The “Glass Ankle” Patient

The “Glass Ankle” Patient

What do you mean by glass ankle?

From time to time, I have patients who replace a common medical diagnosis with a slang term or name.   The first time I heard that my patient had “glass ankles, I remained uncertain as to what he meant.  I asked him to explain further.  He explained that a simple misstep, stumble or twist would lead to his ankles giving out.  When this occurred, he explains that it is difficult for him to walk.  Furthermore, his ankles become weak, swollen and movements are painful.

Why compare the ankle to glass, you ask? 

As with glass, you need to be very careful not to tilt, drop or misplace it…if you do it will break into many pieces.   With those with “glass ankles“, they must make sure to be delicate on their feet and avoid compromising positions.  In Medical terms, the glass ankle refers to someone with ankle instability.  Usually, this is caused by multiple ankle sprains.

Within this blog, I will go into the anatomy of the ankle, who is predisposed to ankle injuries, signs and symptoms of a twisted ankle/sprain, and treatment methods used to assist with the healing of a twisted ankle or sprained ankle.

What is a twisted ankle?

A twisted ankle, ankle twist, rolled ankle, ankle sprain/strain, or someone with a glass ankle is one of the most frequent types of injury seen by health practitioners.  The ankle joint, which connects the foot with the lower leg, is injured often when an unnatural twisting motion occurs to the foot when it is planted awkwardly.  This usually occurs when the ground is uneven or when an unusual amount of force is applied to the joint. Such injuries happen during athletic events, while running or walking or even doing something as simple as getting out of bed. There are various ligaments in the ankle which can be twisted or sprained, however the most common is the one located on the outside of the ankle. This ligament is known as the ATFL (Anterior Talofibular Ligament).

What makes up the ankle joint?

The ankle joint is composed of three bones, which include the tibia, fibula, and talus.  The tibia is a large leg bone (on the inside of the leg) that bears most of the body’s weight.  The fibula is the smaller leg bone (on the outside of the leg).  Both the tibia and fibula attach to the talus (the top bone of the foot).  The three bones together create the ankle joint. Tendons and ligaments cover these three bones.  On the outside of the ankle you find the anterior talofibular liagament (ATFL).  On the inside of the ankle is the deltoid ligament.   Most ankle sprains involve the outside ligament,  the ATFL.

What are the signs and symptoms of a twisted ankle?

Ankle sprain symptoms may vary from being very mild to severe.

Usually a sudden trauma, twisting or turning over of the ankle will happen.  The patient will experience pain on the outside of the ankle.  Swelling or bruising may be present but not always.  Ankle sprains are graded 1, 2, or 3 depending on severity.  Furthermore, the patient may pain, redness, warmth, trouble walking & stiffness in the ankle.

Grade 1 sprain:

  • Some stretching or perhaps minor tearing of the lateral ankle ligaments.
  • Little or no joint instability.
  • Mild pain.
  • There may be mild swelling around the bone on the outside of the ankle.
  • Some joint stiffness or difficulty walking or running.

Grade 2 sprain:

  • Moderate tearing of the ligament fibres.
  • Some instability of the joint.
  • Moderate to severe pain and difficulty walking.
  • Swelling and stiffness in the ankle joint.
  • Minor bruising may be evident.

Grade 3 sprain:

  • Total rupture of a ligament.
  • Gross instability of the joint.
  • Severe pain initially followed later by no pain.
  • Severe swelling.
  • Usually extensive bruising.

What treatments are available for a twisted ankle?

Despite common medical practice, treatment of ankle sprains should not be limited to rest and ice.  Modalities such as ultrasound, interferential current, TENS, Graston Therapy, Laser Therapy and soft tissue therapy can and should be used to assist in the healing  of the sprained ligaments in the ankle.  Furthermore, acute ankle injuries need to be addressed immediately, both passively (with modalities and soft tissue work) and actively (exercises and rehabilitation).  If treatment does not commence immediately, you will probably experience stiffness, tightness and instability in the ankle joint at some point in the future.  Moreover, ankle instability will most likely lead to more ankle sprains. Ultimately, more ankle sprains may dub you – the person with the glass ankles. 

I hope you found this blog informative.  If you have any questions, please feel free to comment.


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Dr. Luciano Di Loreto