Ankle Sprains
Ankle sprains are one of the most common injuries treated by physiotherapists. They typically involve stretching or tearing of the ligaments that support the ankle joint.
What causes a sprained ankle?
An ankle sprain can be caused by abnormal or excessive joint motion. Many ligaments to provide stability support the ankle joint and a sprain can occur in almost any direction depending on the injury! The most common type of ankle sprain is on the outside of the ankle, and usually caused by rolling on the side of the foot.
What are the symptoms of an ankle sprain?
Symptoms of an ankle injury can vary and are dependent on the grade of ligament sprain. For example a grade 1 ligament sprain can appear quite mild with only some tenderness to touch and minimal swelling. If you sustain a grade 3 injury, you may present with lots of swelling, an inability to weight bear and instability at the ankle.
Early Treatment for Sprained Ankles
During the early stages after an ankle sprain (depending on the grade), there may be a period of rest, icing, compression, elevation and minimal weight bearing to manage swelling, with some gentle movement exercises to maintain range. Your physiotherapist will guide you on when it is safe to start increasing mobility, strength, functional gait, balance and stability, and may begin some gentle mobilizations to the ankle joint to reduce stiffness.
Once general function has improved along with strength, your physiotherapist will support with sport specific exercises; this will usually be around 8 weeks depending on the presenting injury.
It is common to have reoccurring injury to the ankle after initial sprain, even years down the line. It is worth having a conversation with your Physiotherapist about appropriate footwear, return to sporting activities and an ongoing rehab program to maintain ankle strength so you can continue to enjoy the sports that you love!
What to do if you have a sprained ankle:
-
Early Management: Using the RICE protocol (Rest, Ice, Compression, Elevation) to reduce swelling and pain.
-
Range of Motion Exercises: Gentle ankle movements to maintain or restore joint flexibility.
-
Strength Training: Progressive exercises to strengthen muscles around the ankle, especially the peroneals and calf muscles, to stabilize the joint.
-
Proprioception and Balance Exercises: Activities such as standing on one leg or using balance boards to improve proprioception and prevent future sprains.
-
Taping or Bracing: Sometimes used initially to provide support and stability during the healing phase.
-
Gradual Return to Activity: A structured plan to reintroduce activities and sports, starting with low-impact exercises and progressing as the ankle strengthens.
Ankle Fractures
OK, so you fell and twisted your ankle while doing a hike or playing soccer, and now your foot swelled up like a balloon. You find out you have an ankle fracture and you’re sidelined for 4-6 weeks in a cast. After a while, the doctor informs you the bone is healed, you’re good to go! You get the cast removed, but you realize your calf is shriveled up and tiny compared to the other side. Even worse, it hurts to move your foot, your ankle feels weak, you can’t even put weight on your foot, now what?! Don’t worry, this is normal and VanCity Physio can help... we’ll get you back up on that trail or field in no time. Keep reading…
What is an ankle fracture?
A broken ankle, also referred to as an ankle fracture, is typically a break in the distal fibula or tibia bone at the ankle joint, which are the bones located in the lower leg on the outside and inside respectively. Ankle fractures typically occur from falls that involve twisting of the foot, awkward landings, and contact sports injuries. Ankle fractures can range from being simple to complex, whether it be just an isolated medial or lateral malleolus fracture or an ankle dislocation with a bi/trimalleolar fracture.
How do I know if I broke my ankle? Should I get an x-ray?
Maybe you stumbled upon this article because you just hurt your ankle and you’re trying to decide if you should seek medical attention or not. Well, you’ve come to the right place! This is a really good question, so good that researchers decided to figure out who should and who shouldn’t get x-rays to save the health care system some money. The Ottawa Ankle Rules concluded the following ankle x-ray screening questions…
- Can you take 4 steps (it is okay if you need to limp)? NO? –> GET AN X-RAY
- Do you have tenderness/pain around your medial or lateral malleoli (the little bone bumps on either side of your ankle)? Specifically, the backside of the bones? YES? –> GET AN X-RAY
In regards to if you possibly have a bone fracture in your foot…
- Do you have tenderness/pain around the base of the 5th metatarsal (bump on the lateral/outside portion of your foot; halfway between your heel and your little toe)? YES? –> GET AN X-RAY
- Do you have tenderness/pain around the navicular bone (bump on the medial/inside portion of your foot?) YES> –> GET AN X-RAY
So I broke my ankle. Now what?
It sucks to be stuck in a cast for 4-6 weeks. However, that doesn’t mean you have to be completely sedentary. Now we aren’t saying you have to lift weights and use cardio equipment with only one leg, but don’t just sit on your butt on the couch for a month! Technically, you can still do upper body exercises and even train your other leg.
Moreover, our foot/ankle is influenced by our kinetic chain, meaning the joints, muscles, and body regions above it! We always preach that it is important to treat the entire body part, not sure the body part that was injured. Exercising on some proximal musculature and joints, including our knees and hips for example can help optimize post-operative outcomes!
Exercises to Help a Fractured Ankle
With your average non-complicated ankle fracture, a gentle introduction to range of motion exercises in every direction is exactly what your ankle wants and needs.
1. Ankle Pumps
Ankle pumps are a great exercise to start immediately to reduce swelling as well as promote the early range of motion. Mike is using a plinth to elevate his leg in this video; however, at home you can use pillows underneath your foot to elevate it!
2. Ankle Alphabets
With this exercise, early on after the surgery, your full range of motion will not be what it used to be. Do NOT be discouraged! What is important is to avoid compensation early on. For instance, one big compensation we see is individuals will move their hip joint into the internal and external rotation when trying to perform active inversion and aversion of the foot/ankle complex. Really focus on JUST using your foot/ankle joints and avoiding compensatory movements up the chain. Do not fear, movement will come with time!
How Physiotherapy Helps Ankle Fractures
Ankle fractures can vary in severity from stable fractures that can be managed conservatively to more complex fractures requiring surgery. Physiotherapy aims to:
-
Post-operative Rehabilitation: After surgery, physiotherapy helps manage pain and swelling, regain range of motion, and prevent stiffness.
-
Weight-Bearing Progression: Gradual introduction of weight-bearing exercises to promote bone healing and restore normal gait.
-
Strength and Stability Exercises: Specific exercises to rebuild strength in the ankle and lower leg muscles, which may have weakened due to immobilization.
-
Functional Training: Incorporating activities that mimic daily tasks or specific sports movements to ensure the ankle can handle functional demands.
-
Education on Assistive Devices: Teaching how to use crutches or walkers if needed, and transitioning to normal walking as appropriate.
Other Common Ankle Injuries
Chronic Ankle Instability
Chronic ankle instability often develops after repeated ankle sprains or inadequate rehabilitation. Physiotherapy focuses on:
-
Identifying Underlying Causes: Assessing contributing factors such as muscle weakness, poor proprioception, or biomechanical issues.
-
Neuromuscular Training: Exercises to enhance muscle reaction times and improve joint stability during dynamic movements.
-
Manual Therapy: Techniques such as joint mobilizations or soft tissue techniques to address any lingering stiffness or restrictions.
-
Sport-Specific Rehabilitation: Tailored programs for athletes to safely return to sport, addressing the unique demands of their activity.
-
Bracing or Orthotics: Recommending supportive devices or orthotics to provide additional stability and reduce the risk of re-injury.
Achilles Tendon Injuries
Injuries to the Achilles tendon, such as tendinopathy or ruptures, require specialized physiotherapy approaches:
-
Eccentric Strengthening: Eccentric exercises to gradually load and strengthen the Achilles tendon, promoting healing and reducing the risk of re-injury.
-
Stretching and Flexibility: Gentle stretching to maintain or improve tendon flexibility and reduce stiffness.
-
Gait Analysis: Assessing walking and running patterns to identify any abnormalities that may contribute to tendon stress.
-
Gradual Return to Activity: Progressive loading of the tendon through activities like hopping or running drills, under the guidance of a physiotherapist.
-
Modalities: Use of modalities such as ultrasound or laser therapy to aid in tendon healing and pain management.
Posterior Tibialis Dysfunction
This condition involves dysfunction of the posterior tibialis tendon, which supports the arch of the foot. Physiotherapy focuses on:
-
Foot and Ankle Strengthening: Exercises targeting the posterior tibialis and other foot intrinsic muscles to improve arch support and stability.
-
Orthotic Management: Recommending appropriate orthotics or shoe modifications to support the arch and alleviate strain on the tendon.
-
Gait Re-education: Correcting walking patterns to reduce stress on the tendon and improve overall foot mechanics.
-
Manual Therapy: Hands-on techniques to address any joint stiffness or muscle tightness contributing to the dysfunction.
-
Activity Modification: Advising on modifications to activities or sports to prevent exacerbation of symptoms while the tendon heals.
Physiotherapy for ankle injuries is always tailored to the individual's specific condition, rehabilitation stage, and functional goals. It's essential to undergo rehabilitation under the guidance of a qualified physiotherapist to ensure a safe and effective recovery process.
