Ankle Injuries

Most of us at some point in our lives have injured our ankles by rolling it during a sports event, misjudging out footing on a kerb or causing a self-inflicted injury during a drunken night (yes! It’s a common injury we see here at City Physio).

With the sports season finally coming into play after the long-awaited lift in restrictions we have seen a lot of ankle ligament sprains walking (or limping) through the door.

There are 26 bones, 33 joints and over 100 surrounding ligaments or muscles in the foot. The ankle is a synovial joint made up of 3 articulations. The talocrural joint is formed between the tibia and fibula (lower leg bones) and the talus (large bone in the ankle) which allows the foot to move in all directional planes: plantar flexion/dorsi flexion (up/down) & inversion / eversion (inwards/outwards).

The inferior tibiofibular joint is the articulation between the tibia and fibula (lower leg bones). This joint is stabilised by thick interosseous membrane and ligaments. The talus and calcaneus (heel bone) connect to form the subtalar joint which allows side to side movements (inversion / eversion). The joint’s stability comes from the structural arrangement of the bones and the surrounding ligaments. So, you can imagine how many injuries can occur in the foot. However, lets focus on the most common ankle sprains we see at City Physio.   

More than 80% of ankle injuries involve the lateral ankle structures. The lateral ligament complex consists of the anterior talo fibular ligament (ATFL), calcaneo-fibular ligament (CFL) and the posterior talo fibular ligament (PTFL). Most commonly, the mechanism of the injury involves the ankle “rolling” in (inversion). Usually the ATFL and CFL ligaments are injured as a pair. HOWEVER, not always!

The remaining 20% of ankle injuries involve the medial compartment – the deltoid ligament. The mechanism of this injury is usually rolling out (eversion of the ankle).

Ligament strains can be distinguished via a grading system.

• Grade 1 – microscopic tearing of collagen fibres, with minimal tenderness and swelling, able to weight bear
• Grade 2 – complete tears of some but not all collagen fibres, moderate tenderness and swelling, decreased range of motion and possibly instability
• Grade 3 – complete rupture of the ligament – significant swelling and tenderness, instability, reduced range of motion and strength. Immobilisation in a boot is required.

Here at City Physio, we run a thorough subjective and physical examination to rule out any serious pathology, fractures or other bony injuries, grade and diagnose the specific structure damaged.  All this to direct a management plan specific for you and your goals – whether that may be to return to play soccer, run or dance!

Early management of an ankle sprain dictates recovery of the injury. Over the years, there have been varying acronyms to guide acute soft tissue injury management, evolving from ICE to RICE, PRICE to POLICE. The newest guideline for care has a holistic approach – PEACE for immediate care & LOVE for subsequent management.

P – Protect the injured structure by eliminating aggravating factors. Prolonged rest should be avoided as it can compromise tissue strength and quality

E – Elevate the limb higher than the heart to promote interstitual fluid flow out of the tissue

A – Avoid anti inflammatories for the first 24-72 hours

C – Compress the injured area using tubi-grip, taping or a compression bandage to decrease swelling.

E – Education of diagnosis and prognosis is critical to promote an active approach to recovery

After the acute phase, move to the acronym LOVE for subsequent management

L – Loading is important to promote repair, remodelling and increase in tissue tolerance through mechanotransduction. Optimal loading will facilitate the return to normal activities.

O – Optimism! A little out of our house, however staying active and optimistic regarding the injury can enhance the likelihood of optimal recovery.

V – Vascularisation is the process of normalising of blood vessels. Pain free cardiovascular movement helps to increase blood flow to the injured structures and improve physical function.

E – Exercise and movement can help recover range of motion, strength, proprioception and sport specific movements.

PEACE and LOVE do sound a bit cheesy, but it’s an easy way to remember how to self-manage before you get to your physio or GP for a thorough assessment, rule out any serious injuries and start your rehabilitation program!

At City Physio we are very patient-focused. We listen to your goals and we want you to achieve them in the safest way. Contact us Now!