Ankle Pain Diagram: Causes, Symptoms & Relief

Ankle pain, a prevalent musculoskeletal complaint often assessed using tools like a pain scale, can significantly hinder mobility. The severity of ankle pain can range from mild discomfort to debilitating agony, impacting daily activities and athletic performance. Understanding the specific location and nature of the discomfort is crucial for accurate diagnosis, where a detailed diagram of ankle pain becomes an indispensable asset. Organizations such as the American Academy of Orthopaedic Surgeons (AAOS) provide resources and guidelines that emphasize the importance of visually mapping the affected area to pinpoint potential causes, which may include sprains, fractures, or conditions like arthritis that orthopedic doctors commonly treat.

The ankle, a seemingly simple joint, is in reality a complex structure critical to our everyday lives. Its health directly impacts our mobility, balance, and overall well-being. A compromised ankle can ripple through our daily routines, affecting everything from walking to participating in recreational activities.

The Ankle's Crucial Role

Ankle health is paramount for several reasons. Firstly, it is the foundation of our upright posture, enabling us to stand, walk, run, and jump. Secondly, the ankle plays a pivotal role in maintaining balance and stability, preventing falls and injuries. Finally, a healthy ankle allows us to engage in various physical activities, enhancing our overall quality of life.

Common Ankle Problems: A Brief Overview

A multitude of issues can compromise ankle health. Ankle sprains, often resulting from sudden twists or impacts, are among the most prevalent. Strains, involving muscle or tendon injuries, are also common, typically caused by overuse or sudden exertion. Chronic conditions like arthritis can gradually degrade the ankle joint, leading to pain, stiffness, and reduced mobility. These are just a few examples, highlighting the range of potential problems that can affect this vital joint.

Seeking Professional Help: When and Why

Recognizing when to seek professional help is essential for effective ankle care. If you experience persistent pain, swelling, instability, or difficulty bearing weight, consulting a medical expert is crucial. Early intervention can often prevent minor issues from escalating into chronic problems.

Medical professionals, such as orthopedic surgeons, podiatrists, and physical therapists, possess the expertise to diagnose and treat ankle conditions accurately. They utilize a variety of diagnostic tools, including X-rays, MRI scans, and physical examinations, to determine the underlying cause of your symptoms.

The Role of Diagnostic Tools in Treatment Planning

Diagnostic tools play a vital role in formulating effective treatment plans. Imaging techniques like X-rays and MRI scans provide detailed views of the ankle's bony structures and soft tissues, allowing medical professionals to identify fractures, ligament tears, and other abnormalities. These tools aid in distinguishing the specific condition affecting the ankle.

Based on the diagnosis, a tailored treatment plan can be developed. This may involve non-surgical interventions like physical therapy, bracing, or medication. In more severe cases, surgical intervention may be necessary. Ultimately, professional medical guidance, combined with appropriate diagnostic tools, is key to restoring and maintaining optimal ankle health.

Anatomy and Biomechanics: The Foundation of Ankle Function

The ankle, a seemingly simple joint, is in reality a complex structure critical to our everyday lives. Its health directly impacts our mobility, balance, and overall well-being. A compromised ankle can ripple through our daily routines, affecting everything from walking to participating in recreational activities.

Therefore, understanding the ankle’s anatomy and biomechanics is fundamental to appreciating its function and vulnerability to injury.

Ankle Anatomy: A Detailed Look

The ankle joint, also known as the talocrural joint, is formed by the interaction of three bones: the tibia, fibula, and talus.

The Bones of the Ankle

The tibia, or shinbone, and the fibula, a smaller bone running alongside the tibia, make up the lower leg. Their distal ends form the medial malleolus (tibia) and lateral malleolus (fibula), respectively, creating a mortise that cradles the talus bone.

The talus is a critical bone that sits atop the calcaneus (heel bone) and articulates with the tibia and fibula. It serves as a bridge, transferring weight from the lower leg to the foot. The calcaneus then distributes that weight to the ground.

Key Anatomical Landmarks: Malleoli

The medial and lateral malleoli are bony prominences that act as important anatomical landmarks, providing stability to the ankle joint and serving as attachment points for ligaments.

Ligaments: The Ankle's Stabilizers

Ligaments are strong, fibrous tissues that connect bones and provide stability to joints. The ankle relies on a network of ligaments to maintain its integrity and prevent excessive movement.

The lateral side of the ankle is supported by three primary ligaments:

The Anterior Talofibular Ligament (ATFL), the Calcaneofibular Ligament (CFL), and the Posterior Talofibular Ligament (PTFL). The ATFL is the most commonly injured ligament in ankle sprains.

The medial side is reinforced by the Deltoid Ligament, a strong, fan-shaped ligament complex that provides broad support.

The Achilles Tendon: Powering Movement

The Achilles Tendon is the largest tendon in the human body, connecting the calf muscles (gastrocnemius and soleus) to the calcaneus. It is crucial for plantarflexion, enabling us to point our toes and push off the ground when walking, running, or jumping.

Peroneal Tendons: Guiding Foot Motion

The Peroneal Tendons run along the outside of the ankle and attach to the foot. They are vital for eversion (turning the sole of the foot outward) and provide dynamic stability to the ankle.

Synovial Membrane and Cartilage: Ensuring Smooth Operation

The Synovial Membrane lines the ankle joint and produces synovial fluid, which lubricates the joint and reduces friction. Cartilage, a smooth, resilient tissue, covers the ends of the bones, allowing for nearly frictionless movement.

Ankle Muscles: Enabling Movement

Several muscles contribute to ankle function, including the peroneal muscles (longus and brevis), calf muscles (gastrocnemius and soleus), and the tibialis anterior.

These muscles work together to produce a variety of movements, including dorsiflexion (lifting the foot), plantarflexion (pointing the toes), inversion (turning the sole inward), and eversion.

Nerves: Sensory and Motor Control

The ankle is innervated by several major nerves, including the Tibial Nerve, Peroneal Nerve, and Sural Nerve. These nerves transmit sensory information (e.g., touch, pain, temperature) and control the muscles that move the ankle and foot.

Biomechanics: How the Ankle Functions

Understanding the biomechanics of the ankle is crucial for understanding how it moves and stabilizes the body.

Ankle Movement and Stability

The ankle joint allows for primarily plantarflexion and dorsiflexion. It also allows for some degree of inversion and eversion, movements that occur primarily at the subtalar joint (below the ankle joint).

The ligaments and muscles surrounding the ankle provide dynamic and static stability, preventing excessive or unwanted movement.

Range of Motion (ROM): Defining Normal Movement

Range of Motion (ROM) refers to the extent to which the ankle can move in each direction. Normal ROM is essential for proper function. Limitations in ROM can indicate injury or underlying pathology.

Proprioception: Balance and Coordination

Proprioception is the body's ability to sense its position and movement in space. The ankle is rich in proprioceptive nerve endings, which provide feedback to the brain about joint position and movement. This feedback is crucial for maintaining balance and coordination, especially during activities like walking on uneven surfaces or participating in sports.

Weight-Bearing: Distributing the Load

During Weight-Bearing, the ankle joint transmits the weight of the body from the lower leg to the foot. The talus plays a central role in this process, distributing the load across the calcaneus and other bones of the foot. Proper alignment and function of the ankle are essential for efficient and pain-free weight-bearing.

Common Ankle Injuries and Conditions: A Comprehensive Overview

The ankle, a seemingly simple joint, is in reality a complex structure critical to our everyday lives. Its health directly impacts our mobility, balance, and overall well-being. A compromised ankle can ripple through our daily routines, affecting everything from walking to participating in athletic activities. Therefore, it is crucial to understand the spectrum of injuries and conditions that can impact this vital joint.

Traumatic Injuries to the Ankle: Acute Disruptions

Traumatic ankle injuries often occur suddenly, frequently as a result of a specific incident such as a fall, twist, or direct impact. These injuries can range in severity from mild sprains to complex fractures, significantly impacting an individual's ability to bear weight and move freely.

Ankle Sprain: The Commonest Injury

An ankle sprain is an injury to the ligaments that support the ankle, typically caused by a sudden twist or impact. The severity of a sprain is classified based on the degree of ligament damage.

A Grade I sprain involves mild stretching and microscopic tearing of ligament fibers. Grade II sprains involve partial tearing of the ligament. A Grade III sprain involves a complete tear of the ligament, resulting in significant instability.

Symptoms include pain, swelling, bruising, and difficulty bearing weight. Management usually involves RICE (Rest, Ice, Compression, Elevation) protocol, pain relief, and physical therapy to restore strength and stability.

High Ankle Sprain (Syndesmosis Injury): A More Significant Injury

A high ankle sprain, or syndesmosis injury, involves the ligaments above the ankle joint that connect the tibia and fibula. These injuries are less common than lateral ankle sprains but often take longer to heal.

The mechanism usually involves a forceful twisting motion or hyper-dorsiflexion of the ankle. Diagnosis can be challenging and may require specific clinical tests and imaging such as MRI.

Treatment often includes immobilization, and in severe cases, surgical stabilization may be necessary.

Ankle Fracture: A Break in the Bones

An ankle fracture involves a break in one or more of the bones that make up the ankle joint, most commonly the tibia, fibula, or talus. Ankle fractures can range from stable avulsion fractures to unstable, comminuted fractures that disrupt the ankle mortise.

These fractures can occur from high-impact trauma, such as a fall from a height or a motor vehicle accident. Symptoms include immediate and severe pain, swelling, deformity, and inability to bear weight.

Treatment depends on the severity and stability of the fracture. Stable fractures may be treated with immobilization in a cast or boot. Unstable fractures often require surgical fixation with plates and screws to restore proper alignment and stability.

Achilles Tendon Rupture: Tearing the Body's Largest Tendon

An Achilles tendon rupture is a complete or partial tear of the Achilles tendon, the large tendon at the back of the ankle that connects the calf muscles to the heel bone. This debilitating injury typically occurs during sudden, forceful movements such as sprinting or jumping.

Individuals often describe a sudden, sharp pain in the back of the ankle. They also describe feeling a "pop" or "snap." There is often an inability to push off with the affected leg.

Diagnosis is usually made through a physical exam and confirmed with imaging. Management options include non-surgical treatment with immobilization and rehabilitation, or surgical repair of the tendon, depending on the patient's activity level and the severity of the rupture.

Peroneal Tendonitis/Tendon Subluxation: Problems on the Outside of the Ankle

Peroneal tendonitis is inflammation of the peroneal tendons, which run along the outside of the ankle. Peroneal tendon subluxation occurs when these tendons slip out of their normal position behind the lateral malleolus (outer ankle bone).

These conditions can arise from overuse, repetitive activities, or trauma. Symptoms include pain, swelling, and instability along the outside of the ankle.

Treatment may include rest, immobilization, physical therapy, and in some cases, surgical repair or reconstruction of the peroneal retinaculum (the tissue that holds the tendons in place).

Stress Fracture: The Insidious Overload

A stress fracture is a small crack in a bone caused by repetitive stress or overuse. In the ankle, stress fractures often occur in the tibia or fibula.

These injuries are common in athletes, particularly runners and basketball players.

Symptoms typically develop gradually and include pain that worsens with activity and improves with rest. Early diagnosis is crucial, as continued activity can lead to a complete fracture.

Management involves rest, immobilization, and gradual return to activity.

Chronic Conditions: The Long Game

Chronic ankle conditions develop over time and can result from repetitive stress, inflammation, or underlying diseases. Unlike traumatic injuries, which have a clear onset, chronic conditions often have a gradual onset and can be more challenging to diagnose and manage.

Achilles Tendinitis/Tendinopathy: The Degenerative Tendon

Achilles tendinitis or tendinopathy refers to chronic inflammation or degeneration of the Achilles tendon.

This condition is often caused by overuse, improper footwear, or poor flexibility. Symptoms include pain and stiffness in the back of the heel, which may worsen with activity.

Treatment typically involves rest, stretching, physical therapy, orthotics, and in some cases, injections or surgery.

Osteoarthritis: The Wear and Tear of the Joint

Osteoarthritis is a degenerative joint disease that affects the cartilage in the ankle joint. Cartilage breakdown leads to pain, stiffness, and decreased range of motion.

Osteoarthritis in the ankle can result from previous injuries, such as fractures or sprains, or from normal wear and tear over time.

Management includes pain relief, physical therapy, bracing, and in severe cases, joint replacement surgery (ankle arthroplasty) or ankle fusion (arthrodesis).

Rheumatoid Arthritis: The Inflammatory Assault

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, including the ankle. RA can lead to cartilage and bone damage, resulting in pain, swelling, and deformity.

Management involves medications to control inflammation and pain, physical therapy, orthotics, and in some cases, surgery to correct deformities or relieve pain.

Tarsal Tunnel Syndrome: Entrapment of a Nerve

Tarsal tunnel syndrome is a condition caused by compression of the tibial nerve as it passes through the tarsal tunnel on the inside of the ankle.

This compression can result from trauma, swelling, or structural abnormalities. Symptoms include pain, numbness, and tingling in the foot and ankle.

Treatment may include rest, orthotics, injections, and in severe cases, surgery to release the compressed nerve.

Impingement Syndrome (Ankle): The Pinch

Ankle impingement syndrome occurs when soft tissues, such as ligaments or joint capsule, become pinched or compressed within the ankle joint. This can occur either at the front (anterior impingement) or the back (posterior impingement) of the ankle.

Anterior impingement is often caused by bone spurs or repetitive dorsiflexion (bending the foot upward). Posterior impingement can result from repetitive plantarflexion (pointing the foot downward).

Symptoms include pain, stiffness, and a clicking or catching sensation in the ankle. Treatment may include rest, physical therapy, injections, and in some cases, arthroscopic surgery to remove the impinged tissues or bone spurs.

Diagnosis and Evaluation: Identifying the Root Cause

Following the understanding of ankle anatomy, biomechanics, and common injuries, accurate diagnosis is paramount for effective treatment. This section outlines the methods and tools medical professionals employ to diagnose ankle issues accurately, emphasizing both physical assessment and advanced imaging techniques. Pinpointing the root cause of ankle pain and dysfunction is the first critical step towards a successful recovery.

Initial Assessment: The Foundation of Diagnosis

The diagnostic process typically begins with a thorough initial assessment. This involves a detailed patient history and a comprehensive physical examination.

The Comprehensive Physical Examination

Physical examination is a cornerstone of ankle diagnostics. Medical professionals will evaluate a range of factors. They will start by observing the ankle for swelling, bruising, or deformities. Palpation (careful touching) is then used to identify areas of tenderness. This helps pinpoint the structures involved.

Range of motion is also assessed, both actively (patient-driven) and passively (clinician-driven). This reveals limitations and pain points. Specific stress tests are performed to assess ligament stability. Examples include the anterior drawer test (ATFL) and the talar tilt test (CFL). Neurological assessment evaluates nerve function, checking for sensation and reflexes. Vascular assessment checks blood flow to the foot. A thorough physical examination provides crucial clues for the diagnosis.

Pain Scales: Quantifying the Subjective

Pain is a subjective experience. However, pain scales provide a standardized way to quantify it. Visual Analog Scales (VAS) and Numeric Pain Rating Scales (NPRS) are commonly used. Patients rate their pain on a scale, usually from 0 to 10. This allows clinicians to track pain levels over time. It also helps to assess the effectiveness of treatment. Pain scales are valuable tools for monitoring patient progress.

Imaging Techniques: Peering Beneath the Surface

While the physical examination offers valuable insights, imaging techniques are essential for visualizing the internal structures of the ankle. This confirms the diagnosis and rules out other potential problems.

X-Rays: A Window into Bone Structure

X-rays are often the first imaging modality used. They are excellent for visualizing bone abnormalities. X-rays can reveal fractures, dislocations, and signs of arthritis. Weight-bearing X-rays provide additional information. They show how the bones align under the stress of body weight. Although X-rays offer limited visibility of soft tissues, they are invaluable for assessing bony structures.

MRI (Magnetic Resonance Imaging): Detailed Soft Tissue Visualization

MRI provides highly detailed images of soft tissues. This includes ligaments, tendons, cartilage, and muscles. MRI is particularly useful for diagnosing ligament sprains, tendon tears, and cartilage damage. It can also detect bone bruises and stress fractures that may not be visible on X-rays. MRI is the gold standard for evaluating soft tissue injuries.

CT Scan (Computed Tomography): Advanced Bone Imaging

CT scans provide cross-sectional images of the ankle. This allows for a detailed assessment of complex fractures. They are useful for evaluating bone alignment. This is especially useful in cases where surgery is being considered. CT scans are particularly helpful for assessing bony impingement.

Ultrasound: Real-Time Imaging of Tendons and Ligaments

Ultrasound uses sound waves to create real-time images of tendons and ligaments. This makes it useful for dynamic assessment. For example, it can show tendon subluxation during movement. Ultrasound is also used to guide injections. It is less expensive than MRI. However, its image quality is operator-dependent.

Treatment Options: A Path to Recovery

Following a thorough diagnosis, the next step is implementing a tailored treatment plan designed to address the specific ankle issue. This section details various non-surgical and surgical interventions available for treating ankle injuries and conditions. Understanding these options is crucial for patients and healthcare providers to make informed decisions.

Equally important is the role of rehabilitation in restoring ankle function and preventing future injuries.

Non-Surgical Interventions: Conservative Approaches

For many ankle conditions, non-surgical interventions are the first line of treatment. These approaches aim to reduce pain, inflammation, and promote healing using conservative methods.

RICE Protocol: Immediate Care

The RICE protocol—Rest, Ice, Compression, and Elevation—is fundamental for managing acute ankle injuries like sprains.

Rest limits further damage. Ice reduces swelling. Compression provides support. Elevation aids fluid drainage.

Application Guidelines

• Rest: Avoid weight-bearing activities immediately after the injury.
• Ice: Apply ice packs for 15-20 minutes every 2-3 hours.
• Compression: Use an elastic bandage to provide support and minimize swelling.
• Elevation: Keep the ankle elevated above the heart level.

Ankle Braces: Support and Stability

Ankle braces offer external support, limiting excessive motion and preventing re-injury. They are particularly useful for individuals recovering from sprains or those with chronic ankle instability.

Types and Uses

• Lace-up braces: Provide moderate support and allow for adjustable fit.
• Semi-rigid braces: Offer more stability and are suitable for moderate to severe sprains.
• Hinged braces: Provide maximum support and allow for controlled range of motion.

Walking Boots: Immobilization and Protection

Walking boots immobilize the ankle and lower leg, providing protection during the healing process. They are commonly used for fractures, severe sprains, and post-surgical recovery.

Features and Benefits

• Rigid structure protects the injured area.
• Adjustable straps ensure a secure fit.
• Rocker-bottom sole facilitates walking.

Crutches: Non-Weight-Bearing Assistance

Crutches allow individuals to avoid putting weight on the injured ankle, promoting healing and reducing pain. They are particularly useful for fractures, severe sprains, and post-operative care.

Proper Usage Tips

• Maintain proper posture while walking.
• Ensure the crutches are the correct height.
• Use hand grips for support.

Physical Therapy Exercises: Restoring Function

Physical therapy is a crucial component of ankle rehabilitation. Exercises aim to restore range of motion, strength, balance, and proprioception.

Key Components of Rehabilitation

• Range of Motion Exercises: Gentle movements to improve flexibility.
• Strengthening Exercises: Targeted exercises to rebuild muscle strength.
• Balance and Proprioception Training: Exercises to improve balance and coordination.

Pain Medications: Alleviating Discomfort

Pain medications can help manage discomfort associated with ankle injuries and conditions. Both over-the-counter (OTC) and prescription options are available.

Types of Medications

• OTC Pain Relievers: Ibuprofen or naproxen can reduce pain and inflammation.
• Prescription Pain Medications: Opioids may be prescribed for short-term pain relief.

Corticosteroid Injections: Targeted Inflammation Reduction

Corticosteroid injections can provide targeted relief from inflammation and pain. They are often used for conditions like tendinitis or arthritis.

Considerations

• Injections should be administered by a qualified healthcare professional.
• Potential side effects should be discussed with the doctor.
• Corticosteroid injections provide temporary relief.

Surgical Interventions: When Needed

When conservative treatments fail to provide adequate relief or when the injury is severe, surgical intervention may be necessary.

Surgery: Indications and Procedures

Surgical options vary depending on the specific condition. Common procedures include:

• Ankle Arthroscopy: For cartilage repair and removal of loose bodies.
• Ligament Reconstruction: To stabilize unstable ankles.
• Fracture Fixation: To stabilize broken bones with plates or screws.
• Tendon Repair/Reconstruction: To address tendon ruptures or chronic tendinopathies.

Arthroscopy: Minimally Invasive Techniques

Arthroscopy is a minimally invasive surgical technique that uses small incisions and a camera to visualize and treat ankle problems. It often results in less pain, reduced scarring, and faster recovery.

Benefits of Arthroscopy

• Smaller incisions
• Reduced pain
• Shorter recovery time

Rehabilitation: Restoring Function and Preventing Re-Injury

Rehabilitation is a critical phase of recovery, regardless of whether surgical intervention was required. It focuses on restoring full function and preventing future injuries.

Key Elements of Rehabilitation

• Gradual Progression: Increase activity levels gradually to avoid re-injury.
• Functional Exercises: Exercises that mimic real-life activities.
• Sport-Specific Training: For athletes, exercises to prepare for return to sport.

Comprehensive treatment plans, incorporating both conservative measures and surgical options when necessary, combined with a robust rehabilitation program, are essential for achieving optimal outcomes in ankle health.

The Role of Medical Professionals: Your Ankle Health Team

Following a tailored treatment plan designed to address the specific ankle issue, navigating the healthcare landscape to find the right specialist can be a daunting task. Understanding the unique expertise each professional brings to the table is essential for effective ankle care and optimal recovery. Let's explore the crucial roles of orthopedic surgeons, podiatrists, physical therapists, and sports medicine physicians in ensuring your ankle health.

Orthopedic Surgeons: The Surgical Specialists

Orthopedic surgeons are medical doctors who specialize in the diagnosis, treatment, prevention, and rehabilitation of injuries, disorders, and diseases of the musculoskeletal system. When it comes to ankle health, orthopedic surgeons offer a wide range of expertise, particularly when surgical intervention is necessary.

Their training encompasses a deep understanding of bone and joint anatomy, allowing them to perform intricate procedures such as ankle fracture repair, ligament reconstruction, and ankle joint replacement. They can also address chronic conditions like severe arthritis or deformities that require surgical correction.

Orthopedic surgeons often collaborate with other specialists to provide comprehensive care. Their surgical expertise is crucial in cases where non-surgical treatments have failed or when the severity of the condition necessitates immediate surgical intervention.

Podiatrists: Foot and Ankle Experts

Podiatrists are doctors who specialize in the care of the foot and ankle. They receive specialized training focusing exclusively on the lower extremities, making them experts in diagnosing and treating a wide array of foot and ankle conditions.

Podiatrists are skilled in both surgical and non-surgical treatments. They commonly address issues such as bunions, hammertoes, plantar fasciitis, and ankle sprains. Their expertise also extends to diabetic foot care, wound management, and custom orthotics.

When dealing with foot-related complications that impact the ankle, such as biomechanical imbalances or deformities, a podiatrist's specialized knowledge can be invaluable.

Physical Therapists: Restoring Function and Mobility

Physical therapists (PTs) are healthcare professionals who specialize in restoring and improving movement and function. They are essential in the rehabilitation phase following an ankle injury or surgery.

PTs develop individualized treatment plans that focus on strengthening muscles, improving range of motion, reducing pain, and enhancing proprioception. Their expertise in biomechanics allows them to identify movement patterns that may contribute to ankle problems and provide corrective exercises.

Physical therapists work closely with patients to help them regain their pre-injury level of activity and prevent future injuries. Their role extends beyond rehabilitation to include injury prevention and performance enhancement for athletes.

Sports Medicine Physicians: Managing Athletic Injuries

Sports medicine physicians are medical doctors who specialize in the prevention and treatment of injuries related to sports and exercise. They possess a comprehensive understanding of the unique demands placed on the ankle during athletic activities.

Sports medicine physicians are skilled in diagnosing and managing acute and chronic ankle injuries common in athletes, such as ankle sprains, tendonitis, and stress fractures. They develop treatment plans that focus on returning athletes to their sport safely and efficiently.

These physicians often work closely with athletic trainers and physical therapists to provide coordinated care for athletes. Their expertise in biomechanics, injury prevention, and performance enhancement makes them an invaluable resource for athletes of all levels. They can also provide guidance on proper footwear, bracing, and training techniques to minimize the risk of ankle injuries.

So, there you have it! Hopefully, this dive into the causes, symptoms, and relief options, paired with the help of a good ankle pain diagram, has given you a better understanding of what might be going on with your ankle. Remember, if the pain persists or worsens, don't hesitate to consult a healthcare professional for a proper diagnosis and treatment plan. Here's to happy and healthy ankles!