle’s muscular and ligament structure creates many possible opportunities for injuries when the ankle is pushed beyond its normal range of motion.
Tendons are elastic tissues that connect muscles to bones. The tendons main role is to stabilize the ankle. There are two major tendons in the ankle.
Ligaments are designed to connect one bone to another. They are soft tissue structures that are strong, but not particularly flexible. Once stretched, they tend to stay stretched, if they stretch too far, they can snap. Ligaments join the ankle bones and provide stability.
The ankle has 7 main ligaments, 3 of which make up the lateral ligament complex.
The medial ligament complex consists of 3 ligaments also known as the deltoid ligament complex. These group of ligaments support the entire inner side of the ankle joint.
In addition, there are also the ligaments listed below.
This is the cushioning that is provided to your ankle joint, ultimately, they act as a shock absorber, cartilage wears out and cannot repair itself. The ankle’s cartilage differs from other joints in two ways.
3 of the 4 joints we have listed previously contain cartilage. The joint which does not contain cartilage is the tibiofibular joint. The image above identifies areas of cartilage in light blue colour.
The capsule is a thick, fibrous structure that wraps around the ankle joint. Inside the capsule is the synovial membrane which is lined by the synovium, a soft tissue that secretes synovial fluid when it gets inflamed and provides lubrication for the ankle.
There are many bursa sacks of various sizes in and around the ankle joints. These sacs are filled with fluid to cushion the joint and reduce friction between muscles, bones, tendons and ligaments. Repetitive movements or prolonged pressure can irritate the bursal sacs.
The 3 main bursal sacks for the ankle joint is;
Osteoarthritis is the most common form of arthritis, and often affects the ankles. In fact, since the cartilage is different in an ankle joint compared to other joints some studies have shown osteoarthritis to be 9 times less likely to develop in the ankles compared to the knee joints. This is odd given the cartilage structure in the ankles are so thin and bear more weight compared to the knees and hips. Caused by aging and wear and tear of cartilage, osteoarthritis symptoms may include pain, stiffness, and swelling. Osteoarthritis is not simple to understand, there are many links with the wear and tear of cartilage that also affects every other part of your joint. We discuss this in our treatment information pack.
An infection caused by bacteria, a virus, or fungus inside the ankle can cause inflammation, pain, swelling, and difficulty moving the ankle. Although uncommon, septic arthritis is a serious condition that usually gets worse quickly without treatment.
GOUT: A form of arthritis caused by buildup of uric acid crystals in a joint. The ankle joint may be affected, causing episodes of severe pain and swelling.
A form of arthritis similar to gout, caused by calcium pyrophosphate crystals depositing in the ankle or other joints.
Issues that often occur with Osteoarthritis
Inflammation of the tendons that are connecting muscle to bone. Tendonitis can be very common. It can occur due to simple overuse, overstrain or even underuse. Tendons can become weak very quickly and they take a very long time to repair due to lack of blood flow.
This is rare in the ankle joint since the cartilage is extremely dense. However, it is still possible. The most common type of cartilage tear occurs with twisting motions of the ankle. Large tears may cause the ankle to physically lock. Tears can occur due to injury or long-term degeneration of the cartilage due to osteoarthritis.
“Rolling the ankle” very common injury. This can cause the calcaneal and/or talofibular ligaments to stretch beyond their normal capacity. These strains can be extreme, therefore leading to a tear. They can be associated with pain, swelling, and regular instability.
The peroneal tendons can slide abnormally or dislocate along the side of the foot. Surgery may be necessary to relocate the tendons in the proper location if subluxation is severe.
Pain, swelling, and warmth in any of the bursae of the ankle. Bursitis often occurs from overuse or injury.