Sports Medicine
Sports Injury Prevention & Rehabilitation

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Ankle Injuries

Pain and injury information are provided for informational purposes only. We recommend consulting a doctor or medical professional if you are in pain, or before performing any rehabilitation, stretching, or strengthening exercises.

Common causes of ankle pain
Patients suffering from ankle pain are commonly seen in our rehabilitation practice. Pain is usually caused by local structures within or around the ankle, however in rare cases, pain may be referred from other sources (such as the lower back).
The most common mechanism of injury in patients suffering from ankle pain is a 'rolled ankle'. This is typically due to an inversion movement whereby the foot and ankle turn inwards relative to the lower leg. In these instances, damage to the lateral ligament of the ankle most commonly occurs (see Sprained Ankle (Lateral Ligament)). However, other structures may also be involved such as the shock absorbing cartilage within the ankle joint, peroneal muscles or local bones (i.e. a fracture).
In patients with a history of a 'rolled ankle' following an eversion movement whereby the foot and ankle turn outwards relative to the lower leg, the medial ligament of the ankle is most commonly damaged (see Sprained Ankle (Medial Ligament)). If weight bearing or compressive forces were involved at the time of injury, damage to the cartilage and / or bone within the ankle joint may occur (Osteochondral Lesion of the Talar Dome).
It is also relatively common for patients to present to the therapist with ankle pain that has developed gradually and can not be related to a specific incident. In these instances, several structures may be implicated. Some of the most commonly affected structures include damage to local tendons (tendinitis or tendinopathy), damage to cartilage within the ankle joint and local soft tissue inflammation.
The most common causes of ankle pain of gradual onset located at the inner aspect of the ankle include Tibialis Posterior Tendinitis (Tendinopathy) and Flexor Hallucis Longus Tendinitis (Tendinopathy). Patients suffering from outer ankle pain that is of gradual onset is frequently caused by either Peroneal Tendinitis (Tendinopathy) or Sinus Tarsi Syndrome. Wile pain that has developed gradually at the front of the ankle is often due to either Tibialis Anterior Tendinitis (Tendinopathy), or Anterior Impingement of the Ankle.

Signs and symptoms of ankle pain
Patients with ankle pain that is of a sudden onset (such as a sprained ankle) may notice an audible snap or tearing sound at the time of injury. The patient may be unable to weight bear at the time of injury due to pain and may develop bruising, swelling and stiffness over the coming days. Pain is usually present on firmly touching the affected tissue. In patients with minor injuries, few symptoms may be present.
Patients with ankle pain that is of a gradual onset and can not be related to a specific incident may only present with pain that increases with rest after activity (e.g. at night or first thing in the morning). In more severe cases, pain may increase during activity and affect performance. Patients will frequently experience pain on firmly touching the affect tissue.

Diagnosis of ankle pain
A thorough subjective and objective examination from a doctor is usually sufficient to diagnose the cause of ankle pain. Investigations such as an X-ray, MRI or CT scan are often required to confirm diagnosis and rule out other injuries (particularly fractures).

Treatment of ankle pain
The vast majority of patients with ankle pain heal well with appropriate therapy. A thorough assessment and diagnosis by a doctor is essential as treatment is dependent on the specific cause of symptoms.
The success rate of treatment in patients suffering from ankle pain is largely dictated by patient compliance. One of the important principles of treatment is that the patient allows their body to heal naturally by avoiding activities that further damage the affected tissue. Patients can determine if an activity damages or aggravates their condition based on their symptoms. Generally an activity aggravates the condition if:
  1. Pain increases during that activity OR
  2. Pain increases upon rest after that activity OR
  3. Pain increases the morning after that activity.
It is therefore vital that patients rest from ANY activity that increases their pain during activity, after activity or the following morning.
Treatment of injuries in the first 48 – 72 hours is vital to reduce bleeding, swelling and inflammation. This should involve following RICE, which comprises of rest from aggravating activities (crutches are often required), regular icing, the use of a compression bandage and elevation of the affected limb. Anti-inflammatory medication may also be useful in this initial phase of injury.
It is also important for patients to perform movement, strength and balance exercises at the appropriate time in the rehabilitation process to prevent stiffness, weakness and instability from developing and to ensure the ankle is functioning correctly. The treating physiotherapist can advise which exercises are appropriate and when they should be commenced. A gradual return to activity should occur as guided by the treating physiotherapist taking into account injury healing times.

Physical therapy for ankle pain
Physical therapy is strongly recommended for all patients who suffer from ankle pain as inadequate rehabilitation can result in a poor outcome with a high likelihood of re-injury. Physical therapy can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint mobilization
  • taping or bracing
  • ice or heat treatment
  • exercises to improve flexibility, strength and balance
  • education
  • activity modification advice
  • crutches prescription
  • biomechanical correction
  • a gradual return to activity program
Other intervention for ankle pain
Despite appropriate physical therapy management, a small percentage of patients do not improve adequately or have serious injuries which require other intervention (such as fractures). When this occurs the treating therapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, pharmaceutical intervention, corticosteroid injection, or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. Occasionally, surgery or plaster cast immobilization of the ankle may be required. This most commonly occurs in the case of fractures or severe soft tissue injuries where conservative measures fail.