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The ankle joint is formed where the tibia and fibula meet at either side of the talus bone in the foot. These two bones are the bony protrusions you can feel in the ankle, with the fibula located on the lateral side (outside) and the tibia on the medial side (inside) of the leg.
When discussing the anatomy clinicians refer to parts of the body in terms of their proximity to the midline of the body (the imaginary centre line), so lateral means outside, medial is the inside, posterior is the back and anterior is at the front. Without this, if you talk about a pain in the right hand side of your left knee, is it your right or the right of the person who is looking at it? If you say that the pain is centred on the lateral side of your right knee then a clinician will know exactly where the issue is.
The diagram below highlights five separate ligaments within the ankle joint in the posterior tibiofibular ligament, posterior talofibula ligament, anterior tibiofibular ligament, anterior talofibular ligament and the calcaneofibula ligament.
The most important of these ligaments are the anterior tibiofibular ligament which connects the talus and fibula on the outside of the ankle and the calcaneofibula ligament which connects to the fibula to the calcaneus (connecting the heal to the ankle).
There are different types of bracing available depending on the level of support required and the condition you wish to manage but can offer compression, stability or both.
Compression: Where there are no stability issues and the main focus is managing inflammation you may just need a compression based ankle support, with a number of options available such as the BioSkin Standard Ankle Skin.
Stability: This can be subdivided once again to splints / stirrups and walker boots (as mentioned above). A stirrup ankle brace offers two solid pieces of plastic which sit at either side of the ankle and prevent any sideways movement without restricting your ability to walk. A walker boot is a solid boot which protects the foot and ankle when active and is an alternative to casting.
Compression & Stability: These types of braces are designed to be worn when active, with many including a strap that acts as an external ligament for greater stability. In this range you have the Form Fit Ankle Support and in the performance market the BioSkin Trilok which offers enhanced compression due to the material it uses.
Typically, a combination of all of the aforementioned treatment methods will be used to offer the best results, with bracing used outside of your physiotherapy sessions to offer support and protection when active. It is worth noting that an ankle support is not designed to be worn forever but just on your path to full fitness so that you don’t become reliant on it.
Most ankle sprains resolve themselves over a period of time, although the most severe grade three injuries may cause some degree of permanent scarring to the ligament which may require dedicated support in the future to avoid re-injury.
A sprain is caused when the ligaments of a joint are torn, stretched or twisted, causing pain and inflammation at the site of the injury. A sprained ankle is one of the most common forms of injury and occurs with a high prevalence across a number of sports where the ankle is subjected to sudden twists and turns whilst supporting the entire weight of the body i.e. football.
The most commonly injured ligament is the calcaneofibula ligament which happens when the ankle is inverted i.e. turns in towards the body whilst your weight goes towards the outside of your body.
Statistics show that accident and emergency departments diagnose over 1.5 million ankle related injuries every year, of which the sprained ankle is one of the most common. This type of injury can happen following a trip, a slip or even landing awkwardly from a jump. They can be common in the workplace with same level falls one of the most common sources of injury.
These will vary depending on the severity of the condition and you as an individual, since we all react differently to injuries and have varying pain thresholds.
Symptoms can include:
In certain cases you may even hear a popping or tear at the time of the injury which would suggest it is a more severe injury and something which may require medical attention straight away.
An ankle sprain can be graded as one, two or three depending on its severity with grade three injuries being the worse.
Grade 1: Sprains involving mild stretching of the ligament are painful but usually heal quickly and easily following a period of rest. You may experience a degree of swelling and bruising as a result.
Grade 2: Usually indicate some tearing of the ligament but not at a level which compromises the overall integrity of the ligament. Again, this can be painful and you will experience swelling and bruising and can expect it to take a few weeks to fully recover from.
Grade 3: These sprains are classed as severe injuries which cause joint instability, often due to a complete rupture of the ligament. This will normally require surgery to remedy and can take several months before you’re back to full fitness.
Sprains can be extremely painful and can require medical attention to ensure that there is no severe underlying injury such as a break or fracture. Hairline fractures can be difficult to diagnose as they sometimes fail to show up on x-rays within the first few days after injury.
Any condition which fails to respond after a few days of rest, pain relief and inflammation management through the application of ice should be referred to a specialist to ensure that the structure of the foot has not been compromised.
On arrival at a hospital a doctor will assess the ankle to understand the symptoms and the impact of range of motion on the joint, as well as looking to understand the source of the injury and anything else which may be relevant i.e. did you hear a popping or tearing sound. They will be focussed on examining the syndesmotic ligaments and the stability of the sub-talar joint.
An x-ray may be taken to understand whether there is any underlying damage to the bones, as a severe sprain may actually be a fracture or broken ankle as the symptoms can be fairly similar. In order to identify the severity of a ligament sprain an ultrasound may be used as this will allow for a clear diagnosis to differentiate between a grade 2 and 3.
Treatment options will vary depending on the severity of the injury, but you will know when you have suffered a mild sprain and when it is something more serious.
Immediately following injury the RICE principles should be followed to help manage the injury and also prevent you from doing further damage.
Resting the affected joint is paramount as continuing to apply weight on the ankle can cause further tears and create further pain and swelling. It's important to provide support and cushioning to the joint and to avoid the risk of twisting the joint thus aggravating the condition. Continuing to remain active on a grade 1 sprain could result in a grade 2 or even 3 should you roll your ankle again.
Ice packs are recommended to offer initial treatment to reduce inflammation and swelling after an ankle sprain, along with pain relief such as paracetamol or other NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen.
Compression normally comes in the form of an ankle support which works to manage inflammation when active and with some types also offering stability.
Elevation is important following an injury to reduce the flow of blood to the affected region by elevating the ankle above the level of the heart.
In contrast to RICE medical advice is to avoid HARM, which stands for Heat, Alcohol, Running and Massage, as these are all likely to exacerbate the original injury.
The purpose of physiotherapy is to work on strengthening the affected joint and enhancing your range of motion so that you can return to full fitness.
The objective from strengthening the joint is to minimise the risk of it happening again, as there will be a weakness in the joint following the initial injury and the last thing you want is for it to happen again.
Surgery will only be used in in the most severe cases where the sprain will not get better on its own, though this is not very common (unless you’re a professional sportsperson). The type of surgery undertaken depends on the injury but the intention is to repair the damage which will involve stitching the ligament back together.
Following surgery you will be placed in a cast or a walker boot to protect the surgeons work, with the latter allowing you to remain mobile which allows for the application of controlled forces through the injured joint which can help with your recovery. If you’re in a cast then you can’t walk in it or use your leg which will lead to muscle wastage.
Sometimes injuries happen and there is nothing you can do about it.
If you’ve suffered a sprained ankle in the past then you are more likely to suffer from one again, with certain sports increasing that likelihood further i.e. running off road. There are however certain things which you can do in order to reduce the risk of a sprain.
Strengthening the affected joint is an important part of your rehabilitation programme but it shouldn’t stop when you feel you’re ready to return to action. You should continue to follow this routine to minimise the risk of the injury happening again in the future, especially as many injuries can happen when you are fatigued, therefore your chances of injury can be increased even further.
As with any sport, technique is a key factor in success and not only that but in minimising the risk of injury. If you lift something heavy with your back rather than your legs then you increase the chance of hurting your back and it’s the same in sport. If you are suffering from the same injury repeatedly then take a look at your technique (among other things) to see if there is anything you can do to tweak it which could make a world of difference, not only to your performance but your fitness.
Running is one sport where you are more susceptible to knee and ankle injuries since it puts a lot of pressure on the lower joints. Poor technique can lead to a multitude of issues so it is advisable to look at a guide of how to run better.
If you looking to start out in running then you should seek some top tips for new runners.
Shoes are very important. How many times have you or heard someone else complain that their shoes are hurting their feet?
If your shoes hurt and continue to do so then you run the risk of causing further problems. If you’re out running and don’t have a pair of trainers which offer the support you need then there is an increased risk of injury either to your ankle or even to your knee from poor alignment of the foot.
When you go into a sports shop there are loads of trainers so the choice can be quite overwhelming but the importance of selecting the right running shoe cannot be overstated enough as we all run differently and therefore have different needs. In the majority of sports shops they will be able to analyse your running style and offer the best pair to help you get the most from them.