16 weeks to fully heal. Doctors consider healing
complete when the injured ankle can bear the
body’s weight without pain and with normal
range of motion during normal activities, though
very severe injuries may result in permanent limi-
tations or laxity.
Risk Factors and Preventive MeasuresSlipping, twisting, and falling are the most com-
mon risks for ankle injury. MOTOR VEHICLE ACCI-
DENTS, athletic activities that involve running and
jumping, and recreational activities such as down-
hill skiing are also frequent causes of ankle
injuries. People who are physically inactive or
who have had multiple ankle strains may have
WEAK ANKLES, a circumstance in which the liga-
ments supporting the ankle are soft or lax. Exces-
sive body weight places further stress on the
ankles and may cause the foot to turn inward,
stretching the muscles and connective tissues in
ways that limit their ability to provide stability
during movement such as walking. OSTEOPOROSIS,
a condition of diminished BONE DENSITY, makes
the bones of the ankle vulnerable to fracture
under circumstances that otherwise would not
cause injury. Osteoporosis is a particular risk in
women who are past MENOPAUSEand in men over
age 65.
Regular weight-bearing activity such as walking
helps strengthen the structures of the ankle. Peo-
ple who are prone to ankle injuries may choose to
wrap, tape, brace, or otherwise support their
ankles during activities that involve increased risk
for unexpected twisting, such as running or sports.
A physical therapist can teach specific exercises to
strengthen weak ankles and improve FLEXIBILITY.
WARM-UP exercises to stretch and loosen the
ankles are important before engaging in physical
activities. It is important to wear the right shoes
for the activity, to give the foot and ankle proper
support. Worn-out shoes, even if designed for the
particular activity, increase the risk for injury.
See also ACHILLES TENDON INJURY; FLAT FEET; MUS-
CLE; PHYSICAL THERAPY; RESISTANCE EXERCISE; SHIN
SPLINTS; SPRAINS AND STRAINS; TENDON; WALKING FOR
FITNESS; WEEKEND WARRIOR.
ankylosing spondylitis A form of chronic,
degenerative arthritis (INFLAMMATIONof the joints)
that primarily affects the spine. The inflammation
permanently damages the vertebrae (bones of the
spine), causing outgrowths of bony tissue that fuse
vertebrae to one another such that their mobility
and range of motion can become extremely lim-
ited. Ankylosing spondylitis, sometimes called
Marie-Strümpell disease, is one of the AUTOIMMUNE
DISORDERSrelated to RHEUMATOID ARTHRITIS. In most
people who develop the condition, symptoms
remain confined to the spine. However, in some
people inflammation also involves structures of
the EYE(IRITISand UVEITIS), the HEARTvalves, the
LUNGS, and other joints such as the shoulders and
hips.Symptoms and Diagnostic Path
Early symptoms of ankylosing spondylitis are gen-
eral and include low BACK PAINand stiffness, espe-
cially upon awakening. The PAIN often becomes
intense at night, which is the primary reason any
people seek medical evaluation. Over time the
stiffness and pain may spread to the entire back,
shoulders, and hips. As the condition progresses,
additional symptoms may include loss of spine
FLEXIBILITYand range of motion, constricted move-
ment of the chest (from inflammation of the joints
connecting the ribs to the spine), fatigue, and
hunched or stooped posture.
The diagnostic path typically includes a com-
prehensive medical examination and PERSONAL
HEALTH HISTORY, X-rays of the spine, and BLOODtests
to look for signs of inflammation within the body.
Because symptoms are fairly general until the
condition is well advanced, early diagnostic efforts
look for more common causes such as OSTEO-
ARTHRITIS.Treatment Options and Outlook
Treatment typically combines prescription medica-
tions such as ANTI-INFLAMMATORY DRUGS (NSAIDS)
and PHYSICAL THERAPYwith lifestyle measures such
as daily physical exercise, stretching and flexibility
activities, and techniques to support upright pos-
ture. Some people experience symptom relief and
delayed progression of the condition with medica-
tions used to treat rheumatoid arthritis, such as
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDS).
Though treatment cannot prevent the vertebrae
from fusing, lifestyle measures can help retain302 The Musculoskeletal System