Twisted Ankle with Dr. Jason Tarno

What are the most common injuries that you see for basketball players?

I think without question ankle injuries lead the way. Of course, knee injuries are not far behind.

What are the common injury patterns of the ankle?

Typically the ankle is injured with an inversion or eversion stress. These terms relate to which way the sole of the foot goes. With an inversion injury, the sole of the foot turns in, and the lateral or outside ligaments are stressed. With an eversion injury, the sole of the foot turns out (or to the side), and the inside ligament is stressed. If the force is significant enough, the bone can actually fracture, or break.

How many bones make up the ankle?

On the medial side of the ankle there is one main ligament called the deltoid ligament. It is a large triangular shaped ligament that attaches the tibia to the talus. It is usually injured with an eversion stress at the ankle. On the lateral, or outside of the ankle, there are three ligaments that connect the fibula to the talus and calcaneus (heel bone). The ligaments are named by what they attach to and their position at the ankle. The first ligament is called the anterior talo-fibular ligament (ATF). This is the ligament that is most commonly injured with an ankle inversion. The next ligament is the calcaneo-fibular ligament (CF). The last ligament on the lateral aspect of the ankle is the posterior talo-fibular ligament (PTF). In some cases all three ligaments can be sprained and the ankle becomes very unstable.

What is the difference between a sprain and a strain?

A sprain refers to an injury to a ligament. Ligaments connect bone to bone. Sprains are graded from grade I to grade III, which refers to the degree of tear. In a grade I sprain, most of the ligament is intact, and just a few fibers are torn. A grade III sprain refers to a complete tear or rupture of the ligament or ligaments. A strain refers to injury of a muscle.

Is it necessary to get an x-ray if someone twists their ankle?

There are no absolutes as to when to take or not to take an x-ray. Physicians train for many years, and often it is still a judgement call on the part of the physician. But, if the athlete cannot weight-bear on the foot and ankle, it probably warrants an x-ray.

Why is it that after an ankle sprain there is often a black and blue mark to the lower aspect of the foot?

This is called dependent edema. That means that there has been swelling in the ankle that has traveled to the lower aspect of the foot due to gravity. The black and blue color is from blood that has accumulated in the tissues. Blood has iron in it that stains the skin for a week or two. This usually resolves itself after the athlete regains weight-bearing status.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

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