Physiotherapy Guidance on Management of Ankle Injuries

What is Physiotherapy and how can it help your Ankle pain?

Physiotherapists are experts in helping people maintain the ability to move and function throughout their lives. We use our extensive knowledge of how the body moves and what prevents the body from moving well and use this knowledge to help people of all ages to improve their wellness, mobility and independence. Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice.

Physiotherapy is a science-based profession and in its approach, considers the ‘whole person’, which includes the patient’s general lifestyle. We encourage patient’s involvement in their own care, through empowerment and participation in their treatment.

Anatomy of the Ankle Joints

The ankle joint is a complex mechanism comprising two joints.  The joint that enables the up and down motion of the foot is called the Talocural joint and is composed of the Tibia (shin bone) the Fibula (smaller bone on the outside of the lower leg) and the Talus of the foot underneath. The second joint, the subtalar joint, comprises the Talus on top and the calcaneus (heel bone) underneath and allows the foot to rock side to side. The ankle joint is supported by a joint capsule, a tough fibrous envelope and strong band like ligaments on either side. Muscles and the tendons that attach either side of the ankle and foot, play an important role in combination with the ligaments in balance senses and stabilizing the joints.

Why do I have Ankle pain? Ankle injuries are very common and can happen to anyone at any time in their life. Sprains, strains and fractures are amongst the most frequently occurring injuries, tendonitis and overuse injuries are also problematic.

  • Fracture – A fracture describes a break in one or more of the bones.  Fractures will usually be managed in a cast with or without the need for surgery, depending on the type and stability of the fracture. Physiotherapy is normally required after the cast is removed to restore full range of movement, strength and normal walking patterns.
  • Sprain – A sprain results from a tear in one or more of the ankle ligaments.  A tear can range from microscopic to full rupture. The lateral (outside) ligaments are most susceptible to sprains, usually as a result of rolling onto the outside of the foot.  Pain, bruising, swelling and an inability to weight bear are common consequences of such an injury. Ligaments usually take 6-8 weeks to settle, symptoms persisting beyond this time frame should be checked with a GP or Physiotherapist.
  • Strain – Strains occur when muscles and tendons are stretched beyond their capabilities. Often, strains and sprains come hand in hand when the joint is stretched beyond its normal limits.
  • Tendonitis  The tendons that connect muscle to bone can become inflamed from repetitive overuse and being overstretched, resulting in micro tears that accumulate over time. Rest from repetitive, exacerbating activities and application of ice (10 minutes at least 3 times daily) can help to reduce symptoms. Physiotherapy can help to treat and establish the cause of tendonitis, to prevent future episodes occurring.

How should you treat your injury?

The advice for any acute injury (first 48 – 72 hours) is P.R.I.C.E.
Protection – protect from further injury with a support or bandage.

REST – You must rest following an injury.  The principle of this is to allow the tissues to heal without further stress being applied on them.  If you are unable to weight bear, seek medical advice on use of walking aids such as crutches.

ICE – It is important that you control the swelling.  Swelling is part of the natural healing process, however you can prevent excessive swelling and therefore stiffness with regular application of ice.  An ice pack should be applied 10-15 minutes at least 3-4 times daily in the first few days after injury.  Protect your skin from ice burns by using a damp towel around the ice pack.

COMPRESSION – After removing the ice pack a compression bandage should be applied to minimise swelling.  A tubigrip bandage is commonly used.  Be careful that you use the correct size bandage so not to impede circulation.

ELEVATION – Elevation is the last component of the P.R.I.C.E principal.  Immediately after injury, the limb must be elevated above the level of the hip, this is to reduce blood flow to the affected area.  This can be achieved with lying down and placing the foot on a pillow.

Note: Suspected fractures should be seen by an Emergency Physician. For injuries that have persisted for more than 4-6 weeks, it is advised that you consult the advice of your GP or a Physiotherapist.

What exercises can I do?

Following an injury to the ankle, it is very important to maintain the range of movement.  Below are some exercises that will help you to maintain and improve movement in all directions.