THERAPY, most people can return to a satisfactory
level of function and participation in many of the
activities they previously enjoyed. A PROSTHETIC
LIMBoften allows nearly normal function. Adap-
tive devices and equipment can improve safety,
mobility, and independence. People who have
amputations as a result of severe chronic disease
such as diabetes or PVD often find they have bet-
ter QUALITY OF LIFEafter amputation because the
remaining tissue of the limb is healthy.
Amputation may be emotionally difficult for
the person as well as for his or her loved ones. The
loss of a body part may affect the person’s self-
image and self-esteem. Some people feel guilty
about their health situations, and others feel angry
or depressed. The health-care team generally
includes a social worker or psychologist to help
the person go through the grieving process and
cope with the range of feelings and emotions.
See also ACCIDENTAL INJURIES; OCCUPATIONAL
HEALTH AND SAFETY; PHANTOM PAIN; SURGERY BENEFIT
AND RISK ASSESSMENT.
ankle injuries Sprains and fractures of the ankle
resulting from accidental trauma. The ankle is vul-
nerable to twisting under the pressure of sudden,
unexpected movement. Though ankle injuries are
common ATHLETIC INJURIES, they also occur during
routine activities such as stepping off a curb, walk-
ing on uneven surfaces, and walking in high
heels. OBESITY AND HEALTHconditions that impair
balance increase the risk for ankle injuries. Doc-
tors in the United States treat about 4 million
ankle injuries each year, most of which are sprains
(injury to ligaments and tendons).
Three bones come together to form the ankle:
the tibia and fibula, the long bones of the lower
leg, and the talus, a platform-like BONEthat forms
the back of the foot. Three sets of strong ligaments
hold these bones in place; equally strong muscles
and tendons give the ankle range of motion. This
structure is necessary because the ankle bears the
body’s weight. Transferring that weight from one
foot to the other when walking places the equiva-
lent of 1^1 ⁄ 2 times the body’s weight on the weight-
bearing ankle and foot.
Most ankle injuries occur when the foot rolls
inward, which stretches, tears, or otherwise dam-
ages structures on the outside of the ankle; these
are lateral or inversion injuries. When the foot
rolls outward, the damage occurs to the structures
on the inside of the foot; these are medial or ever-
sion injuries. A sharp blow or twist can break the
base of the tibia or more commonly the fibula (the
smaller of the lower leg bones). A severe LIGAMENT
stretch or tear can pull a piece of the bone away,
called an avulsion FRACTURE. Repeated stress such
as occurs with intense running or jumping can
cause stress fractures in the bones of the ankle or
OSTEOARTHRITISwithin the ankle JOINT.Symptoms and Diagnostic Path
PAINand swelling after a sudden twist or blow to
the ankle are the typical symptoms of ankle
injury. Both can be intense, and most people are
reluctant to or cannot bear weight on the affected
ankle. There is a strong correlation between the
severity of symptoms, including the ability to walk
or bear weight, and the type or seriousness of
injury. When it is possible to bear weight on the
ankle immediately following the injury and there
is no pain to the lower portion of the fibula, frac-
ture is unlikely. The doctor may order an X-ray of
the ankle to rule out fracture.Treatment Options and Outlook
The mainstay of treatment for ankle injuries of
any kind is RICE—rest, ice, compression, and eleva-
tion. An elastic wrap may help support the injured
ankle, though caution is necessary to make sure
the wrap is not too tight, particularly during the
first 48 hours when the ankle may continue to
swell. The doctor may choose to cast a serious
sprain. Fractures require casting or surgery or
both. Casting is generally adequate for simple frac-
ture in which the broken bone remains nondis-
placed (stays in relative alignment). Displaced,
comminuted, and open fractures typically require
pins, screws, or plates to hold the bones in place
while they heal. Sometimes this hardware
remains in place and sometimes the surgeon
removes it when HEALINGis complete, depending
on the nature of the fracture.
Most simple strains (injury to the muscles and
tendons) heal in 4 to 6 weeks. A simple sprain
(injury to the ligaments), which doctors may clas-
sify as grade 1 or grade 2, generally heals in 4 to 6
weeks. A severe sprain (grade 3) may take 12 toankle injuries 301