Ankle Pain

Ankle Injuries

Article by H.Giebeler, N.Stewart

Common Ankle Injuries

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 achieve your goals as soon as possible.

Your Ankle Ligaments

Your ankle joint, which is known as the talocrural joint, is made up of 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.

ankle ligaments

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

  • 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.

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.

FAQs

FAQs 2

Pain

Pain is the built-in alarm that informs you something is wrong! Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Pain travels along these nerve pathways as electrical signals to your brain for interpretation. Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells. Most cells sense pain. When there is an injury to your body, these tiny cells send messages along nerves into your spinal cord and then up to your brain. In general, pain receptors are classified according to their location. Receptors that respond to injury or noxious stimuli are termed nociceptors and are sensitive to thermal (heat), electrical, mechanical, chemical and painful stimuli. Each nociceptor is connected to a nerve that transmits an electrical impulse along its length towards the spinal cord and then, ultimately, your brain. It is your brain that informs you whether or not you are experiencing pain. Plus, your pain can plays tricks - especially when you suffer chronic pain.

Pain messages travel slower than other nerve stimulation.

Nerves can also be categorised according to their diameter (width) and whether a myelin sheath is present. Three types of nerves are concerned with the transmission of pain: A-beta fibres, which have a large diameter and are myelinated A delta fibres, which have a small diameter and also have myelinated sheaths. C fibres have small diameters and are non-myelinated (slowing their conduction rate) and are generally involved with the transmission of dull, aching sensations. Nerves with large diameter conduct impulses faster than those with a small diameter. The presence of a myelin sheath also speeds up the nerve conduction rate. One method of easing your pain is to provide your nervous system with high speed "good feelings" such as rubbing your injured area. This is the same principle that a tens machine (pain-relieving machines) utilises to provide pain relief.
Most standard strapping tapes are non-elastic. Rigid strapping firmly wraps around your injured structures. They aim to provide rigid support and restrict movement. These rigid strapping tapes can only be worn for short periods, after which you must remove them to restore your circulation and mobility. kinesiology tape Alternatively, kinesiology tape has some unique elastic properties that allow it to provide active support, protecting muscles or joints, while still allowing a safe and functional range of motion. Rather than being entirely wrapped around injured joints or muscle groups, kinesiology tape is applied directly over or around the periphery of troublesome areas. This non-restrictive characteristic of kinesiology taping allows most applications to continue for several days. This period reinforces therapeutic benefits to accumulate 24-hours a day for the entire time they’re worn. You can wear kinesiology tape during intense exercise, showering or swimming. It quickly dries after a quick pat with a towel.

Does Kinesiology Taping Help to Hasten Your Recovery Time from Swelling or Bruising?

Researchers, Bialoszewski et al. 2009, have discovered that kinesiology tape can quicken the reduction in joint swelling (oedema) and a  bruise (haematoma). The theory is that the elasticity of kinesiology tape lifts the skin away from the swollen tissue below by loosely "crinkling" the skin. This skin lift is known as a sub-dermal vacuum, which provides less physical resistance to the removal of the retained fluid by your lymphatic and venous drainage systems. Test this theory out by a quick squeeze of your skin. It will resemble an "orange-peel" appearance. You'll notice loose skin between your fingers. The lower skin tension allows your venous and lymphatic systems to drain the sub-dermal fluid away quicker. Now isn't that clever!
Tendinopathy (tendon injuries) can develop in any tendon of the body. You may have heard of tendinopathies being referred to as its aliases: tendonitis, tendinitis, tenosynovitis and tendinosis. In simple terms, they are all tendon injury pathologies so the medical community now refers to them as tendinopathies. Typically, tendon injuries occur in three areas:
  • tendon insertion (where the tendon attaches to the bone)
  • mid-tendon (non-insertional tendinopathy)
  • musculotendinous junction (where the tendon attaches to the muscle)

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading. As mentioned earlier, health care professionals may use different terms to describe a tendon injury. You may hear: Tendinitis (or Tendonitis): This means "inflammation of the tendon". Mild inflammation is actually a normal tendon healing response to exercise or activity loading, but it can become excessive, where the rate of injury exceeds your healing capacity.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent.
  • Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good.
  • The tendon tissue is attempting to heal.
  • It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Prognosis: Poor!
  • Tendon cells are dying!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

What is Your Tendinopathy Phase?

It is very important to have your tendinopathy professionally assessed to identify it’s current injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment since certain treatment modalities or exercises should only be applied or undertaken in specific tendon healing phases.

Systemic Risk Factors

The evidence is growing that it is more than just the tendon and overload that causes tendinopathy. Diabetics, post-menopausal women and men with high central adiposity (body fat) seem to be predisposed to tendinopathies and will need to carefully watch their training loads.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
The symptoms of a tendon injury can be similar or combined with bursitis.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist or doctor will ask questions about your past health, your symptoms and recent exercise regime. They'll undertake a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan. They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI.

Tendinopathy Treatment

Tendinopathies can normally be quickly and effectively rehabilitated. However, there is a percentage of tendinopathies that can take months to treat effectively. As mentioned earlier in this article, it is important to know what phase your tendinopathy currently is. You physiotherapist can assist not only your diagnosis but also guide your treatment to fast-track your recovery. Before you seek the advice of your physiotherapist or doctor, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:
  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.

When to Return to Sport

Every tendinopathy is different, so please be guided by your physiotherapist assessment. It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting loads. Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage, and set you back weeks!

Tendinopathy Prevention

To minimise reinjuring your tendon, you may require some long-term changes to your exercise activities. These should be discussed with your physiotherapist. Some factors that could influence your tendinopathy risk include:
  • Altering your sport/activities or your technique
  • Regular prevention exercises.
  • Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
  • Always take time to warm up before and cool down / stretch after you exercise.

Tendinopathy Prognosis

While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve. Long-term or repeat tendinopathies usually have multifactorial causes that will require a thorough assessment and individualised rehabilitation plan.  Researchers have found that tendon injuries do respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery. For specific advice regarding your tendinopathy, please seek the advice of your trusted healthcare professional with a special interest in tendinopathies.

Ankle Strapping

How to Strap an Ankle

how to strap an ankle Ankle strapping or taping can be used effectively in both the prevention and treatment of ankle 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 a form of insurance against ankle injuries. This injury prevention strategy, in turn, helps to reduce the loss of performance time by any player.

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 sport, 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 the 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, and it depends upon how much you need to protect your ankle versus the necessary flexibility for you to perform 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:

Sprained Ankle High Ankle Sprain

What is the PhysioWorks Difference?

You'll be impressed with the experienced physiotherapists, massage therapists and reception staff who represent PhysioWorks.  To ensure that we remain highly qualified, we are committed to participating in continuing education to provide optimal care. If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level. We also currently provide physiotherapy and massage services for numerous sports clubs. Our experience helps us understand what you need to do to safely and quickly return to youryouryour sporting field, home duties, or employment.

How You'll Benefit from the PhysioWorks Difference?

At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quickeffective and long-lasting results by providing high-quality treatment. We aim to get you better quicker in a friendly and caring environment conducive to successful healing. With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.

What are Some of the BIG Differences?

Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc. Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that in reality, only last for a short time. We attempt to treat the cause, not just the symptoms. PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge. Our staff care about you!  We are always willing to go that 'extra mile' to guarantee that we cater to our clients' unique needs. All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.

What is Therapeutic Ultrasound?

Therapeutic ultrasound is an electrotherapy modality which has been used by physiotherapists since the 1940s. Via an ultrasound probe through a transmission coupling gel in direct contact with your skin, ultrasound waves are applied. ultrasound Therapeutic ultrasound may increase:
  • healing rates
  • tissue heating
  • local blood flow
  • tissue relaxation
  • scar tissue breakdown.

How Could Ultrasound Help?

Ultrasound increases local blood flow. This increase may help to reduce local swelling and promote soft tissue healing rates. A higher power density may soften scar tissue.

Specific Ultrasound Uses

Mastitis or blocked milk ducts successfully respond to therapeutic ultrasound. The effect is quite dramatic, with improvement within 24 to 72 hours. The most common conditions treated with ultrasound include soft tissue injuries such as muscle, ligament injuries or some tendinopathies. Phonophoresis uses ultrasound in a non-invasive way of administering medications to tissues below the skin. This method may assist patients who are uncomfortable with injections. With phonophoresis, the ultrasonic energy forces the drug through the skin.

What is an Ultrasound Dose?

A typical ultrasound treatment will take from 3-10 minutes. Where scar tissue breakdown is the goal, this treatment time could be much longer. During the procedure, the head of the ultrasound probe is in constant motion. If kept in continuous motion, the patient should feel no discomfort at all. Some conditions treated with ultrasound include soft tissues injuries such as muscles or ligament injuries, tendinopathy, non-acute joint swelling and muscle spasm.

How Does an Ultrasound Work?

A piezoelectric effect, caused by the vibration of crystals within the ultrasound head of the probe creates the sound waves. The ultrasound waves generated then pass through the skin cause a vibration of the local soft tissues. This repeated cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, an athermal application occurs. Athermal doses are typical during acute fresh injury and the associated acute inflammation.

When Should Ultrasound be Avoided?

Contraindications of ultrasound include:
  • local malignancy,
  • over metal implants,
  • local acute infection,
  • vascular abnormalities,
  • active epiphyseal regions (growth plates) in children,
  • over the spinal cord in the area of a laminectomy,
  • over the eyes, skull, or testes
  • and, directly on the abdomen of pregnant women. Treatment ultrasound differs from diagnostic ultrasound!
Like all medical equipment, when used by highly trained professionals, such as your physiotherapist, therapeutic ultrasound is very unlikely to cause any adverse effects. Please consult your physiotherapist for their opinion on whether therapeutic ultrasound could assist your injury. Therapeutic Ultrasound differs from Real-Time Ultrasound Treatment.

What is Osteoarthritis?

Osteoarthritis is one of the most common forms of arthritis, often referred to as degenerative arthritis. The joints show signs of wear: joint cartilage becomes thin, extra bony spurs grow in response to stress, and joint motion lessens. In advanced stages, osteoarthritis can be painful, functionally limiting and depressing.

What is the Osteoarthritis Cure?

Unfortunately, there is no cure for osteoarthritis. But the good news is that there are some better ways to manage your osteoarthritis and slow the degeneration process. This improvement will result in making your life easier and more comfortable. Physiotherapy is a significant part of making your life living with osteoarthritis less painful, comfier and keeping you active. Research supports physiotherapy. Physio can reduce the pain and disability associated with arthritis, especially knee osteoarthritis. http://dx.doi.org/10.1136/bjsports-2016-096458 Seek the professional and helpful advice of your physiotherapist to start enjoying life again today!

Your Osteoarthritis Diagnosis

X-rays are the most straightforward test to confirm osteoarthritis. An experienced practitioner will have an excellent idea of whether you have osteoarthritis when they examine you.

How Does Osteoarthritis Affect Older People?

As you age, most people develop some degree of osteoarthritis. Our joints' wear and tear may occur due to ageing, injury, prolonged microtrauma, overuse of joints, or excess weight. Permanent bony changes occur and will exist even when there are no painful symptoms. Your degree of suffering varies. Whereas some people may be symptom-free others may suffer continuous disabling pain. The most common is mild or intermittent pain provoked by episodes of increased use or minor trauma. The joints most commonly affected are the weight-bearing joints: hip, knee, ankles, feet and spine. However, osteoarthritis can affect any joint in the body and is quite common in the hands and shoulders. Severe cases may require surgical treatment, but most will respond very well to your doctor's physiotherapy and medication.

Osteoarthritis Symptoms

You can suspect osteoarthritis if you experience one or more of the following symptoms:
  • joint pain or tenderness that intermittently returns
  • stiffness, particularly early morning stiffness
  • joint swelling or deformity
  • noticeable joint heat and redness
  • joint movement is strenuous.

Osteoarthritis Treatment

For advice on your osteoarthritis diagnosis, self-help tips or the best treatment of your osteoarthritis, please contact your physiotherapist or trusted health care professional.