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

Shoe Size Conversion Chart

Aust. Mens 4 5 6 7 8 9 10 11 12
Aust/US Womens 6 7 8 9 10 11 12 13 14
US Mens 5 6  7 8 9 10 11 12 13
European 37 38 39.5 40.5 42 43 44.5 46 47
UK 4 5 6 7 8 9 10 11 12
Centimetres 22.8 23.7 25.1 25.4 26.3 27.1 28 28.8 29.6

Growing Pains

Growing Pains are a concern for most teenagers, pre-teens and their parents. As a rule, growing pains are poorly understood and often brushed aside as something you must go through during adolescence. This is not necessarily true. In fact, most "growing pains" can be eliminated or at least eased with some quality care and attention.

What Causes "Growing Pains"?

A prevalent time to suffer  "growing pains" is when your bones are quickly lengthening.  Consequently, your muscles also have to lengthen to keep a normal "muscle length-tension ratio".  Unfortunately, this doesn't always happen naturally. If your muscles do not lengthen adequately, it increases muscular tension pulling on the soft bone growth plates. Commonly we find that those kids who suffer "growing pains" have excessively tight muscles that cause their pain.

What Can Be Done to Help Growing Pain?

The good news is that your physiotherapist is trained to assess your child's normal muscle length.  Immediately after their assessment, your child will be prescribed corrective techniques to lengthen any tight soft tissue. Every child is different, and they do have individual genetics. As you would be well aware, not everyone can be a contortionist! Therefore, the rate your child's improvement, techniques used, or exercises performed will vary from individual to individual.

What Results Can You Expect?

Luckily, growing pains usually disappear within days or just a few weeks once the correct treatment commences. Considering that most untreated "growing pains" can last 18 months or more, that's very pleasing news for your child.  Why let your child needlessly suffer when there is a straightforward, safe and effective solution available?

Common Youth Leg Injuries

youth sports injuries

Why are Children's Injuries Different to Adults?

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

Common Adolescent Leg Injuries

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. It is because of excessive participation in running and jumping sports that 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. It is because of excessive participation in running and jumping sports that 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 have a better blood supply and are more elastic in adolescents than in 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 bone (femur) and lower leg bone (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these types of 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 as a result of excessive volume of 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 some of 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. An ankle sprain usually improves in 2-6 weeks with the correct treatment. Your ankle physiotherapist should check even simple 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 piece of 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 the young sportsperson. Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This period of active rest 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. In rare cases, an excessive gap between the avulsed bone fragment and main bone may not rejoin naturally. 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.

Common Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain Common Youth Arm Injuries

Yes! You Can Definitely Improve Your Balance.

The research has confirmed for many years that balance retraining works. It can also take only a few weeks progressed balance exercises to improve or normalise your balance and corrective reactions. You can perform simple exercises initially, such as standing on one leg with eyes open and progress to eyes closed. Still, after that, the best way to improve your balance is to exercise on an unstable surface. For more information about balance assessment and retraining, please contact your physiotherapist.

Balance Enhancement Products:

Over the years, there have been numerous devices developed to assist clinicians in improving their clients' balance. This has greatly reduced the incidence of ankle and knee ligament sprains and, at the same time, improves the athlete's performance. These balance devices can be used by you, in your own home to improve your balance and reduce your injury chance or eliminate your joint pain.

Are You Tired of Your Joints Clicking?

Can You Be Click Free?

Would you love your joints not to crack?  Have you ever wondered what really makes your bones moan and groan in the first place?  Despite many myths, here are three real and different reasons why your joints persist in clicking... Your tendons may be simply slipping over some bumps on your bones so that when the tendon slips over the bump, it clicks.  But don't worry, this isn't usually a problem.  Occasionally it is due to poor joint positioning or ligament damage.  Easy remedies include simple alignment or stabilisation exercises. Ask your helpful physiotherapist if you have any doubts. When joints click, this could indicate arthritic problems.  Joints are held under tight compression that results in the two bone surfaces grating back and forth, over the top of each other. Sounds as unpleasant as running your fingernails down a blackboard. However, this can usually be easily fixed through some simple physiotherapy treatment and sticking to an exercise program that improves your joint alignment, muscle strength and flexibility. But don't procrastinate ... the problem can rapidly deteriorate if left unattended. The third main reason is gas, that normally builds up within a joint, suddenly popping out of the joint, when the joint is forcibly stretched or compressed.  It's just like bursting a balloon, but much quieter. You'll know the guilty people—those who regularly crack their knuckles, neck, back or toes. You can achieve the same result with less long-term harm by gentle joint stretching and mobility techniques to gradually loosen stiff joints.  You'll probably also require some simple strength exercises to control the newly gained movement.  Ultimately, these conservative methods are preferable in the long term, as repeat manipulation or cracking destroys the supportive ligaments, and eventually, the joints fall out of position much easier! And the looser your joints, the quicker they develop degenerative arthritis and subsequent pain. Grandma was right - excessive knuckle cracking can cause arthritis. By performing specific exercises and stretches and following the advice of your physio, you can wake up, stand or sit up - click free!

Why Do Physiotherapists Prescribe You Exercises?

The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning or are recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose. Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.

What Exercises Should You Do?

Your exercises shouldn't be painful. Please take caution with some overzealous exercise prescribers who believe that the more painful the activity, the better. Thus simply isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person. You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.

What Happens When You Stop Exercises?

Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage. It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs. The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.

Would You Stop Your Daily Prescription Drugs?

Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working? We would hope not! Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional. So, next time you skip your "exercise dose" just remember that you are not putting your health first. If you have any questions, please contact your Physio Works physiotherapist for your best care.

Private Health Insurance Rebates

PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for the majority of your treatment fees, leaving you with only a small gap payment.

However, Private Health Funds do vary their rebates payable depending upon the level of cover that you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly others haven't, with rebates similar to what they were a decade ago.

HICAPS - Instant Health Fund Claims


Most health funds are members of the HICAPS instant claims system.  Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. For more information, please visit Hicaps for the latest funds which can use their instant claiming system.

Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.

Third-Party Insurers

PhysioWorks practitioners are registered providers for government, Workcover and insurance companies including:

  • Workcover
  • InjuryNet
  • Australia Post; Coles Myer; Woolworths
  • Medicare
  • Department of Veterans' Affairs
  • CTP & Sports Insurers
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