Due to our modern lifestyle and activities, stress on the body and ankle pain is almost inevitable in some individuals. We’ll go on to explore why and how this occurs throughout our article. We’ll also equip you with the essential tools you’ll need to cure your ankle pain and return to the activities you love! But, firstly, let’s establish a little basic theory to help you develop a fuller understanding of the issue at hand.
The Ankle Joint
In its entirety, the ankle joint is made up of three bones. These are the following:
- The front bone known as the Tibia or shin bone.
- The small bone on the outside known as the Fibula.
- Then we have the Talus, which sits above the calcaneus (heel bone).
The ankle joint is a synovial hinge joint, which means that it only allows forward & backwards motions. This is a design mechanism that provides superb stability to the ankle. A great way to picture this in action would be to lookup a mortise and tenon joint, which is commonly used in woodworking to tremendous effect because of its flush fitting design.
Every synovial joint has a capsule that surrounds the whole joint. The capsule is thin anteriorly (front) & posteriorly (back), thus, allowing the forwards & backwards motion of the ankle. In medical speak, this is commonly known as flexion & extension.
Ligaments of the Ankle
The ankle lateral ligaments consist of the anterior talofibula ligament, the posterior talocalcanean ligament and the calcaneofibular ligament. To put it simply, ligaments attach bones to bones, whereas tendons attach muscles to bone.
Needless to say, perhaps, but at ATLPhysio we come across plenty of ankle injuries! Therefore, we can tell you with some certainty, that the calcaneo ligament is the ligament mostly sprained during injury to the ankle.
Finally, the Deltoid ligament adds stability to the inside of the ankle. Its tough fibres are thick and the ligament is larger than those on the outer aspect of the ankle.
Stability of the Ankle
If a side rolling movement of the ankle happens, then the stability of the ankle can be compromised, and the end result can often be a sprained ankle.
Also, if the force is strong enough, then it is possible that the lateral ligament stays intact but results in a chip of the bone, as it is pulled off the Fibular. This is commonly known as an avulsion fracture.
If this happens, then the individual finds putting any weight through the foot extremely painful. It is unlikely that the individual is able to walk, and only with help.
When a person sprains an ankle, most can bare to put the foot to the floor and walk. With an avulsion fracture, however, this will not be tolerated (unless you’re thinking of auditioning for the next Terminator film!) Additionally, an avulsion fracture would only be diagnosed through an X-Ray.
Types of Ankle Pain
The most common injuries are:
This is where soft tissue, as in the ligaments, are injured. The best way to treat a lateral ankle sprain is a short distance below this section on the page. Always remember that proper care, guidance & rehabilitation are the key factors for a comfortable speedy recovery.
These can happen in the same way that we mentioned earlier, when describing the avulsion fracture of the fibular. Also, fractures of the medial malleolus can occur, as well as both medial and lateral malleoli.
This is not as common as in, say, the hip joint or the knee. Whilst I have treated many arthritic hips, knees and also replacement hips and knees, I have only treated two ankle replacements in over 30 years.
In this instance, crystals appear in the ankle joint, causing severe pain. It is most common in the great toe, which results in it becoming red, swollen and painful.
There are other several other conditions, but these are very rare in the ankle and not the primary purpose of this article.
Sprains and Strains
A sprain is where one or more of the ligaments of the ankle are partially or completely torn.
The lateral ligaments of the ankle are the anterior talo-fibular ligament (ATFL), the calcaneo-fibular ligament (CFL) and the posterior talo-fibular ligament (PTFL).
Lateral ligament injuries are perhaps one of the most common sports-related injuries seen by myself in the physiotherapy department.
In my experience, they usually occur as a result of a forced plantarflexion/ inversion movement; the complex of ligaments on the lateral side of the ankle being torn by varying degrees.
Rest assured, the ankle sprain is a relatively benign injury, but do keep in mind that inadequate rehabilitation can lead to prolonged pain and discomfort. Therefore, make every effort to be consistent in your application of the treatment program we recommend to you in this article.
Sprains and strains are very common injuries affecting the muscles and ligaments and you’ll be pleased to discover that most can be treated at home without seeing a doctor.
The best way to treat a lateral ankle sprain yourself
For the first 24 to 48 hours you will need to follow these four steps to ensure a better faster recovery. This method is a tried & tested way to treat an acute ankle sprain.
It is known as RICE:
Stop any exercise or activities and try not to put too much weight on the injured ankle.
Apply an ice pack (a bag of frozen peas wrapped in a tea towel) makes a great ice pack because you can mould the bag around the contours of the ankle. I recommend a 20/25 minute application every 3 hours.
This can be done by wrapping a support bandage around the ankle to give it support. It will also make the ankle feel more comfortable and stable.
Raise and support the foot higher than your shoulders, if possible, for 20 minutes every few hours. Otherwise, rest the leg slightly higher than your waist and keep it supported.
These stages depend on the severity of the ankle sprain, which I will explain later.
The most important thing in the early stage of your injury is the ice treatment, as this helps prevent swelling and acts like a mild analgesia, thus reducing the pain.
Contrary to popular belief, in all circumstances, avoid heat, hot and cold treatment, hot packs or soaking in the bath! Also avoid stretching and massages, certainly for the first 2/3 days post injury.
When your ankle pain and swelling goes down, keep the ankle mobile. You might find walking flat footed more comfortable as it reduces the amount of pressure put on the ankle.
Symptoms of a Sprained Ankle
Signs and symptoms of a sprained ankle can and do vary depending on the severity of the injury. They may include:
- Pain from weight bearing on the injured ankle, or even without.
- Throbbing or pulsing sensation.
- Bruising a few days later around the injured ankle, across the toes and even on the inside of the ankle.
- Restricted range of motion
- The feeling of instability in the ankle
- You may have heard a popping sound or sensation at the time of the injury.
1 to 3 days: Post injury is RICE (see section above).
3 days to 2 weeks: Individuals will recover at different times, but the aim is to recover and restore active range of motion. Gradually increase weight onto the ankle as pain allows, as this minimises the risk of re-injuring your ankle and slowly strengthens the muscles. You might find your balance affected too! Again, this will depend on the severity of your injury.
Begin these next exercises after 3 days
a) Ankle pumps in long sitting: Sitting on the floor with your legs out straight.
Briskly, as pain allows, push your toes, foot and ankle forwards and backwards.
Complete 3 sets of 30 repetitions (15 each foot), allowing a short rest between each set.
b) Sitting in a chair: keeping the toes on the floor raise and lower your heels. Do this with alternate feet or both together.
Complete 3 sets of 30 repetitions, allowing a short rest between each set.
c) Sitting on the floor: put your legs out straight. You will need a belt, towel or exercise band.
Put the belt, towel or band around your foot and gently pull backwards until you feel a stretch in your calf muscle. Hold the position for 10 seconds, then let the ankle and foot relax. Repeat on the other foot.
Repeat on each foot x 10
Do the exercises as quick or as slowly as you feel comfortable with and repeat the exercises 2/3 times a day.
Don’t get despondent during your rehabilitation. We completely understand how frustrating it can be to be cruelly taken away from the activities that you love, but it’s important to remember that soft tissue takes time to heal. Ligaments take longer than other soft tissue, so you do not want to aggravate or overuse the ankle in the early days.
Complete these next exercises during the period of weeks 2-4, post injury.
There may be some cross over with days, here, as individuals will recover at different times, but we would always lean in favor of caution.
My advice is to be conservative in your approach because what you don’t want is a recurrent injury.
a) Stand up and use a chair, table or worktop for support and balance. Keep the feet flat on the floor and bend your knee 30/40 degrees, only as pain or discomfort allows, then straighten your legs.
You can do this exercise for 30 seconds, then stop for 30 seconds, repeating 3 times.
b) Stand up (using a chair, as in the exercise above) on your toes and raise your heels as far as comfortable, then lower. You can do this exercise slowly or fast as pain or discomfort allows.
Complete 3 sets of 10 repetitions.
c) Stand with one foot in front of the other and imagine you are standing on a rope or walking on a line. Do this along the side of a wall or work surface in case you lose your balance. Walk the length of a room or corridor several times.
d) Stand up, as in exercises “a” and “b”. Bend your knees 30/40 degrees, then straighten your legs and raise up on your toes, then lower yourself. This is a combination of “a” and “b” exercises.
Again, you can do this exercise quickly or slowly as pain allows.
Complete 3 sets of 10 repetitions.
As we come into the final section of the rehabilitation, there should have been a significant reduction in pain, but you may have some residual bruising around the ankle or toes. However, walking should feel comfortable, which means your body has achieved a good rate of progress during your rehabilitation.
Complete these next exercises during weeks 4-8
During this stage, you will be going from graded, controlled, resisted exercises to a much more active form of exercise, introducing light impact to medium impact exercises and training.
a) You can start by doing one of the exercises from weeks 2 to 4 as a warm up exercise.
b) Standing straight, lift one leg by bending your knee keeping your balance.
Lift your leg only a short distance from the floor to begin and hold it up for 5 seconds. As your balance improves, then lift your knee higher.
Repeat each leg 10 times.
c) Using a chair, table or work top stand for support, stand on one leg, then raise up on the other on to your toes.
Complete 3 sets of 10 repetition each leg. (This gives the injured ankle resting time.)
d) Standing, keeping your toes on the floor, raise one heel off the floor by bending the same leg, then lower & immediately change legs.
This is like jogging without losing contact with the floor. This exercise can be done quickly or slowly and you should have minimal discomfort at this stage.
This exercise can be done for 1 minute or 2 minutes at a time with 10 seconds rest and can be repeated up to 5 times.
e) Standing, walk the length of a room or corridor on your toes. Turn around and walk back on your heels.
Repeat 10 times or as many as you feel comfortable. You could also try walking 10 steps at a time.
f) When approaching the 6 to 8 week stage, I like to incorporate light jogging on the spot, mini hoping, trampette jumping and skipping exercises.
The natural progression on from this would be a return to your sport or activities.
At any stage, you might wish to visit your GP or physiotherapist or feel confident enough to start going back to the gymnasium under the guidance of an instructor or physio.