Ankle Injuries

We can help with all ankle issues, mild or severe.

The ankle is comprised of three main bones: the talus (from the foot), the fibula and tibia (from the lower leg). The three bones together form a mortise (on the top of the talus), as well as two joint areas (on the inside and outside of the ankle), sometimes called the "gutters." The ankle is surrounded by a capsule, as well as tissue (the synovium) that feed it blood and oxygen. Some of the more important structures that hold the ankle together are the ankle ligaments.

Ankle injuries can be deliberating, seriously affecting quality of life, literally stopping you in your tracks. Injuries can cause pain, sometimes but not always swelling in the ankle joint. Pain on movement of the ankle can be continual or intermittent. Often sharp intermittent pain that “catches you”  can seems to appear from nowhere while walking.

Ankle injury can occur when one rolls over a rock, lands off a curb, or steps in a small hole or crack in the road. Usually the sprain is only mild, but on occasion it may seriously injure the ligaments or tendons surrounding the ankle joint.

Most ankle sprains involving the ligaments are weight bearing injuries. When a foot rolls outward (supinates) and the front of the foot points downwards as he or she lands on the ground, lateral ankle sprain can be a result.

It is usually this situation that causes injury to the anterior talo-fibular ligament. However, when the foot rolls inwards (pronates) and the forefoot turns outward (abducts), the ankle is subject to an injury involving the deltoid ligament that supports the outside of the ankle.

When assessing an ankle sprain we will want to know the mechanism of injury and history of previous ankle sprains. Where the foot was located at the time of injury, "popping" sensations, whether you can put weight on the ankle are all important questions needing an answer. If past ankle sprains are part of the history, for example, a new acute ankle sprain can have a significant impact.

The physical examination should confirm the suspected diagnosis, based on the history of the injury. We look for any obvious deformities of the ankle or foot, black and blue discoloration, swelling, or disruption of the skin. When crackling, extreme swelling and tenderness are present, together with a limited range of motion, we may suspect a fracture of the ankle. A feeling of disruption on either the inside or the outside of the ankle may indicate a rupture of one of the ankle ligaments.

To check for ankle instability, you should be evaluated while weight bearing. Manual muscle testing is also valuable when checking for ankle instability. One of the more critical tests that you should be able to perform before allowing resumption of activity is a "single toe raise" test. If you is unable to do this, we might suspect ligamentous injury or ankle instability.

Certain “stress tests’ examine the strength or congruity of the various ligamentous structures within or surrounding the Ankle joint, these are perform utilising local anaesthesia.

X-rays help but do not rule out fractures,  degenerative joint disease, osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage (arthritis). MRI and CT can also often miss these types or lesions. Stress X-rays are taken when ligamentous rupture or ankle instability is suspected.

A diagnostic local anaesthetic block, isolating the ankle joint or the affected area is useful to diagnose the injury, it is also useful to rule out damage or injury to the Subtalar joint that is positioned just below the Ankle joint and can be overlooked when diagnosing this type of injury.

In the past, more commonly, ankle arthrography has been used. This involved injecting a dye into the ankle joint as it is X-rayed. It helped determine if a rupture of a ligament or tear of the ankle capsule has occurred. However, this procedure did involve some discomfort during the injection process, and, on rare occasions, an allergy to the dye occurred.

Management of this injury relies on early and accurate diagnosis.

Once a diagnosis is confirmed, treatment of an acute low grade ankle injury usually begins with an aggressive physical therapy program that controls early pain and inflammation, protects the ankle joint while in motion, re-strengthens the muscles, and re-educates the sensory receptors to achieve complete functional return to running activity.

Resumption of running activity is usually dependent on the runner's limits of pain and motion, and is begun to tolerance. As the runner improves, diagonal running can be prescribed. It is important to protect the runner with braces such as air casts, ankle braces, etc., which help to allow motion at the ankle joint under weight-bearing.

Home exercise programs are very helpful for the post-ankle sprain runner. Proprioception re-education is critical for both the acute as well as the chronic ankle sprain. It may involve using a simple tilt board or more sophisticated proprioceptive training and testing devices.

For severe acute grade III lateral ankle sprain, or complete deltoid tear, complete immobilization is usually recommended for at least four weeks. Afterwards, a removable cast is used to restrict motion and allow for physical therapy. If the ankle does not respond and ankle instability is diagnosed, surgical intervention may be required.

Degenerative changes at the may also require surgical intervention.

Today, ankle arthroscopy - a much less invasive procedure than other surgery - allows the ligament to be repaired and if necessary stabilized with tissue anchors. Endoscopic technique can also repair osteochondral defects (OCD) or osteochondral lesions of the Ankle.  This eliminates an extended period of immobilization, joint stiffness and muscle atrophy. Post-operatively, this primary ligament repair is protected for approximately a two to three week period of time in either a cast or removable cast boot, with daily-continued passive motion, cold therapy, and controlled exercise.

At three weeks, a simple air cast or ankle brace is applied for an additional three weeks while therapy and rehabilitation is progressing. At six weeks, these devices are used only during running and other athletic activity as a safeguard. As the runner resumes strength and proprioceptive capabilities, the devices are discontinued.

Please remember, when an acute or chronic ankle sprain is not treated, as unfortunately is all too often the case, repeated ankle sprains may occur. Because chronic ankle injuries do not show acute inflammation even when the ankle is weak and unstable, this may set you up for another ankle sprain when least suspected. A successive sprain may be more severe than the first, and cause an even more significant injury.

The most important point to keep in mind when talking about ankle injuries, then, is to prevent the condition from becoming chronic or recurrent.

So the next time you roll over that stone, or land in that small hole, make sure that your simple ankle sprain is just that: "simple."

If you don't want to have a swollen ankle all the time while running, don't ignore early warning signs. If you have any doubts about its seriousness, please contact our rooms and we will do our best to help.

For further advice or to make an appointment, please contact one of our professional team, our numbers and contact details are listed on the Contact page.