Ankle Injuries- All you need to know
How common is an Ankle Injury?
The ankle joint, which connects the lower leg to the foot, is often injured. It is estimated that 4% of the western world population suffer ankle sprains. An unnatural twisting motion happens when the foot is plated awkwardly. A large majority of these ankle injuries are sustained during sporting activity or even something as simple as getting out of bed. Ankle sprains have been shown to be the most common injury in a total of 24 different sports and there is a high re-injury rate. They are particularly common in sports that involve changes of direction or jumping and landing (Soccer, Volleyball, GAA, Rugby).
How do you injure your ankle?
Ankle sprains occur when you roll to the outside of the foot. It is often caused when the ankle is forced to bend more than normal. This overstretches and damages the lateral ligaments. This often happens due to a lack of lower limb balance and strength. Almost 70-85% of ankle injuries involve the ligaments on the outside of the foot. Damage to the ligaments on the inside (medial) part of the ankle is less common but can be more severe and take longer to rehabilitate.
iesA high ankle sprain or ‘Syndesmosis’ involves the joint just above the ankle at the front of the shin and this is often a more severe injury and can take longest to heal. In the case of surgical repairs following an ankle ligament rupture it is vital to commence rehabilitation to regain strength and balance once the cast or brace has been removed.
What are the Symptoms of an Ankle Injury
- Sudden Pain and Ache in the ankle joint
- Inability to move the ankle normally
How can I rule out a Fracture of my Ankle or Foot?
OTTOWA ANKLE RULES
An ankle and foot X-ray is needed if there is any pain or bone tenderness at:
- The base of the Fibula on the outside of the ankle
- The base of the Tibia on the inside of the ankle
- In the Mid foot zone
- Inside or Outside aspect of the Foot
- Inability to weight bear immediately and at clinical assessment for four steps.
Who is most susceptible to an Ankle Injury?
- Individuals with less leg muscle bulk
- Poor Range of Motion in the Ankle
- Lack of Strength and Balance
- Those with previous Ankle injuries
Complications with Chronic Ankle injuries
The most sever cause of chronic ankle in jury is what we call chronic Ankle Instability. It is reported that only 50% of people who have suffered an ankle sprain seek medical attention. A high proportion of individuals who sustain an ankle sprain will suffer recurrent sprains known as chronic ankle instability (CAI). Further more, CAI involves persistent complaints of pain, swelling and/or giving way with recurrent ankle sprains for at least 12 months after the initial injury. This can lead to long term absence from sport and work. Joint degeneration and bony lesions have been associated with CAI.
Accurate Diagnosis is important.
Accurate diagnosis, treatment and prevention of injury recurrence can reduce the chance of long-term injury associated complications. It is best to seek advice from your physio. Ankle injuries are often one that everyone just says to themselves “it will be better in a couple of weeks”, OR “I’ll just play through it”. As a result, half way through the season you are complaining about your ankle as you just push through it and continue playing. If you take the right advice and guidance you can quickly get back pain free and playing sport.
Factors associated with Chronic Ankle Instability
Intrinsic factors related to Ankle Injuries
- Limited Range of motion
- Lower BMI
- Poor Co-Ordination and Strength
- Females have a higher risk of ankle sprains
Extrinsic factors Related to Ankle Injuries
- Uneven playing surface – Grass has a higher risk
- Sports involving Jumping/Landing e.g Basketball, Volleyball, GAA, Soccer
- High Heels
5 Tips for Acute Ankle Injuries
- Apply the P.O.L.I.C.E protocol
- Work on Range of motion and Balance exercises with Physio
- Walk Normally after 2 days with a low level of pain
- Pain relief – Ice & Anti- Inflammatories
- Begin Graded Rehabilitation Programme.
Prognosis an for Ankle Injury
Generally Ankle injuries often respond well to the correct early management, treatment and rehabilitation protocols. With good management patients typically recover in 6-10 weeks. After the initial reduction in pain and inflammation, patients often neglect the underlying factors for the issue in the first place and fail to recover fully. Exercises to regain full movement should follow a graded balance and strengthening programme.
How Physiotherapy can help an Ankle Injury?
The aim of physio is to reduce pain, restore normal function such as range of movement, strength and neuromuscular control.
We can do this via a variety of techniques such as:
- Pain management – Ice & Anti-Inflammatories
- Rule out a Fracture or refer for X-Ray
- Early Loading – Getting back walking with normal gait ASAP
- Manual Therapy & Massage
- Strengthening and Balance Rehabilitation
- Sports-Specific Exercises
- Landing and Plyometric Techniques
Our therapists have extensive experience in treating and rehabilitating this type of injury. The first treatment stage will be to calm the inflammation and control swelling and pain. This is managed with the POLICE protocol. Early weight bearing after 48 hours has been shown to help sprained ankles heal quicker. Therefore, most people with acute ankle sprains will not be given crutches. Try to walk normally as early as tolerable with your heal striking the ground first, then rocking on to your foot and pushing off with the toes.
P.O.L.I.C.E protocol for Ankle Injuries
Generally, after injury the main focus is to avoid further tissue damage. During the first few days after injury you should certainly rest the injury. This means using crutches, a boot or having the ankle taped to allow the ligaments to heal.
Initially, rest will help prevent further injury and allow healing. For the first couple of days reduce the amount of walking you do. Early weight bearing exercises after 72 hours has been shown to help sprained ankles by stimulating the healing process. This must be done with guidance from you physio to ensure the correct rehab strategy is in place.
Ok ice helps reduce swelling and pain. Use an ice pack or some crushed ice in a damp towel. Put the pack on the injured ankle for 10 minutes every hour. Use the ice pack 3 times a day until the swelling goes down.
So compression serves to limit the amount of swelling due to inflammation. A compressive bandage is used to provide comfortable compression force without causing pain or constricting blood vessels. It also provides some protection for the ankle to limit movement in the early stage.
Keep the injured ankle rested above hip height for the first few days after injury to help with swelling and pain.
Do you need Physio?
If you feel you have an acute or chronic ankle issue our therapist have over 18 years treating common and sporting ankle injuries.
Success rate of ankle rehab are high, once rehab protocols are adhered to.
Think of it this way if you ankle has been at you for over 4 months it is unlikely it will return to full strength without physio intervention.
Doing nothing wont help it, get it fixed by professionals