Ankle Pain, Injuries & Physiotherapy Treatments

The ankle or talocrural joint is a modified hinge joint made up of the talus which is the bone in the top of the foot that moves between the medial and lateral malleoli. These are the prominent bones you can see on the inside and outside of the ankle. The outside or lateral malleolus is a prominence at the end of the fibula and the medial (inside) malleolus is part of the tibia or shin bone.

Ligaments on the inside and outside stabilise the joint and allow stretch and movement so your ankle can adapt to movement-over rough ground for example.

In reality the ankle does not work in isolation but with the other joints of the heel and foot which allow flexibility and mobility of the whole foot/ankle complex.

However there are some specific and common injuries to the ankle joint.

Inversion Sprain (Sprained or Twisted Ankle)

When your ankle collapses outward due to a fall or stepping awkwardly
As the ankle collapses out it can stretch or tear the outside ligaments of the ankle. There are 3 grades to the injury:

Grade 1: A few ligament fibres are stretched or torn
Symptoms: Pain, some difficulty walking. The joint may swell after a while.

Grade 2: A greater number of fibres are torn
Symptoms: More severe pain, difficulty putting weight on the foot. Fairly rapid swelling.

Grade 3: Complete tear or rupture of many if not all of the ligament fibres.

Symptoms: Severe pain (enough to make you feel sick!), unable to bear weight at all, immediate swelling, often bleeding or bruising under the skin which may be extensive.
Sometimes instead of the ligament tearing it actually pulls off the end of the bone in the ankle (Avulsion fracture). This requires an x-ray to diagnose and may result in a plaster cast being applied.
The ankle can on rare occasions twist the other way and affect the inside ligaments. The symptoms and treatments are similar as those already discussed.

Physiotherapy Treatment For A Sprained Ankle

Immediate first aid includes ice and avoiding walking on the ankle. If there is a suspected fracture then a trip to A& E is required.
Then depending on the severity of the injury, ankle physiotherapy aims to:

Initially reduce the pain and swelling using ultrasound, frictions (a specialist massage technique that optimises the healing of the ligament), special exercises and stretches for you to do to keep the ankle mobile but allow healing to take place.
Provide support to the joint while it heals using a brace or taping techniques. You may need a stick or elbow crutches.
Assess whether there has been damage to any other structures in the ankle or foot and treat accordingly
Rehabilitate the joint to regain the balance mechanisms (proprioception) using balance exercises and to strengthen the muscles around the ankle.
Finally to ascertain whether there are any factors that makes this injury more likely again in the future and addresses those. This may anything from poor footwear to the structure of an individual’s foot and the way they walk.

Everybody’s lower limb and foot anatomy is different and certain traits can make this type of injury more likely. Also once it has happened once, without the proper rehabilitation it is much more likely to recur so treatment is vital-especially with the more severe injuries.

Broken Ankle

A broken ankle simply means that one or some of the bones in the ankle, the tibia, talus or malleoli have cracked or fractured. The severity of this as an injury varies from a simple fracture that will do well after a few weeks in plaster to injuries that require extensive surgery and fixation (often using plates and screws)
If you suspect you have a break then an immediate x-ray and diagnosis is vital.
Symptoms:

Immediate pain especially when trying to move the joint
Unable to weight bear or walk
The joint may appear deformed-the foot may be at an odd angle
Immediate swelling

The joint will be immobilised by the hospital in a cast for a few weeks to allow the bones to heal.

Physiotherapy Treatment For A Broken Ankle

Even while the ankle is in a cast there are lots we can do to keep other parts of the body flexible and strong. This will optimise your rehabilitation when the cast is removed
Once the fracture is stable and the cast is off the ankle will be VERY stiff. Treatment aims at increasing the ankle’s mobility and building the muscle strength around the joint
Techniques to reduce pain: massage, joint mobilisations, acupuncture.
Retrain the body to walk and run properly (the body can very quickly forget how to walk properly after an injury like this!)
Retrain the balance mechanisms (proprioception) within the joint which will be reduced after injury so making re-occurrence more likely if not addressed.

There are many other problems in the foot and ankle that can cause pain and weakness. The ankle/foot structure is very complex and pain in the ankle may even be caused by a back problem. A full physiotherapy assessment is therefore essential to work out the causes and then be able to treat them successfully
The advantages of having physiotherapy for any ankle pain or injury are:

An accurate diagnosis so we can understand and treat the problem

To speed up healing and recovery
To reduce pain
To help prevent recurrences
To address any issues of the foot or ankle that make this injury more likely
To regain better movement and function and more quickly