Ankle Conditions

How are ankles injured?

Ankles are usually injured in sporting trauma where there is a requirement for jumping and landing, dodging, body contact and tackling or participation on uneven or unpredictable surfaces. The usual mechanism is the foot giving way under body weight and twisting beyond the normal physiological limit of the joint and ligamentous restraints. Because of the anatomy of the ankle joint, by far the most common injuring force is inversion (inward tipping of the foot). This will lead to a stretch injury to the lateral ligaments and compression injury to the medial side of the ankle. Depending on the force, it may be sufficient to cause damage to the joint surface cartilage. If severe enough, the ankle bones may fracture and/or dislocate. Medial ligament tears are less common because of the size and strength of the ligament. However, if injured, a medial ligament tear can be devastating and require much more time, treatment and often surgery to restore stability to the joint. There are a large number of other injuries and conditions that affect the ankle joint, and these are often sport-specific, e.g. anterior and posterior impingement in football, fractures in motocross riding.

How are ligament tears graded?

  • Grade 1 – minor tear or sprain; ligament still intact
  • Grade 2 – partial tear resulting in moderate to major laxity.
  • Grade 3 – complete rupture of ligaments

How are ligament tears treated in the early stages?

Initial treatment of ligament tears in the ankle:

  • RICE = rest, ice compression, elevation for 48 hours
  • No HARM = heat, alcohol, running, and massage

Disciplined early management of a ligament injury can make a big difference to the length and success of rehabilitation.

How are injured ankles rehabilitated?

Rehabilitation requires avoidance of the injuring force while the ligament heals. Braces are preferable for grade 2+ – 3 tears. Mobilisation and stretches are required to restore normal ankle mobility, particularly into dorsiflexion (squatting/lunging motion). Balance or proprioceptive exercises are essential to restore brain-muscle coordination and provide dynamic stability to the joint. Strapping or bracing may be required to facilitate return to sport. Surgery is required for reconstruction where there is severe or recurrent instability, or cartilage damage; rehabilitation is essential to optimise the surgical result.

What non-traumatic ankle conditions affect the ankle?

Non-traumatic conditions are usually as result of faulty biomechanics, eg. flat feet, pronated ankle, tibial alignment problems (knock-knees, bow-leg). Weight bearing on the ankle joint while it is out of ideal alignment will place adverse and undesirable forces across the joint, which if sustained will extra demand on other structures to compensate, or cause premature degenerative changes, as well as pain and restriction of activity. Comprehensive examination to permit correction of faulty mechanics is the key to this problem, which often includes prescription orthotics and exercises.