Dodgy Ankles - A guide to common ankle injuries

Football season is about to hit the Eastern Suburbs with full force and already a few ankle injuries have been limping through the Total Physiotherapy doors. No better time to have a quick look at the common types of ankle injuries and how you might manage them. 

The "roll in" inversion injury. This is the most common ankle injury, where the foot turns in and you roll over the outside of your ankle. You will likely have pain and swelling on the outside of the ankle. It might be a result of uneven ground, wearing high heels or simply putting your foot in the wrong spot. When the foot rolls in it stretches the ligaments on the outside of the foot – these are quite thin and relatively weak so the chances are you have a tear of these ligaments. Don't worry, in most cases the tear will scar up and heal if managed properly. What you want to do is settle the pain and swelling, keep the ankle moving and start weight-bearing through that foot as soon as possible. Ice will help settle the initial pain and inflammation. Support – such as compression, strapping or a brace can help improve the initial recovery. It will be important as it heals to regain full movement and strength in that ankle so it doesn't become the type of injury that keeps recurring.  

The "roll out" eversion injury. Less common than rolling out, here your foot will turn out and you roll over the inside of your ankle. This stretches the thicker and stronger ligaments on the inside of the ankle joint. Side stepping or being hit on the outside of the lower leg by an opposition player can cause this injury. As these ligaments are stronger than the outside ligaments it often requires more force to damage these and as a result may take a little longer to recover. It is important these ligaments heal well as they provide a lot of stability to the ankle. Again icing and compression in the early stages will help and in many cases these injuries will require bracing or even a boot as they settle. This will help manage pain, get you weight-bearing and mobile earlier (which helps with healing and a better end result from my experience) and allows the ligaments to scar up and heal. As this injury heals stiffness and weakness are a bigger issue than the "roll out" injury so require a bit more time and effort in restoring normal range of motion and strength.   

The "stick and twist" injury. This is how the dreaded syndesmosis injury occurs – an injury feared by coaches and players alike, especially in football codes. This is where a players foot is planted on the ground and sticks in a fixed position while the rest of the body is twisted, often while being tackled or pulled down by an opposition player. This is quite a traumatic injury, potentially causing damage to both the ligaments on the outside and inside of the ankle, across the front of the ankle joint and in many cases what we call the syndesmosis, which is tissue which holds the shin bones (tibia and fibula) together. If it tears through the syndesmosis a very unstable ankle is the result as these bones will spread apart when putting weight through the ankle or with twisting movements. In severe cases the ankle can dislocate and bones at the ankle or further up the shin can fracture. Surgery will be required in this case, and also in cases where there is significant damage to the syndesmosis resulting in an unstable ankle. Following surgery a period of time in a boot is required to allow adequate healing and this will be followed by intensive rehab to restore range of motion and strength before returning to sport. This injury will likely rule a player out for the rest of the season. If the injury does not require surgery, a period in a walking boot is required to allow the injury to heal sufficiently to ensure the ankle will be stable. This again is followed by intensive rehab to restore range of motion and strength before returning to sport. In these non-surgical cases I find it's at least a 12 week period until a player can successfully return to sport.  

The "foot pointed" injury. Often this is from a fall or getting caught in a tackle with the foot pointed and weight going through the top of the foot. This may result in injury to the ligaments at the front of the ankle, outside of the ankle, ligaments of the mid-foot or forefoot. When ligaments of the foot are involved it is best to treat these for a period in a walking boot as it is very painful to weight-bear and walk with these injuries. These injuries will heal well with a period of immobilisation in a boot then rehab to restore strength and range of motion. A more severe injury that can occur in this way is called a Lis Franc injury, where the ligament between the big toe and 2nd toe occurs. These tears do not heal as well due to the amount of movement and force that goes through that joint so as a minimum you will need to be treated for a period in a boot. More severe cases may require surgery to stabilise the joint. If you have sustained a suspected Lis Franc injury this will need to be investigated with imaging and in many cases followed up by a doctor or Specialist.  

For more information about sporting ankle injuries check out Sports Medicine Australia's Fact Sheet.

Stuart McKay
APA Physiotherapist
Principal Physiotherspist, Total Physiotherapy