Ankle Injuries & Physiotherapy

Your ankles and feet lie at the very bottom of the leg, bearing your entire body and coping with the stress of movement and the complications therein.

Commonly occurring ankle injuries

• Sprained ankle – Ankle sprains are possibly the most commonly injury of the sort, occurring to both athletes and anyone who simply walks around. A quick jarring motion whether by misplacing your foot whilst sprinting or by missing a step while going down the stairs can cause soft tissue damage that typifies the condition. The injury is usually to ligaments in the area, and can be an inversion (inward twist) or eversion (outward twist) injury. The former is considerably more common simply due to the arrangement of bones in the ankle, and lateral ligaments (outside the ankle) are the victims, including for example the Anterior Talo Fibular (ATF) ligament. Symptoms vary in intensity, and like muscle sprains can be graded from first degree (minimal ligament damage) to third degree (rupture and potential dislocation). The ankle is enclosed by a capsule which is also damaged in this injury.
• Broken ankle – Also quite a common injury typical of road accidents for example, an ankle breaks typically as the structure twists under a load, resulting in a break. The ankle itself is comprised of the bones of the lower leg (Tibia and Fibula) and the Talus, with all three bound by ligaments. Fractures in the ankle vary immensely depending on where the breaks occur. For example a fracture if the outer part of the Tibia is called an Isolated Medial Malleolus Fracture, whereas three breaks, two to the Tibia and one to the Fibula, is called a Tri Malleolar Fracture. Presentation typically involves pain in the ankle, swelling, loss of function, and in the event of an open facture, bone fragments appearing through the skin causing bleeding.
• Achilles Tendinopathy (Achilles Tendonitis) – Named because of the ancient Greek hero who, according to myth, was shot in this part of the ankle, the Achilles Tendon is a long tendon composing the lower part of the calf and connecting to the heel. In this condition the tendon degenerates (Tendinosis), causing the loss of structural strength which increases the likelihood of rupture as the tendon can no longer support the leg as well. Tendinopothy is slow, gradually occurring over the years and hence more prevalent in people above the age of 40. The areas of degeneration are sore and tender, with the tendon itself being stiff.

Physiotherapy and ankle injuries

If the ankle injury is acute, as in a fracture or severe sprain, the early phase of treatment will involve the PRICE protocol which involves the protection of the damaged area, resting the structures that have been injured, applying ice packs regularly to reduce swelling and bleeding, compression using support bandages or braces, and finally elevation.

After the initial management phase by doctors or surgeons, in which a physiotherapist might be involved depending on the hospital, the patient will be referred for physical therapy to rehabilitate the injury and restore functional use. Some more specific tools have been developed to deliver these, for example the Aircast Ankle Cryocuff which is designed to provide both cold therapy and compression.

Your physio will stress the importance of not putting too much weight on your injured leg, and will suggest crutches at least initially to avoid placing an unnecessary and exacerbating load on your joint. After giving your injury some time to heal, a physiotherapist will decide when to begin exercising your ankle to restore function. This will normally begin by gently placing some weight on the ankle. The importance of not pushing yourself too far is in that overloading an injured ankle both hinders the healing process and also develops abnormal gait and posture because of the pain involved in trying to walk.

The ideal is restoring your ankle functionality to equal its uninjured counterpart. After the protection and recovery phase, rehabilitation conducted by your physiotherapist will essentially involve increasing the load your joint takes, resistance training, massage to stimulate blood flow to the deep ankle, and eventually walking with a normal gait.

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