Ankle Injury

Injuries to the ankle joint are the sports injury which is most often seen in the Accident and Emergency Department at the Hospital. Government figures suggest almost 2 million attendances to the hospital each year.

Types of ankle injury

Ankle sprain or strain – the only difference between a strain and a sprain is the second letter of the word! These terms are used most often to describe what is correctly described as an inversion injury. This is where the foot turns inwards in relation to the lower leg (or more often the foot stays still and the leg moves outwards in relation to the foot). Imagine that you are playing football on one of the less than perfect pitches around Portsmouth and your foot finds a dip in the pitch – your leg remains upright and your foot turns underneath you. This movement is controlled by a collection of supportive structures called ligaments on the outside of the ankle joint; as your foot turns in these structures are stretched and if there is sufficient force they will tear, resulting in an ankle strain.

Treatment of Sprained Ankle

This depends on the exact nature and severity of the injury. Strains are divided into three categories or grades, imaginatively called Grade 1, 2 or 3, with Grade 1 being the least severe. Most sprains we see are Grade 1; there is an egg shaped swelling on the outside of the joint, there is often quite impressive bruising, it can be very painful and you may not have been able to walk on the foot straight after the injury.

A word on X-rays: We are often told by our patients that the ankle was not X-rayed when they went to the hospital and that surely it must be broken as the ankle is so swollen and painful!   Hospitals follow protocols in the management of these injuries – guidelines which indicate the appropriate actions to take and whether investigations like an X-ray are necessary. These protocols are well established; the vast majority of ankle injuries do not need an X-Ray and an X-Ray will not be performed “just to make sure”. Rest assured, if your ankle is X-rayed it was because the doctor was already pretty certain it was broken!

Immediate treatment of a sprained is aimed at reducing the pain and swelling and limiting further injury. As time progresses, treatment aims to help the damaged tissues repair as fully as possible and in the later stages is aimed at returning the ankle to full strength, flexibility and stability. Most people who suffer an ankle sprain will suffer the same injury again at some point and so are treatment is aimed at making sure this does not happen. Many people after an ankle injury will complain that the ankle feels unstable or that they do not feel confident if they are walking over uneven ground. It is quite rare to develop true instability in the joint and this would normally follow a Grade 3 strain where the ankle ligaments are completely ruptured; in most cases it is a feeling of instability and this relates to one of the body senses called proprioception.

Proprioception or position sense is the bodies awareness of where it is in space – we do not need to see our arm to know whether it is bent or straight, we can feel it. After an ankle strain, the proprioception of the joint is reduced and this is the root cause of most instances of  re-injury. We must work hard to regain this sense. When sport is being played we do not concentrate on the positions of our joints – we are thinking of our performance in the match and exercises which help to regain this innate sense of position are an essential part of rehabilitation.

Sportsman’s Ankle

This term is used to describe changes that occur in the ankle joint and are seen most in sports which involve jumping and landing in potentially awkward positions (think of a defender jumping in a congested penalty area or a gymnast landing a vault). If repeated poor landings are made the bottom of the shin bone (which forms the top of the ankle joint) impacts onto the top surface of one of the bones in the foot and eventually forms a ridge on the bone. This causes a painful pinching in the front of the joint, worse when running or walking on an uphill slope. Treatment from the physiotherapist is aimed at maintaining the mobility of the joint to ensure that the normal pattern of walking is not affected.  The pain may also be helped by using an orthotic or insole in the shoes to improve the function of the joint. In the most severe cases, surgery may be required to remove the bony ridges from the bone. This can normally be performed via keyhole surgery and a return to sport would be expected in the vast majority of cases.

At City Physio you can expect us to perform a thorough examination of your ankle and to help you undertake an appropriate course of action. If your ankle requires help beyond physiotherapy we will be able to arrange follow up care with local specialists who have an interest in the foot and ankle.

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