Ankle Injuries & Physiotherapy

Hello and welcome back to the ThreeSpires Physiotherapy blog where we discuss all things physiotherapy related. In this physiotherapy blog we are going to have a look at one of the most commonly injured parts of the body: the ankle. Before we get into this I would like to remind anyone reading that we are a home visit physiotherapy service and our mobile physios will come out to you at home. Our physios serve a wide area including Sutton Coldfield, Lichfield, Tamworth, Cannock, Rugeley, Walsall & Burton.

Anatomy of the Ankle Joint

A good place to start when thinking about how any part of the human body gets injured is the anatomy, so before looking at how it gets injured it would be a good idea if we had a look at the structures involved. As a physiotherapist I was taught that the first thing to look at when you were wanting to learn about a particular joint was the bones involved. Now, with the ankle this can be a little difficult as the ankle and the foot pretty much merge into one with a lot of bones in the foot actually comprising the ankle. However, let’s start with the basics: the two main bones of the ankle are the tibia (shin bone) and fibula. You can feel each of these bones at the ankle yourself: the tibia is the bony bump at the inside of your ankle and the fibula is on the outside. Both of these bumps of bone are called malleoli (malleolus for singular). The tibia and fibula are connected above these two bony bumps by a structure called the ankle syndesmosis which provides added strength to the overall ankle and also below by a series of ligaments which join the tibia and fibula together. Below these two malleoli the tibia forms the main ankle joint where it meets the talus at the talo-crural joint. This is a hinge joint and allows the foot/ankle to bend upwards and downwards. Now, obviously your foot and ankle is able to do a lot more than just bend up and that is because of the tarsal bones of the foot. These are the equivalent of the carpal bones of the hand/wrist and are just below the two malleoli.

Joining all of these bones together are a series of strong ligaments that give the ankle a large amount of stability, especially at end of range. Plus we have the thickest and strongest tendon in the body: the Achilles tendon just behind the ankle. On each side of the malleoli of the ankle there are ligaments attaching the bones of the tibia and fibula to the bones underneath. On the inside part of the ankle we have the deltoid ligaments which join the tibia to the calacaneus (heel bone), talus and navicular bone. This is an extremely strong ligament and a serious injury to this often results in part of the bone being pulled off. At the outside part of the ankle there are also a series of ligaments joining the fibula to the talus and calcaneus with the most commonly injured being the anterior talo-fibular ligament (ATFL).

Ligament Strains

Okay, so let’s have a look at the most common injuries that we as physiotherapists see at the ankle. First thing to note is that by far the most common cause of ankle injuries is a sporting injury from a sport that involves lots of stop start and twisting and turning such as football. Then next point to note is that lateral ankle (the outside of the ankle) strains are much more common than medial ankle (inside of the ankle) strains.

So, let’s have a look at lateral ankle sprains and injuries. Due to the amount of inversion (inward twisting of the foot) possible and the general bony mechanics of the ankle the ligaments on the outside of the ankle are much more likely to be injured. The most commonly injured part is the anterior talo-fibular ligament (ATFL) which joins the fibula and talus together. When most people describe “going over” on their ankle this is the area that is most likely to be damaged. If you injure this ligament usually you will experience immediate swelling and very sharp pain with potentially some bruising. One important point to note is that if you have gone over on your ankle and you can’t stand on it and take a few steps, you likely need an x-ray to rule out a fracture. Another important point to note is that lateral ankle sprains take a long time to fully recover from: at least 6 – 8 weeks and probably longer depending upon the severity. To help your recovery it would generally be advisable to see a physiotherapist as soon as possible.

It is also possible (but much less common) to injure the inside part (medial) of your ankle. However this is not very common due to the mechanics of the ankle and also the fact that the deltoid ligament is very strong. In fact if you injure this part you almost certainly need an x-ray as an injury to the deltoid ligament of the ankle will often pull a part of the bone off rather than rupture the ligament! Again swelling, pain and bruising are very common symptoms and rehab/recovery times are quite long.

Lastly we have what are called “high ankle sprains” which in general are attributed to the joint between the tibia and fibula called the ankle syndesmosis and damage to the ligaments that make up this joint. Injuries here are much less common than lateral ankle injuries and are generally seen from a twisting a rotating force. These can be common in footballers and in any sport where there can be a large amount of rotational force at the ankle. Symptoms can range from very mild to severe feelings of instability at the ankle.  

With all the ankle injuries described above I would strongly recommend that to improve your chances of a good return to sport or normal activities you should see a physiotherapist. If you live in any of the following areas our physiotherapists would be able to see you at home in Lichfield, Sutton Coldfield, Tamworth, Cannock, Walsall and Rugeley.

For anyone reading this blog for the first time: we are a home visit physiotherapy service, based in Lichfield and serving Sutton Coldfield, Tamworth, Cannock, Walsall and Rugeley.