Your ankles are feet are very important for everyday movement because they are what supports the weight of your entire body, what allows you to move, and what you need to stand, walk, run, jump, or kick. But, because they are involved in so many daily movements, that increases their risk of injuries.
Ankle injuries are not just limited to athletes, even though a high percentage of ankle injuries happen because of sports. Some athletic causes for ankle injuries are rolled ankles while pivoting while playing basketball, stepping in a dip in the grass while running while playing soccer, softball, baseball, lacrosse or field hockey, landing wrong while landing a gymnastics, dance or cheerleading routine, or overuse from track and field or cross country (just to name a few).
But there are times that non-athletes can hurt their ankles while walking on an uneven surface because that can also cause some strain on the ankles. Other potential causes of ankle sprains are tripping and falling, a sudden impact like car crashes, or really anything that causes the ankle to twist or rotate beyond its limit. There are studies that have been done that state that every day in the United States, more than 25,000 people are seen in the emergency room from sprained ankles. And, more than one million people go to the emergency room every year for ankle injuries or pain.
The most common forms of ankle injuries are fractures and sprains, but there is also the risk of a tear or a tendon strain. You can define the type of ankle injury based on what area is damaged. This can either be the bone, the tendon, or the ligament. Your ankle is the meeting point of where three bones meet: the tibia and fibula of your lower leg, connecting to the talus located in the foot. All of these bones are bound together at the ankle joint by ligaments, which are essentially strong elastic bands of connective tissue that keep the bones in place while providing normal ankle motion. Your tendons attach the muscles to the bones, which does the work of making the ankle and foot move, and also they help keep the joints stable.
Here is how you can split up the three main ankle injuries.
Fracture – A fracture is when there is a break in one or more of the bones.
Ligament Sprain – A sprain describes the damage that has been done to ligaments when they are stretched beyond their normal range of motion. A ligament sprain can range from a bunch of microscopic tears in the fibers that comprise the ligament to a complete tear or rupture. This is one of the most common injuries doctors and physical therapists see.
Strain – A strain is when there is damage that has been done to muscles and tendons as a result of being pulled or stretched too far. The most common strains that physical therapists see are in the peroneal tendons, which help stabilize and protect the ankle. These tendons can become inflamed as a result of overuse or trauma/an injury. Acute tendon tears result from sudden trauma, injury, or force. The inflammation of a tendon is called tendinitis. This happens when microscopic tendon tears that accumulate over time, because of being repeatedly overstretched, and because of prior injuries that don’t heal properly.
Some common symptoms for ankle injuries are pain (often severe and sudden), swelling, bruising, and an inability to walk or bear weight. If you have ever suffered an ankle injury, you know that there are two kinds. There is the kind that you can walk off, but you still feel some pain, and then there is the kind that leaves you unable to walk or put any weight on that ankle. If you can walk it off, it is most likely a mild sprain. This means that the swelling and pain might be slight, but it is manageable.
If this is the case for you, then it is recommended that you start range of motion exercises within the first 72 hours of your injury. It is important to start slow and to keep an eye on pain levels. If movement feels too painful, then you will move on to the next section talking about more intense injuries. But if you can move the ankle slightly, then movement is the next best thing to do. They are simple and can be done while working or watching TV. A great way to progress would be to work up to doing these exercises five times a day and then icing after. Some simple range of motion exercises can be tracing the alphabet with your toe. Doing this helps encourage ankle movement in all directions, and you should try to work up to doing the entire alphabet one to three times in a row. Another good range of motion exercise involves sitting in a chair with your feet flat on the floor. Try moving your knee side to side while keeping that foot planted to the floor for two to three minutes. Lastly, a range of motion exercises to help your ankle is a towel curl. This involves having you sit and place a towel on the floor. With your toes, work to scrunch the towel closer and closer to you. Then, also by using your toes, push the towel away from you. Ways to make this exercise even harder is by putting something on the towel that makes it heavier, like a can of beans.
Another thing that should happen after an injury, if it is not severe, is stretching. It is important to start stretching your achilles tendon as soon as you can (without pain, of course). The achilles tendon is what connects the back of the leg and the calf muscles to the bones located at the base of the foot. One good exercise is a towel stretch. This involves sitting with your leg out straight in front of you. What you need to do is place a rolled towel under the ball of your foot, while still holding the towel at both ends. Next, you gently pull the towel toward you while keeping your knee straight. Try to hold this position for fifteen to thirty seconds, and repeat two to four times. In sprains ranging from moderate to severe, it may be way too painful at first to pull your toes far enough to feel a stretch in your calf. Make sure to use caution, and let the pain that you are feeling be your guide. Another good stretch is a calf stretch. What you need to do is to stand facing a wall with your hands on the wall at about eye level. Next, you put the leg you want to stretch about a step or so behind your other leg. While keeping your back heel on the floor, try to bend your front knee until you feel a stretch in the back leg. You should aim to hold this stretch for fifteen to thirty seconds, repeating two to four times. If you can, try to repeat the exercise with the back knee bent a little, still keeping your back heel on the floor. This will stretch a different part of the calf muscle and will reach deeper into the foot.
If the sprain is severe, there will be a lot more selling and the pain will be much more intense. If you are unable to weight bear immediately after injuring your ankle and think you have a severe sprain, you need to look into it more carefully because there could be something more serious going on, such as a broken or fractured bone. If you are unsure if you should get an X-Ray or not, we recommend you check out the Ottawa Ankle Rules and then see a medical professional. Make sure to tell the medical professional everything that leads up to the injury and be detailed when explaining your level of pain. Most ankle injuries do not require surgery, and minor sprains are often treated with a physical therapy program that matches the activities that you do either in sports or in daily life.
The Ottawa Ankle Rules are to determine if there is a need for an X-Ray or further imaging. The goal is to reduce the number of unnecessary radiographs by as much as 25-30%, which can improve patient flow imaging centers, reduce wait time, and shorten waitlists.
X-rays are only necessary if there is pain in the malleolar zone and if there is bone tenderness, and the inability to bear weight.
-If ankle pain is present and there is tenderness over the posterior 6 cm or tip of the lateral or medial malleolus, then ankle x-ray is indicated.
-If midfoot pain is present and there is tenderness over the navicular or the base of the fifth metatarsal, then foot x-ray is indicated.
-If there is ankle or midfoot pain and the patient is unable to take four steps both immediately and in the emergency department, then an x-ray of the painful area is indicated.
The management of pain under the Ottawa Ankle Rules is to X-Ray, follow the RICE plan (rest, ice, compression, elevation), and splinting/crutching.
To go into more detail about the RICE plan, this is a general rule of thumb to follow after any injury. If you don’t already know, RICE stands for Rest, Ice, Compression, and Elevation. Rest is important to prevent further damage by keeping weight off it. Ice is important to slow or reduce swelling and also ease pain by providing a numbing sensation. You should never leave ice on for more than 15-20 minutes at a time, and you should wait at least 40-45 minutes between icing sessions. The best way to add ice is by using a towel between your skin and the bag, to prevent frostbite. Compression is important to keep the ankle immobile and supported. But, make sure not to wrap the ankle too tightly, and if your toes start turning colors, the wrap is too tight. The elevation is important because if the ankle is elevated at least to the level of your heart, it will help reduce both swelling and pain.
A trip to the doctor should be done as soon as possible, and putting weight on the ankle should be avoided until that appointment is made. The doctor will be able to determine the severity of the injury and will determine the need for an X-Ray (as you already read about the Ottawa Ankle Rule). Fractures and sprains left ignored or untreated can lead to many bad things, including long-term chronic problems with the ankle, like repeated injury, weakness, and even arthritis.
If you are still able to bear weight, you are less likely to have broken something. The best thing to do for the ankle in this situation is to not stress it for several weeks after. The general recommendations are to decrease impact weight-bearing such as running or jumping, keep the ankle moving gently, ice/heat, rest and compression. Physical therapy can be beneficial immediately following an ankle sprain to help with swelling control, mobility, and range of motion. When appropriate, strengthening and functional training can be added back in.
To ensure that you do not re-injure your ankle, here are the steps we recommend that you take when seeking treatment. Immediately after the injury occurs, the first step in recovery involves resting, protecting, and reducing the swelling of the ankle. But after a week or so of that, and once the swelling calms down and the ankle is less sensitive to touch, we move on to the next step, which is where we come in. Our physical therapy clinic will help you restore your ankle’s flexibility, range of motion, and strength. This process might take a few weeks, but it is an important step to take seriously if you want to heal this injury without increasing your risk of injuring it again. The last step in the healing process is to gradually return to activity. This means slowing returning to sports or activities that could put your injured ankle at risk. But once you are back to doing daily life, it is important to continue to do maintenance exercises for months afterward. It is important for you to strengthen your muscles and ligaments to increase your balance, flexibility, and coordination. At first, you might need to have your ankle taped, wrapped, or you might need to use a brace in order to keep the ankle in the place it needs to be.
It’s very important to complete your rehab program and to continue to build strength even after you are done seeing your physical therapist, because it makes it less likely that you will hurt the same ankle again. If you don’t complete rehabilitation, you could suffer chronic pain, looseness, and arthritis in your ankle. If your ankle still hurts, it could mean that the sprained ligament has not healed right, or that some other injury occurred. To prevent future sprained ankles, pay attention to your body’s warning signs to slow down when you feel pain or fatigue, and stay in shape with good muscle balance, flexibility, and strength.
With the help of our trained physical therapists and strength coaches, we aim to help increase your strength, balance, and coordination so that you can stay active and potentially ankle injury-free for the rest of your life.
Some recommended exercises and treatments we suggest to our patients are…
Elastic band work
With the help of a resistance band, there are four exercises you can do to help strengthen your ankle in all directions. Resistance bands work by adding an external resistance just by pulling it away from where the force is being applied. Once you wrap the resistance band around the base of the foot and pull, you can try the following:
This involves pulling your toes towards your body with the help of the resistance band in order to work the muscles that support the front of the ankle.
This involves pushing your foot forward while pulling the resistance band toward you. This helps strengthen the arch of the foot and calf muscles.
This involves turning the foot out (towards your little toe) with the resistance from the band.
This involves turning the foot in (in the direction of your big toe) with the resistance from the band.
These four exercises help strengthen all sides of the ankle which can lead to improved function and stability.
Single leg and BOSU Ball balance
Balancing helps strengthen the muscles around the ankle in all directions and is an important functional movement to get back after an injury.
Easing slowly back into sport-specific movements is very important. Agility exercises like ladders, step ups, and jumps are a great transition to get you back into those sorts of movements. It is also important to practice cutting and planting the foot so that the ankle can get used to the frequent changes of direction and strengthen back to normal. If your ankle injury was a fracture, it may take at least six weeks for your bones to heal.
Before attempting any of these exercises, we recommend first learning proper form from either one of our trained physical therapists or strength coaches here at Tensegrity Physical Therapy. If you would like a one-on-one personalized treatment plan to help deal with your ankle sprain/injury, book an appointment today by calling 541-338-7088 or visiting our contact page.