ANKLE PAIN AND INJURIES
 Ankle sprains are one of the most common sports injuries we see as physiotherapists and they account for around 20% of all sporting injuries. The ankle is fairly susceptible to injury when playing sport due to the amount of forces that transmit through the joint from the body to the ground.
 The Joint
The ankle is a fairly mobile joint made up of three bones. The joint gets its stability from the ligaments around it. The ligaments on the inside of the joint are, however, generally stronger and less likely to be damaged than those on the outside.
Risk Factors
- Lack of strength and stability related to the ankle
- Previous or existing ankle injury
- The condition of the playing surface
- Wearing inappropriate footwear for the activity
- Lack of, or extreme flexibility in the ankle joint
- Poor body alignment of the knees, ankles and feet
- Poor body awareness and balance
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Prevention Measures
Proprioception
The ability to sense the position of the joint and use appropriate muscle activity to maintain posture and balance. With poor proprioception, there is some delay in sensing body position, so on landing awkwardly the ankle may roll in, resulting in an ankle sprain.
Strengthening
Developing strength in the muscles that support the ankle joint is important. Strength can be improved by using a resistance training program that targets these muscles. Once you have developed more strength around the ankle join, you can progress to sport-specific drills that require strength and agility.
Flexibility
Stretching will improve and maintain flexibility of your calf muscles to help prevent ankle injuries. Remember to warm-up prior to stretching
Footwear
Poor footwear is a significant factor in injuries around the ankle. When choosing footwear, there are many different factors to consider:
- Foot type
- Shoe Stability
- Shock Absorption
- Heel Counter
- Flexibility
- High-cut shoes vs low-cut shoes
Make sure you get correct advice from a footwear specialist or ask us for advice during your consultation. physiotherapist.
Taping or bracing
Taping or bracing has been shown to be effective in reducing the risk of ankle injuries.
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Ankle Injuries
The most common injury to the ankle joint generally occurs if the foot is grounded and the weight of the person is moved laterally (away from the midline of the body). Here, the outside ligaments will be damaged if the force is strong enough. This is known as an inversion sprain.
The degree of damage will depend on the strength of the ligament to begin with (the more sprains, the weaker the ligament) and the force that was applied to the ligament.
- Grade 1 sprain is a micro-tear or an over-stretching of the ligament and usually recovers well within 1-2 weeks. The athlete is usually able to walk within 1 hour of the injury without crutches.
- Grade 2 sprain is a significant tear of the fibres of the ligament/s and usually results in large amounts of swelling and an inability to weight-bear for 2-7 days. If a fracture is suspected, immediate imaging/X-Ray is required. This usually takes between 4-8 weeks to heal with the appropriate physiotherapy treatment and rehabilitation
- Grade 3 injury is a full thickness tear of the ligament and can often occur with an avulsion fracture (tearing off a bit of bone from the ankle bone with the ligament). This may require surgery, and definitely needs an X-Ray. This injury may take between 6-12 weeks to heal and in some cases, the injured person may need surgery to recover or to return to sport.
- Consulting your physiotherapist is very important as soon after the injury as possible as that is one of the major influences on the speed of recovery
- Please see our sports injuries page for the immediate management of your injury.
Other injuries to the ankle region include:
ANKLE FRACTURES:
- Lateral / Medial / Posterior malleolus (Potts)
- Difficult to distinguish from severe ligament sprain
- Both cause severe pain and inability to weight-bear
- Tibial plafond fractures
- Base of Fifth Metatarsal
- Anterior process of the calcaneus (heel)
- Lateral / posterior process of the talus
- Os Trigonum
- Osteochondral lesions of the talar dome
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Ankle Pain
Ankle pain can be divided into 3 sections depending on where the pain is felt in the ankle. This can develop without a significant cause and can be due to many factors including:
- Previous ankle injuries
- Repetitive abnormal force applied to the joint such as in ballet or football
- Poor posture or body alignment while doing exercise or repeated activity
- Poor footwear / external factors
Below is a guide to some of the causes of ankle pain, but it is very important to get your pain or injury assessed accurately and treated under the guidance of either a sports physician or a physiotherapist.
MEDIAL ANKLE PAIN (on the inside):
- Tendinopathy
- Different muscles that start in the leg and have their tendons finishing in the foot can become irritated and inflamed causing pain
- This may occur as a result of prolonged stretching into eversion in association with excessive rolling in of the foot (pronation).
- Treatment is aimed at decreasing pain with ice / analgesia / electrotherapeutic modalities, strengthening of the tendon performed by concentric and eccentric exercises, massage therapy and taping / orthoses to control excessive pronation
- Tarsal Tunnel Syndrome
- Medial Malleolus stress fracture
- Medial Calcaneal nerve entrapment
LATERAL ANKLE PAIN (on the outside):
Tendinopathy
- Sinus Tarsi Syndrome
- Overuse injury secondary to excessive subtalar pronation
- May occur as a sequel to an ankle sprain
- Often more severe in the morning and may diminish with exercise
- Treatment = relative rest, NSAIDS, electrotherapeutic modalities, subtalar joint mobilisation and taping to correct excessive pronation if present.
- If unsuccessful, may need corticosteroid injection.
- Anterolateral impingement
- Posterior Impingement Syndrome
- Stress fracture of the talus
- Referred Pain
ANTERIOR ANKLE PAIN:
- Anterior impingement of the ankle
- Cause of some chronic ankle pain or result in pain or disability persisting following an ankle sprain. Spurs can develop on the anterior, upper surface of the neck of the talus and the anterior tibia just above the joint margin. As these become larger they impinge on the overlying soft tissue and cause pain.
- Footballers ankle or ballet dancers due to the forced dorsiflexion
- Tendinopathy
- Inferior tibiofibular joint injury
- May occur with ankle sprains
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Role of Physiotherapy
 As with all ligament sprains the RICE protocol should be followed. This stands for REST, ICE, COMPRESSION and ELEVATION . (This is outlined in more detail under Sports Injuries and General advice.)
Physiotherapy can be very beneficial in the initial stages in reducing the amount of inflammation and maximising the rate of recovery. Techniques such as ultrasound, taping to support the joint and advice on activity level and exercise are all crucial in  the initial stages.
The recovery time will be proportional to the degree of damage done and your physiotherapist will be able to advise you on this. It is also important to strengthen the joint so as to prevent injuries recurring.
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Treatment and Rehabilitation
Rehabilitation and appropriate management of the injury are essential to ensure full recovery is achieved. A sports physician or physiotherapist should be consulted after an injury so the severity of the injury can be assessed, appropriate treatment and advice given and a comprehensive rehabilitation program put in place.
Full rehabilitation of an ankle injury includes strength, flexibility and proprioceptive exercises of the ankle. A physiotherapist will help you set goals aimed at assisting you to return to sport as soon as possible. They can also advise whether your ankle needs to be taped or not.
For more information, please contact us or click on the right to make an appointment now.
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