Managing ankle injuries
The ankle joint is made up of four bones: the talus, calcaneus, tibia and fibula. The joint is supported by ligaments; bands of tough, fibrous connective tissue, connecting bones to other bones. If this support system of ligaments is put under too much stress, tears can develop – this is what is called an ankle sprain. This most frequently occurs during activities with sudden changes in direction, particularly on uneven surfaces. These ligaments are designed to prevent the ankle from turning too far inwards or outwards. Usually the foot will roll inwards, causing damage to the ligaments on the outside of the ankle, and occasionally the foot will roll outwards, damaging the inner ankle ligaments.
The area over and around the damaged ligaments will typically be painful and tender to touch, with swelling and bruising which can also extend to other areas of the foot and ankle depending on the severity of the sprain. It is frequently painful to bear weight through the injured foot, and the pain may shoot into the foot and shin.
When managing an ankle sprain, the common acronym RICE should be applied for the first 2-3 days. It helps to reduce inflammation – and the earlier it is started, the more effective it is.
- Rest: stay off the ankle as much as possible, in some cases this is best implemented using crutches
- Ice: 20 minutes of ice, every 2 hours
- Compress: a firm compression bandage should be worn around the ankle, foot and lower leg
- Elevate: don’t just put it up beside you on the couch, prop it up on a pillow or two, so it is above the level of the pelvis
HARM should be avoided during this period also, as these activities increase inflammation and delay recovery:
- Heat: can lead to increased bleeding and swelling at the area by increasing blood flow
- Alcohol: is also likely to increase bleeding and delay the healing process
- Running: or excessive activity and weight bearing is likely to cause further breakdown to healing tissue
- Massage: although there are some exceptions to this rule, unless knowledgeable of swelling reduction massage techniques, massage to the area should be avoided as it can increase bleeding and swelling
After minimising inflammation and pain, it is vital for correct rehabilitation to ensure this does not become a recurrent problem. Although in the initial stages you may be not be able to put weight through the ankle, a gradual return to weight-bearing is important to avoid excessive stiffness at the ankle joint. Stretching, range of motion exercises and mobilisation techniques may also be necessary to ensure return to full movement. A graduated program of balance, proprioception and muscle strengthening around the ankle and lower limb is crucial as soon as pain allows, ensuring the best recovery possible.
Tim Saunders – Principal Physiotherapist and Director of Back In Motion Alphington