Ankle Pain

Ankle Injuries

Article by John Miller

Ankle Injury Information

Your ankle muscles and tendons dynamically control, move and protect your ankle joint. In simple terms, your muscles move your foot and stabilise your ankle joint to avoid you overstretching your ligaments. Unfortunately, when your muscles lose control or are not quick enough, your ligaments are not protected, resulting in overstretched ligaments (ankle sprain) or complete ligament rupture. Ouch, that hurts!

However, there are many other types of ankle injuries besides a sprained ankle, and we categorise them by the kind of tissue injured, e.g. bone (fracture), ligament (sprained ankle), muscle (strain or tear), or tendon (tendinopathy or tendonitis).

Ankle pain can arise from traumatic ankle ligament sprains or ankle fractures (broken bones). Plus, ankle pain can be more subtle in origin. Tendinopathies, degenerative arthritis and biomechanical disorders can develop ankle pain over time.

There are a lot of ankle injuries – not just sprained ankles. It is essential to accurately diagnose what is wrong with your ankle to ensure that both your short and long-term treatment achieves your goals as soon as possible.

When Should You Worry About Ankle Pain?

Some cases of foot and ankle pain require urgent attention.

Sudden Onset Ankle Pain

Traumatic injuries that occur at speed or involve a multi-direction component such as twisting may result in foot or ankle fractures or significant soft tissue injuries, e.g. syndesmosis or high ankle sprains.

The Ottawa Ankle Rules determine the need for X-rays in acute ankle injuries.

Ankle X-ray is only required if:

  • There is any pain in the malleolar zone; and,
  • Any one of the following:
    • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, or
    • Bone tenderness along the distal 6 cm of the posterior border of the fibula or end of the lateral malleolus, or
    • An inability to bear weight immediately and in the emergency department for four steps.

Chronic Ligament Instability

Chronic ligament instability in your foot and ankle can cause premature osteoarthritis and joint deformity. Some conditions can be safely rehabilitated without surgery, whereas other conditions, such as a Lisfranc injury, may require surgical repair.

Please consult your doctor or physiotherapist for specific foot or ankle injury advice.

Gradual Onset Pain That Fails to Improve

Stress Fractures

Stress fractures can be serious. While you may not have had a sudden traumatic injury, the ankle and foot are highly susceptible to stress fractures. Several bones in your foot can have their blood supply compromised by a stress fracture, leading to bone necrosis (death). These potentially life-changing conditions should seek an early assessment from your doctor or physiotherapist.

The good news is that most ankle and foot pain is not sinister and improves with physiotherapy and other non-surgical options.

Please ask your physiotherapist or doctor for specific advice.

Common Ankle Injuries

Ankle Sprains

FAQs

Ankle Fractures

Ankle Tendinopathies

Ankle Arthritis

Biomechanical Conditions

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions that may cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information

For specific advice regarding your ankle injury, please visit one of the particular ankle injury information pages on this website, or arrange a consultation with one of our ankle physiotherapists.

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Common Ankle Injuries

ankle pain

Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.

Ankle Tendinopathies

While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide you with a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Would you please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist?

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion contr. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions That May Cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information

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Book Your Appointment Here!

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Article by John Miller

When Should You Worry About Foot Or Ankle Pain?

Some cases of foot and ankle pain require urgent attention.

Sudden Onset Foot Or Ankle Pain

Traumatic injuries that occur at speed or involve a multi-direction component such as twisting may result in foot or ankle fractures or significant soft tissue injuries, e.g. syndesmosis or high ankle sprains.

The Ottawa Ankle Rules determine the need for X-rays in acute ankle or foot injuries.

Ankle X-ray is only required if:

  • There is any pain in the malleolar zone; and,
  • Any one of the following:
    • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, or
    • Bone tenderness along the distal 6 cm of the posterior border of the fibula or end of the lateral malleolus, or
    • An inability to bear weight immediately and in the emergency department for four steps.

Foot X-ray is indicated if:

  • There is any pain in the midfoot zone; and,
  • Any one of the following:
    • Bone tenderness at the base of the fifth metatarsal (for foot injuries), or
    • Bone tenderness at the navicular bone (for foot injuries), or
    • An inability to bear weight immediately and in the emergency department for four steps.

Chronic Ligament Instability

Chronic ligament instability in your foot and ankle can cause premature osteoarthritis and joint deformity. Some conditions can be safely rehabilitated without surgery, whereas other conditions, such as a Lisfacnc injury, may require surgical repair.

Please consult your doctor or physiotherapist for specific foot or ankle injury advice.

Gradual Onset Pain That Fails to Improve

Stress Fractures

Stress fractures can be serious. While you may not have had a sudden traumatic injury, the ankle and foot are highly susceptible to stress fractures. Several bones in your foot can have their blood supply compromised by a stress fracture, leading to bone necrosis (death). These potentially life-changing conditions should seek an early assessment from your doctor or physiotherapist.

The good news is that most ankle and foot pain is not sinister and improves with physiotherapy and other non-surgical options.

Please ask your physiotherapist or doctor for advice.

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Foot & Ankle Pain FAQs & Products

Article by Matthew Batch

How Long Do Sprained Ankles Take To Heal?

This varies depending on the location of the injury, as well as the severity of it. The remainder of this blog focuses on “low” ankle sprains - injuries to ligaments around your ankle and foot, rather than those supporting your shin bones.

Depending on the severity of your condition, a six to twelve-week timeframe can be expected. However, this depends on appropriate rehabilitation of the condition and whether or not your condition warrants surgery. Sprained ankles are associated with changes to the mobility of your ankle, strength of the surrounding muscles, and reduced balance and coordination. Whilst the amount of pain you are in may decrease “with time”, complete recovery from the injury requires this extra attention to the changes in how your body functions.

Physiotherapies are highly skilled in assessing and managing ankle injuries, so if you have experienced an ankle sprain, then call or book online today!

More info: Sprained Ankle

Foot & Ankle Pain FAQs & Products

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Article by Matthew Batch

How Do You Know If Your Ankle Is Sprained?

Ankle sprains are usually an acute injury - there is usually a single, clear event that a person can point to and say, “that’s when the symptoms started”. In most cases, this involves a “rolling” of the ankle when the bottom of the foot turns inwards towards the other ankle. This is the usual cause of a “lower” ankle sprain - an injury to ligaments that support the ankle and foot. This is different to a “high” ankle sprain”, which involves the ligaments that support the ankle and shin bones. The remainder of this blog focuses on “lower” ankle sprains”.

You can expect some ankle swelling, usually around the bone on the outside near your heel, and may also experience bruising in this area. You might have also noticed a popping sensation at the time of injury. Walking on the injured ankle is usually possible unless the pain is particularly high or other structures have also been affected. You can expect to have difficulty with how much you can move your ankle - particularly if trying to point your toes towards your head, as well as difficulty balancing, and tenderness to touch.

More info: Ankle Sprain

Foot & Ankle Pain FAQs & Products

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Article by John Miller

Which Are The Most Commonly Injured Ankle Ligaments?

Your ankle joint, known as the talocrural joint, comprises three bones. Your tibia (shin bone; inside ankle bone), fibula (outer lower leg bone; outside ankle bone), and your talus (deep ankle bone). Beneath your talocrural joint lies the subtalar joint, articulating the talus and the calcaneus (heel bone). This forgotten joint is overlooked frequently during assessment, diagnosis and rehabilitation.

Your ankle ligaments attach bone-to-bone. They passively limit the motion available at each joint.

Outside of the ankle are the lateral ligaments.  These ligaments are the most frequently injured in a lower ankle sprain. These include the following:

  • anterior talofibular ligament (ATFL)
  • calcaneofibular ligament (CFL)
  • posterior talofibular ligament (PTFL)

The main medial (inside of the ankle) ligament is the much stronger deltoid ligament.

High ankle sprains involve the inferior tibiofibular ligament and syndesmosis. These are more disabling ankle injuries. Unfortunately, misdiagnosis is common.

Ankle Products & FAQs

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Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

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Ankle Strapping

How to Strap an Ankle

how to strap an ankle

Ankle strapping or taping may effectively prevent and passively support ankle ligament injuries.

As an aid to prevention, the role of ankle strapping is to decrease the frequency and severity of the injury. In particular, a sprained ankle. Ankle strapping aims at preventing damage or minimising the risk of injury.

Prevention is Better than a Cure

In many professional sports, clubs have significant financial investments in their players and cannot afford to lose a player at any stage of the playing season. Therefore, clubs use preventative strapping tape as insurance against ankle injuries. This injury prevention strategy, in turn, helps reduce any player's loss of performance time.

Which Strapping Tape is Best?

Most ankle strapping uses a rigid sports tape. In most cases, 38mm width strapping tape will suffice. Larger ankles may prefer 50mm width. 25mm strapping tape usually is too constrictive for ankle strapping.

In amateur sports, athletes risk the same injuries. However, there is generally little encouragement to take such preventive measures even though the amateur risks the consequence of time off work and paying medical bills.

In these situations, the use of strapping tape, particularly for high-risk sports such as Football, Netball, Basketball, Hockey etc., is potentially far more critical to the individual where the cost of prevention could be far less than the value of the treatment.

There are many methods to strap an ankle, depending on how much you need to protect your ankle versus the necessary flexibility from performing your sport. Some ankle strapping techniques include simple stirrups, figure-6, figure-8, basket weave and heel locks.

For more information, please seek the advice of your trusted physiotherapist.

More info:

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Article by John Miller

Common Youth Leg Injuries

Why are Children's Injuries Different to Adults?

youth sports injuries

Adolescent Leg Injuries

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (Anterior Cruciate Ligament) Injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal Injuries

Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries

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