Ankle Injuries: The design of the ankle enables you to walk and run on flat as well as uneven surfaces. To achieve this the joints of the ankle and foot allow movement in 'up and down' and 'in and out' directions. The ankle therefore relies on strong ligaments and good balance reactions for stability.
Traumatic Injury
A traumatic injury commonly involves a sudden twist of or kick to the ankle. The ankle is vulnerable to being sprained by rolling over onto the outside of the foot. The ligaments on the outside of the ankle are more frequently damaged than those on the inside. Repeated minor sprains, if left untreated, may lead to a weak and unstable ankle.
Pain
- At the time of injury a localized sharp pain is felt, usually on the outside of the ankle. This is followed by a constant dull pain.
- As the injury heals, the constant pain is replaced by an intermittent pain that is felt only when the soft tissues are overstretched.
Swelling & Bruising
- Swelling frequently develops around the ankle shortly after injury. This may extend into the foot.
- Bruising may appear after a few days.
Movement & Activity
Movement and activities limited by pain are:
- Pointing the foot down
- Turning the foot in
- Walking, running, and hopping
Serious Injury
Your injury may be serious when:If one or more of the above points apply to you, seek medical advice. In the meantime refer to DAY ONE for the application of RICE to limit further damage. If none of the above points apply to you, you are an ideal candidate for self-treatment.
- You are unable to support any weight through your affected leg
when attempting to walk one hour after the injury occurred.- Substantial swelling appears within five minutes of the onset of the
injury.- Severe pain lasts longer than one hour after the injury occurred.
- Your pain gets worse over two days or you generally feel unwell
Self-Treatment
Day One
R.I.C.E.
Apply rest, ice, compression and elevation every three hours. If walking does not cause any pain, continue to walk with care. If walking is painful, rest for 24 hours. The use of a walking stick will help when you have to walk short distances.
Day Two
Review your progress
Answer the questions below to review your progress:
- Is your pain intermittent?
- Is your pain constant but less severe than yesterday?
- Are you able to walk short distances with the use of a stick?
If you answer 'yes' to one or more of the above questions, your ankle injury is improving. Progress to DAY TWO to DAY THREE of the treatment program. If you answer 'no' to all of the above questions, seek advice from a doctor or physiotherapist.
Day Two to Day Three
Movement
Even though you still may have constant pain, you may begin to exercise your injured ankle and walk short distances as comfort allows. Try to walk smoothly and with even steps. When exercising, carefully move your ankle. Gentle movement may cause discomfort but should not produce or increase pain at your injury site. Perform exercises 1 and 2 every three hours.
Exercise 1:
Position yourself with your leg resting on a firm surface. Gently move your foot up and down as far as is comfortable. Return to the starting position and perform this exercise four times.
Exercise 2:
Position yourself with your leg resting on a firm surface. Gently move your foot in and out as far as is comfortable. Return to the starting position and perform this exercise four times.
RICE
Apply relative rest, ice, compression and elevation following each exercise session.
Day Four
Review your progress.
Answer the following questions to review your progress:
- Has your pain become intermittent?
- Do you have less swelling at your injury site?
- Is there increased movement at your ankle?
- Is walking more comfortable?
If you answer 'yes' to all of the above questions, your ankle continues to improve. Progress to DAY FOUR and DAY EIGHT of the treatment program. If you answer 'no' to one or more of the above questions seek advice from a doctor or physiotherapist.
Day Four to Day Eight
- Start here if your injury is more than three days old *
Movement
Gradually increase the exercising of your injured leg. Walk smoothly and with even steps. Perform exercises 3 and 4 and 5 every three hours. When exercising move your injured area to the point of stretch but not pain. If you started this treatment program at Day One, stop exercises 1 and 2.
Exercise 3
Position yourself with your leg resting on a firm surface. Slowly move your foot up until you feel a gentle stretch at your injury site and hold for one second. Return to the starting position and perform this exercise four times.
Exercise 4
Position yourself with your leg on a firm surface. Slowly move your foot in until you feel a gentle stretch at your injury site and hold for one second. Then slowly move your foot out until you feel a gentle stretch at your injury site and hold for one second. Return to the starting position and perform this exercise four times. Keep your leg still to ensure these movements occur only at the ankle.
Exercise 5
Stand close to a chair, table or wall for support. Balance on your injured foot for up to 10 seconds. Perform this exercise four times.
RICE
Continue with the application of relative rest, ice, compression and elevation following each exercise session. If you are starting the program now, refer to Day One - RICE and Relative Rest - of this treatment.
Day Nine
Review your progress
Answer the questions below to review your progress:
- Do you have intermittent pain only when overstretching the injured area?
- Do you have little or no swelling at your injury site?
- Are you able to perform exercises 8.3, 8.4, and 8.5 without difficulty?
- Can you walk without limping?
If you answer 'yes' to all of the above questions, your injury continues to improve. Progress to Day Nine to Day Twenty-One of the treatment programs. If you answer 'no' to one or more of the above questions, seek advice from a doctor or physiotherapist.
Day Nine to Day Twenty-One
Movement
Return to your daily activities as comfort allows. Do not attempt to run until you can walk on your tiptoes and hop several times without pain. Regain and maintain your general fitness by activities that are unlikely to aggravate your injury; for example, swimming or cycling. Stop exercises 3, 4, and 5. Perform exercises 6, 7, 8 and 9 every three hours. When exercising move your injured ankle to the point of a firm stretch but not pain.
Exercise 6
Position yourself on the floor on your hands and knees. Taking your weight through your hands, slowly lower yourself onto your heels until you feel a firm stretch at your injury site and hold for three seconds. Return to the starting position and perform this exercise four times. As your injury improves, take less weight through your hands until you no longer require support. If you have a knee problem, do not attempt this exercise. Continue with exercises 3, but move your ankle until you feel a firm stretch at your injury site and hold for three seconds. Perform this exercise four times.
Exercise 7
Position yourself standing with your feet shoulder width apart. Taking most of the weight through your uninjured leg, slowly roll over onto the outside of your injured foot until you feel a firm stretch at your injury site and hold for three seconds. Return to the starting position and perform this exercise four times. As your injury improves you will be able to take more weight through your injured leg.
Exercise 8
Position yourself with your hands against a wall with your feet parallel and your injured leg behind. Bend your rear knee and ankle, keeping your heels on the ground. Slowly bend further until you feel a firm stretch at your injury site and hold for three seconds. Return to the starting position and perform this exercise four times.
Exercise 9
Stand close to a chair, table or wall for support. Balance on your injured foot for up to 30 seconds. Once every ten seconds carefully rise up on your toes and ease down whilst maintaining your balance. Perform this exercise four times.
RICE
As your pain and swelling decrease, you may reduce the number of times you apply RICE.
Day Twenty-Two
Review your progress
Answer the questions below to review your progress. Are you able to:
- Perform exercises 6, 7, 8 and 9 with your injured ankle almost as well as your uninjured ankle?
- Jog or run without any pain?
- Hop without pain?
If you answer 'yes' to all of the above questions, progress to Prevention or Re-Injury. If you answer 'no' to one or more of the above questions, continue with Day Nine to Day Twenty-One of the treatment program for up to a further three weeks until you answer yes to all of the above questions. If, after three weeks, you still answer no to one or more of the above questions, seek advice from a physiotherapist.
Prevention of Re-Injury
If your work or recreational activities involve running or jumping, a gradual build-up over three weeks is essential. This allows your ankle to fully regain the ability to perform these more demanding tasks without the danger of re-injury.
If your ankle feels unstable when walking on uneven ground, running or jumping, strapping may be required for additional support. Seek advice on strapping from a physiotherapist.
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