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Dr. Zach Tankersley

Dr. James Thomas

Dr. Kenneth Avery

Mofootandankle

FootandankleThe division is led by Dr. James L. Thomas, D.P.M. and Dr. Zach Tankersley, D.P.M.  Dr. Thomas and Dr. Tankersley offer state-of-the-art care in the diagnosis and treatment for conditions of the foot, ankle, heel and toes.  Marshall Orthopaedics has developed this webpage to be used as a resource for your pre-procedure and post-recovery concerns.  For a complete listing of the conditions we treat in the foot and ankle division, please see below.



Q: What is an ankle fracture?

A: A broken ankle is also known as an ankle "fracture." This means that one or more of the bones that make up the ankle joint are broken. A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place, and may require that you not put weight on it for a few months.

Q: What is an ankle sprain?

A: A sprain is caused by trauma- a fall, a twist, or a blow to the body, for example- that applies stress to a joint and overstretches or even ruptured supporting ligaments.

Ina mild sprain, a ligament is stretched, but the joint remains stable and is not loosened. A moderate sprain partially tears the ligament, causing the joint to be unstable. With a severe sprain, ligaments tear completely or separate from the bone. This loosening interferes with how the joint functions. You may feel a tear or pop in the joint. Although the intensity varies, all sprains commonly cause pain, swelling, bruising, and inflammation.

The ankle is the most commonly sprained joint, and a sprained ankle is more likely if you've had a previous sprain there. Repeated sprains can lead to arthritis, a loose ankle or tendon injury.

Q: What causes ankle and foot injuries?

A: Ankle and foot injuries occur when the ankle joint is twisted too far out of its normal position. Most ankle injuries occur either during sports activities or while walking on an uneven surface that forces the foot and ankle into an unnatural position. The unnatural position of the ankle in high-heeled shoes or walking in unstable, loose-fitting clogs or sandals is also a factor that may contribute to ankle injuries. In addition to wearing faulty footwear, an ankle injury can happen as a result of:

  • Tripping or falling
  • Landing awkwardly after a jump
  • Walking or running on uneven surfaces
  • A sudden impact such as a car crash
  • Twisting or rotating the ankle
  • Rolling the ankle

Q: How are ankle fractures classified?

A: Doctors classify ankle fractures according to the area of the bone that is broken. For example, a fracture at the end of the fibula is called a lateral malleolus fracture, or if both the tibia and fibula are broken, it is called a bimalleolar fracture.

Q: What are the different signs of ankle injuries?

A: The symptoms of a sprain and of a fracture are very similar. In fact, fractures can sometimes be mistaken for sprains. That's why it's important to have an ankle injury evaluated by a doctor as soon as possible. The symptoms include:

  • Pain, often sudden and severe
  • Swelling
  • Bruising
  • Inability to walk or bear weight on the injured joint

With a sprain, the ankle may also be stiff. With a fracture the area will be tender to the touch, and the ankle may also look deformed or out of place. If the sprain is mild, the swelling and the pain may be slight. But with a severe sprain, there is much swelling and the pain is typically intense. Tendinitis and acute tears of the peroneal tendon result in both pain and swelling. In addition, the ankle area will feel warm to the touch with tendinitis. With an acute tear, there will be a weakness or instability of the foot and ankle.

Tendinosis may take years to develop. Symptoms include:

  • Sporadic pain on the outside of the ankle
  • Weakness or instability in the ankle
  • An increase in the height of the foot's arch

With the subluxation you will notice ankle instability or weakness. You also may notice sporadic pain behind the outside ankle bone and a "snapping" feeling around the ankle bone.

Q: How does the docture diagnose an ankle injury?

A: The first thing a doctor will do is ask questions about how the injury occured. Then the doctor will examine the ankle, noting the amount of swelling and bruising. The physical examination of the ankle may be painful because the doctor needs to move the anke to evaluate the pain and swelling in order to make a proper diagnosis.

The doctor may order an ankle X-ray to determine whether there are any broken bones. In addition to an ankle X-ray, your doctor may ask for X-rays of the leg and foot to determine whether there may be other related injuries. If the doctor suspects a stress fracture, the doctor will ask for other imaging scans such as an MRI, which will show more detail about the injury. If there is a fracture, the doctor may also ask for a stress test, which is a special X-ray taken with pressure applied to the joint. This will help the doctor determine whether surgery is needed.

For most ankle injuries, pain is controlled by using an over-the-counter medication such as acetaminophen or other nonsteroidal anti-inflamatory drugs such as ibuprofen. The specific treatment of the injury depends on the type of injury.

Q: How do you treat a sprained ankle?

A: You can apply first aid for an ankle injury by remembering R.I.C.E.: Rest, Ice, Compressing, Elevation.

  • Rest: It's important to rest the ankle to prevent further damage and keep weight off of it.
  • Ice: Using ice will help slow or reduce the swelling and provide a numbing sensation that will ease the pain. Proper icing includes icing within 48 hours of an injury, never leaving ice on for longer than 15 to 20 minutes at a time to prevent frostbite. Wait 40 to 45 minutes before applying ice again to allow tissues to return to normal temperature and sensation, and repeat as needed. you can apply an ice compress using a plastic freezer bag filled with ice cubes and water to mold to your ankle or use a frozen bag of veggies like corn or peas, (don't eat them after you use them and refreeze them), and use a layer of towel between the skin and the plastic bag.
  • Compression: Wrapping the injured ankle with an elastic bandage or off-the-shelf compression wrap will help keep it immobile and supported. Be sure not to wrap the ankle too tightly. If the toes turn blue, get cold, or lose sensation the wrap is too tight.
  • Elevation: Elevating the injured ankle to at least the level of yoru heart will reduce swelling and pain.

It is important to not put any weight on the ankle until after it's been evaluated by a doctor, which should be done as soon as possible. Fractures and sprains that are ignored or are not treated properly can lead to long-term chronic problems with the ankle, such as repeated injury, ankle weakness, and arthritis.

Q: How do you treat a fracture?

A: Fractures can be treated either surgically or nonsurgically. The doctor may treat the break without surgery by immobilizing the ankle if only one bone is broken, and if the bones are not out of place and the ankle is stable. Typically the doctor will do this by putting on a brace that works as a splint or by putting on a cast. If the ankle is unstable, the fracture will be treated surgically. Often the ankle is made stable by using a metal plate and screws to hold the bones in place. Following the surgery, the ankle is protected with a splint until the swelling goes down and then with a cast.

It usually takes at least six weeks for the bones to heal. Your doctor will probably ask you to keep weight off the ankle during that time so the bones can heal in the proper alignment. Ligaments and tendons can take longer to heal after a fracture is fully mended. It can take as long as two years to completely recover full painfree motion and strength after an ankle fracture, although most people are able to resume their normal daily routine within three or four months.

After the doctor has determined it is safe for you to start moving your ankle, you may need physical therapy to provide gait training, balance, strengthening, and mobility exercises. The therapist will develop a home program that you can use to regain your previous normal function. It can take several months to return to a normal walking pattern without limping.


Questions and Answers from American Academic of Orthopaedic Surgeons. For more information visit http://www.aaos.org/home.asp