Ankle Joint
An ankle sprain is the most common injury among athletes, occurring during an improper landing, an awkward step, or excessive twisting of the foot.
The upper ankle joint, or ankle, is made up of three bones: the tibia (shin bone), the fibula (calf bone) and the talus (ankle bone). The articular surfaces that connect in this joint are the lateral malleolus of the tibia (the bony prominence on the outer side of the lower leg) and the upper surface of the talus. These articular surfaces form a kind of saddle that provides stability and mobility in the upper ankle joint.
Ankle joint injuries:
-Ankle sprains (distortions), as the most common injury
-Inflammation of the Achilles tendon
-Partial or total rupture of the Achilles tendon
-Morton’s neuroma syndrome
-Bursitis
-Plantar fasciitis
-Ankle fractures
-Tarsal tunnel syndrome
The text refers to a distortion or sprain of the ankle, which can have three degrees of damage. A distortion is an injury to the soft-tissue structures of the ankle joint. In this case, the soft-tissue structures most often refer to the ligaments of the ankle. However, depending on the intensity of the injury, soft tissues such as muscles and muscle tendons may also be damaged. Accordingly, there are several degrees of distortion:
- Degree of elongation – indicates stretching of the ligaments;
- Degree of laceration – indicates partial tearing of the ligaments;
- Degree of rupture – indicates a split or complete tearing of the ligaments.
An ankle sprain is the most common injury among athletes, especially during an improper landing, an awkward step in sports, or excessive twisting of the foot. However, this injury can also occur in everyday life in various situations, when a sudden twisting of the joint takes place.
People with reduced range of motion, inflexible joints, weak muscles, and poor joint stability are at greater risk of this kind of injury. Surgical treatment of an ankle sprain is very rarely recommended; orthopedists generally advise immobilization of the segments as part of the therapy.
Ankle Rehabilitation
The first aid in the treatment and rehabilitation is the RICE method. RICE consists of four components:
- R (rest)
- I (ice)
- C (compression)
- E (elevation)
An ankle sprain primarily requires rest, avoiding loading the leg. In some cases, the use of crutches, one or both, may be indicated depending on the degree of the injury. The leg should be iced (cooled), i.e. cryotherapy should be applied, which is one of the best methods for reducing swelling and relieving pain.
Compression means bandaging the leg with bandage material or using a brace. In this way, further spread of the swelling is prevented and the stability of the affected joint is increased.
Elevation means raising the leg above the level of the rest of the body in order to encourage the reduction of swelling and facilitate its resorption through the lymphatic system.
A distortion (sprain) as an injury always has an individual course of treatment depending on the degree of damage, and recovery can take anywhere from a few weeks to several months. As many as 75% of people who have suffered an ankle distortion will face the same injury again due to insufficient or improper rehabilitation.
This can lead to instability in the ankle joint. For this reason, it is advisable to seek the help and advice of an expert team after an injury for proper rehabilitation and the prevention of future complications.
If an ankle or foot distortion is not treated in time, the swelling around the joint can last from 6 to 12 months after the injury. Physical therapy is essential for treating this condition, but it is also important to carry out adequate kinesitherapy in order to restore the mobility, stability and strength of the ankle joint.
If mobility is not restored, which is often the case, a disturbance of statics may occur, which can result in persistent swelling that appears when the joint is loaded. Therefore, timely treatment and adequate rehabilitation are important in order to prevent long-term complications.
In the case of a third-degree ankle distortion, where rupture of the ligaments and surrounding tissues has occurred, it may be accompanied by a fracture of the fibula. In such situations, it is very important to take an X-ray (X-ray imaging) in order to determine how large the fracture is.
Based on the degree of the injury, an immobilization plan is made (cast, bandage, splint) and the period during which the segment will be immobilized is determined. Walking with the aid of crutches is unavoidable in these situations, and the doctor determines how long the crutches will be used and when weight-bearing on that leg can begin. If an X-ray is not taken and the possible presence of a fracture is not established, the symptoms can cause pain even after rehabilitation has been completed.
In parallel with the use of crutches, physical therapy can be started in the rehabilitation process.
Ankle Pain
Pain in the ankle joint can be acute (the first 4 weeks after the injury), subacute (4 to 12 weeks after the injury) and chronic (from 12 weeks up to 6 months).
Acute pain occurs immediately after the injury, at the moment the joint structures are damaged. Within half an hour, significant swelling appears around the lateral malleolus (the outer ankle), which can limit the joint’s mobility. Pain is also present when walking and bearing weight on the ankle joint.
Chronic pain in the ankle joint is characterized by less swelling compared to acute pain, and it varies in intensity depending on the load. An increase in pain can occur when walking down stairs, during increased physical activity, or during a longer car ride. The mobility of the ankle joint is still limited, which can lead to the recurrence and increase of swelling.
Treatment
Magnet therapy, the currents of a BTI device (using devices such as IFS, TENS, DD and electrophoresis), Tecar therapy and laser therapy are used as the main procedures for accelerating bone regeneration in the treatment of the ankle joint. Ultrasound is used in cases where there is no fracture, in order to reduce swelling of the ankle joint.
Laser therapy is also used for accelerated tissue regeneration, pain reduction, and faster healing of the bones in the joint.
As part of kinesitherapy, manual therapy and drainage are applied in order to maintain the mobility of the ankle joint and prevent the possible formation of thrombosis due to a lack of movement.
After the period of immobilization, the mobility of the ankle joint is impaired. To restore movement, the therapist applies passive exercises that include stretching and manual mobilization techniques for the ankle joint, using the Brian Mulligan concept.
When the patient gains full weight-bearing on the injured leg, gait training and kinesitherapy begin, including proprioception, balance and strength exercises. These exercises aim to restore stability, strengthen the muscles, and improve the functionality of the ankle joint.
Joint Strengthening Exercises
Static resistance therapy: The therapist provides manual resistance, and the joint does not move. The patient resists the therapist’s resistance, which activates the muscles of the joint.
Eccentric exercises with elastic bands or manual resistance: The patient performs exercises in which the joint moves in a controlled way in the direction opposite to the resistance of the elastic band or the therapist.
Concentric exercises with bands or manual resistance: The patient performs exercises in which the joint moves in the direction of the resistance of the elastic band or the therapist, and a gentle stretching of the foot is carried out.
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Related services: for an ankle injury we recommend Tecar therapy and electrotherapy. To make an appointment book an examination.