Ankle Pain & Injuries: Causes and Management
Updated: Nov 30, 2018
Ankle Pain & Injuries: Causes and Management
Ankle injuries can be very common more so among people taking part in sport, but also commonly occur due to trauma (falls and accident). Sprains are the most common form of ankle injuries. Ankle sprains account for up to 1.5 million visits to A&E in the UK every year.
Ankle injuries can involve - bone, ligament or tendon. The bones of the ankle are held together at the ankle joint by ligaments, which keep the joint stable. There are also muscles and tendons that protect the ankle joint, do the work of making the foot move and help to hold the joint in place.
A fracture can occur when there is a break in one or more of the bones. A sprain refers to damage to ligaments when they are stretched beyond their normal range of motion. A sprain can range from microscopic tears in the fibres that comprise the ligament to complete tears or ruptures of the ligament. A strain on the other hand refers to damage done to muscles and tendons, which connect muscles to bones, as a result of being pulled or stretched too far.
Muscle strain: there are two tendons at the ankle that stabilise the ankle and foot and protect them from damage. These are the peroneal tendons. They can become inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, rupture or slip out of place.
Acute muscular or tendon damage can result from repetitive activity or trauma. If the tears are degenerative (occurring over a longer period of time) as a result of being overstretched, the condition is called tendonosis.
Causes of Ankle Injuries
Fractures and sprains can result from the ankle joint being subjected to trauma or exceeding too far out of its normal position. This can happen as a result of:
• Tripping or falling
• Landing awkwardly after a jump
• Walking or running on uneven surfaces
• A sudden impact such as a car crash
• Twisting or rotating the ankle
• Rolling the ankle
Most ankle injuries occur during physical activities or being on an uneven surface that forces the foot and ankle into an unnatural position.
Signs and Symptoms for Ankle Injuries
The signs include:
• Pain, often sudden and severe
• Swelling / stiffness
• Bruising / deformity
• Inability to walk or bear weight on the injured joint
Tendonosis is more of a degenerative process and may take years to build. Symptoms include:
• Intermittent pain
• Weakness or instability
• An increase in the height of the foot's arch
With the subluxation you will notice ankle instability or weakness. You may also notice sporadic pain behind the outside ankle bone and a "snapping" feeling around the ankle bone.
What to do if you have suffered from an Ankle Injury?
You can apply PRICE method.
• P stands for protection further injury.
• R stands for rest.
• I stands for ice. Using ice in the first 48-72 hours will help to slow or reduce the swelling and provide a numbing sensation that will ease the pain. You can use ice by wrapping an ice pack in a towel and placing it on the site of the injury. Use the ice for between 15-20 minutes every two to three hours. Do not apply heat to the injury. Heat stimulates blood flow and will cause more swelling and pain.
• C is for compression. Wrapping the injured ankle with a crepe bandage will help keep it immobile and supported.
• E means elevate. Elevating the injured ankle to at least the level of your heart will reduce swelling and pain.
It is important not to put any weight on the ankle until after you have seemed medical advice.
Treatment of fractures
Fractures can be treated either surgically or non-surgically. If only one bone is broken, and if the bones are not out of place and the ankle is stable, the doctor may treat the break without surgery by immobilising the ankle. Typically the doctor will do this by putting on a brace that works as a splint or by putting on a cast. If the ankle is unstable, the fracture will be treated surgically. Often, the ankle is made stable by using a metal plate and screws to hold the bones in place. Following the surgery, the ankle is protected with a splint until the swelling goes down and then with a cast.
Treatment of Ankle Sprains
The treatment for sprains depends on the severity of the injury. Surgery is not usually a treatment option unless the damage is extensive and involves more than the ligaments or unless other treatment options fail.
Mild sprains -- called grade 1, are treated with the PRICE approach for several days until the pain and swelling improve. With a mild sprain, you won't need a splint or a cast.
If your sprain is classified as moderate, or grade 2, your practitioner will use the PRICE approach but allow more time for healing. Then may also use a device such as a boot or a splint to immobilise the ankle. You will be given exercises to do first to improve range of motion and then to stretch and strengthen the ankle. The practitioner then may also prescribe therapy to help you regain full use of your ankle.
Grade 3, or a severe sprain, involves a complete tear or rupture of a ligament and takes considerably longer to heal. It's treated with immobilisation of the joint followed by a longer period of physiotherapy for range of motion, stretching and strength building. Occasionally, especially if the sprain does not heal in a reasonable time, surgery will be considered for reconstructing the torn ligaments.
On average, the initial stage of healing a sprain, which involves resting and protecting the ankle until swelling goes down, takes about one week. That's followed by a period of exercise to restore range of motion, strength and flexibility that lasts for one to two weeks. Then it takes several more weeks to several months to gradually return to your normal activities while you continue to exercise.
Treatment of Ankle Tendon Injuries
Options for treating tendon injuries are similar to options for treating sprains. They include:
• Immobilisation using a cast or splint
• Oral or injected anti-inflammatory medications to reduce pain
• Physiotherapy for range of motion, strength and balance
• A brace to provide support during activities
• Surgery to repair the tendon or tendons and sometimes to repair the supporting structures of the foot
Ankle Injury Prevented
Recommended steps for reducing your risk of an ankle injury:
• Avoid exercising or playing sports when you are over tired or in pain.
• Take precautions against falling and adopt correct technique at all time
• Wear shoes that fit well and that are appropriate for the activity you are doing.
• Don't wear shoes that have heels worn down on one side.
• Warm up and stretch before exercising or playing a sport.
• Wear the proper equipment for whatever sport you play.
Any further questions or advise please contact Dynamic Osteopaths on:
T: 07966 317712 (Clinic Mobile)
Ankle joint pain
Ankle joint treatmnet and management
Ankle joint rehabilitation
Ankle injuries and pain.