Ankle injuries and complicated ankle injuries
Ian Cardle outlines the importance of the structures and functions of the ankle, the damage that can occur through the common ankle injury, and details the importance of proper diagnostic techniques, the appropriate use of initial treatments, and how functional rehabilitation increases ankle mobility.
The Ankle joint is made up of 4 bones (tibia, fibula, talus, and Calcaneus) and ligament structures (anterior Talofibular ligament, posterior Talofibular ligament, and the Calcaneofibular ligament) that support ankle stability.
All these structures and movements play an important part in an ankle injury and rehabilitating the ankle joint after it has been injured. Many more structures should be considered when rehabilitating an injured joint. The ankle joint is considered to have a major part to play in the stability through the knee and hip joint, and often these structures are not properly rehabilitated together within the injured ankle joint rehabilitation program.
Consideration must be given to other structures not injured in the initial injury incident. The other structures will have a considerable part to play in the prevention of future injury both to these structures and also future ankle instability and proper progression to full mobility.
On many occasions, it has been evident that sportsmen and women break down after returning to their sport far too quickly or return only to injure the same joint or injure another structure that is associated with the initially injured area. A proper injury management system has not been put in place and appropriately controlled to the extent that the sportsperson completes most or part of the rehabilitation unsupervised. This becomes problematic to many sportspeople later in their careers when proper management through the different rehabilitation stages would certainly make for better performance and sustainable sports involvement.
The importance of proper assessment and diagnosis
Proper assessment and diagnosis at the very onset of the ankle injury will aid in appropriate and fundamental treatment and rehabilitation programming to be developed. Paramount to this diagnosis is the knowledge of the injury itself.
The ankle sprain is where the ankle ligaments are stretched to their extreme range of movement without completely tearing, and an ankle ligament tear is where the ankle joint has moved beyond its range of motion causing the ligaments to tear completely. Ankle injury symptoms can include:
Initial treatment for the above symptoms should be:
All ankle joint injuries should be assessed by a suitably qualified physician either at a hospital or in general practice as this allows for a good history and treatment to be programmed as quickly and safely as possible.
Advanced treatment and therapy can then be managed appropriately when the initial settling time of the injury has been completed. This treatment should include range of motion (ROM) exercises, strength progression exercises, functional rehabilitation, and hydrotherapy.
Range of motion (ROM) exercises
The importance of beginning a series of ROM exercises is not to overstretch the injured ankle structure at the initial point of rehabilitation. ROM exercises are essential for the injured person to feel comfortable and positive that the joint is healing within the time and not being rushed or overused too early in rehabilitation
Strength progression exercises
Strengthening the muscles around the ankle injury with isometric exercises, and balancing exercises which are important for regaining the proprioceptive sensory around the injured joint should be introduced steadily when the injury is showing signs of improvement and the injured person is comfortable to increase their level of rehabilitation.
Functional rehabilitation exercises focused on further strengthening and stabilizing the ankle by using a set of closed kinetic chain exercises used when the foot is fixed to the ground, will allow for further development of non-injured support structures i.e.: the knee joint and hip joint designed to allow the muscles around the ankle to exercise while easing stress on the injured ligaments and joints. These exercises are functional as they represent the activities of the ankle during normal daily movements.
Hydrotherapy is an ideal functional rehabilitation-exercising program to include at this stage of injury recovery. Hydrotherapy allows the injured person to work on their non-weight bearing exercise program and also a more general fitness program without stressing the injured joint further.
Two of the more complicated ankle injuries that will benefit from proper injury management and rehabilitation programming are ankle fractures and ankle dislocations.
The injury further complicates both these injuries to the ligament and joint capsule structure during the initial injury. Both these injuries have different rehabilitation problems for the injured person as both will need a period in a cast to allow for the healing process to be complete. It is important to understand that other rehabilitation of the non-injured areas can be started very quickly during the period of casting. It is also possible to complete some small controlled rehabilitation program while the cast is on as this will help to keep the person-focussed and their self-confidence intact. It can also aid the recovery of the injury if controlled in the proper management structure of rehabilitation programming.
Ankle structure, function, ankle injuries, and complicated ankle injury with proper rehabilitation management is a large part of understanding the needs of the injured person from the initial injury happening, being cared for at the scene of the accident by a qualified First Aider, to the outcome of a qualified physicians assessment and treatment needs and the conclusion of rehabilitation management programming from the physiotherapist.
All this will be paramount to making sure that the injured person returns to normal function, and back to their sport with safety first uppermost in their future development after injury.
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About the Author
Ian Cardle Ian has worked in professional sports physiotherapy both at the UK and International level for over 30 years. He has travelled and worked in many countries on sports Injury and rehabilitation development.