Jumping, running or walking — it all goes through the ankle joint, which makes it one of the highest impacted joints of the body!

The ankle acts as a connection between the foot and leg and is designed to withstand large amounts of force — up to 3.5 times your body weight during running.

The ankle joint consists of three bones; two lower leg bones — the tibia (shin bone) and the fibula — which connects with the talus. These form three separate joints that make up the ankle: the talocrural joint (tibia and talus), sub-talar joint (talus and the foot) and the inferior tibiofibular joint (tibia and fibula). In addition to the bony structure of the joint, it is surrounded by a group of extremely strong ligaments on the outside and inside of the ankle as well as groups of muscles, making it an extremely strong and robust joint. As well as connecting the foot to the leg, the ankle allows for transmission of forces and for movement of the ankle up (dorsiflexion) and down (plantar flexion).

So what can make an ankle painful?

Ankle sprain

An ankle sprain injury is caused when the foot rolls over forcibly, stretching the ligaments of the ankle. This mechanism occurs due to a sudden change in direction and the degree of injury can range from a slight tear to a complete rupture. Treatment and management begins with a good clinical assessment to determine the level of injury, which is categorised from grades one to three.

Initially, management focuses on allowing the injured tissue to heal by reducing the pain and swelling. Using ice, compression, taping, reduced mobilisation and elevating the ankle are all common management strategies to help with this.  Once it has settled, a guided rehabilitation program is essential to restore full range of motion and strength. This will be guided by your physiotherapist to prevent reoccurrence and to help return your ankle to it’s pre-injury level.

Ankle strain

Confused between an ankle sprain or a strain? Check out Sprain or strain for more information, but the main difference is that a sprain is an injury of the ligaments and a strain is of the muscle and tendons.

In the ankle, a group of muscles called the peroneals — which are located on the outer part of the ankle — are affected by an ankle strain. An acute strain occurs due to a sudden increase in load or a sudden increase in tendon/muscle stress, causing the tissue to strain or tear. Damage to the muscle fibres or tendon can cause bleeding and swelling resulting in reduced function but also, pain!

Chronic strains in the ankle are common in repetitive activities such as running and result in micro-tears due to the repeated stretch load onto the muscle and tendon.

In both cases, it is important to first settle symptoms, which may require a short period of reduced activity (rest, ice, compression and elevation). In a chronic injury, it is important to identify the underlying cause such as running technique, over or under training or a strength issue. Once the pain is settled, an outlined tailored rehabilitation program is essential to help you return back pain free and to prevent any re-occurrence of the injury.

Ankle arthritis

Osteoarthritis is caused by the gradual wear and tear of the protective cartilage (tough flexible tissue that cover joint surfaces and acts as a shock absorber).

Symptoms of arthritis include stiffness, swelling and pain, but usually it is mild. It is a common misconception that nothing can be done to help, but what we do know is, is that the amount of wear and tear on a scan is a poor indicator of pain and function. Being afraid to use the joint and a loss of strength is a greater indicator for pain and loss of function.

How can you help your pain?

• Get strong: Strengthen the muscles around the ankle as well as the muscles throughout the leg
• Get lighter: Reducing the body weight by 10% can result in a 50% reduction in pain!
• Moving normally and improving general health and fitness

Ankle bursitis

Within the ankle like many other joints, there is a bursa: a fluid-filled sac that reduces friction between the tissues of the body.

In the ankle there are three main bursas: inside of the ankle (subcutaneous bursa), on the heel (calcaneal bursa) and behind under the Achilles tendon (retro calcaneal bursa). Inflammation of the bursa can occur due to overloading of the joint or tissues because of poor technique, a sudden change in ankle loading or if there is insufficient strength. Treatment aims to first settle symptoms by avoiding aggravating activities then focuses on addressing the deficits as the inflamed bursa is usually just a symptom, not the cause of the problem.

At Life Ready Physio, we’re driven to not only to reduce your discomfort and pain but also to develop a treatment management plan to identify the cause and to work towards rehabilitation and prevention.

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