Acute ankle injuries are a common problem seen by Physiotherapist, particularly in health and fitness programs where rapid changes of direction are required. The most important aspect of managing injury in this region is ensuring a correct diagnosis.
The key issue is deciding on whether the injury involves damage to the ankle ligaments only, or a more complex injury involving possible fractures or tendon dislocations.
The ankle consists of three joints:
- talocrural joint (ankle joint) – a hinge joint between the bottom of the tibia and the top of the talus
- inferior tibiofibular joint – this is the joint between the distal parts of the tibia and fibula
- subtalar joint – this is the joint between the talus and the calcaneous ( heel bone)
There are 3 major ligaments on the lateral side of the ankle, these are the anterior talofibular ligament (often written as ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). The medial side of the ankle is supported by the strong, fan shaped medial or deltoid ligament which runs from the medial malleolus down to the navicular, talus and calcaneous.
Due to the relative weakness of the lateral ligaments and the instability of the lateral side of the ankle it much more common to sustain an inversion injury (where you roll onto the outside of the ankle) than an eversion injury (where you roll onto the inside of the ankle). As with all traumatic injuries it is essential the client is examined by a Physiotherapist as soon as possible. The Physiotherapist will evaluate the extent of the injury, outline an approximate time line for rehabilitation, as well as excluding any more serious problems such as fractures and dislocations.
Pain free ankle mobilisation exercises are commenced following the application of ice and compression, these gentle range of motion exercises are performed for 5-10 minutes each hour with the ice/exercise cycle repeated as often as possible. Depending on the extent of the injury the patient may need to be non weight-bearing for the first 24 hours – after that it is important to commence partial and then full weight-bearing with normal gait to assist in the restoration of full pre injury range of motion, and prevent long term ankle stiffness.
A functional rehabilitation and strengthening program is commenced as soon as symptoms allow but always under the direction and guidance of the treating physiotherapist. Common exercises used at this time include one leg squats, balancing single leg with eyes initially open then closed, wobble boards and various balancing and catching drills.