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 | ANKLE PAIN
85% of all ankle injuries are sprains. To define “sprain,” these injuries include any damage to the ligaments of the ankle joint. As you can see from the picture, the ankle joint is comprised of the far end of the tibia sitting on the talus bone and extending down the inside of the ankle an inch or so. The far end of the fibula bone runs down adjacent to the tibia and extends down the outside of the talus. Since the fibula sort of ‘floats” alongside the tibia, it contributes to the strength of the ankle joint by attaching to the fibula, the talus, (twice), and the calcaneus, or heel bone. With all this attaching going on, you can see that ligament injury is going to be the most frequent complaint.
HIGH ANKLE SPRAIN: Technically, this is not an ankle injury. There are ligaments and fascia membranes that hold the fibula to the tibia. A trauma to the ankle causing the joint to bend upward or downward way past the normal motion can force the tibia and fibula to separate. When the two leg bones are forced apart, ligament damage occurs.
Treatment: Muscle-test the injured leg to ascertain if the joint displacement is severe enough to proprioceptively weaken the hip flexors or quadriceps. If so, the doctor must realign the talus, calcaneus, navicular and cuboid bones of the ankle AND position the fibula and tibia properly at the knee.
(A) Ice the injured area for 24-48 hours, 15 minutes of cold application followed by 20-30 minutes of rest and light dorsiflexion exercise. Important. Exercise within the pain-free range of the ankle, only. 8-10 cold treatment per day is adequate, more, if you want to hurry things up.
(pic #2 RIGHTF)
|  | B) Using an overlapping herringbone, tape the lower leg from just above the tibiotalar joint to the level of the Achilles tendon muscle origin. Don’t cover the soleus or gastrocnemius muscles.
(C) Continue with 3-4 applications of ice daily, best after the workout.
(D) Two exercises that seem to help are (1) “drawing O’s with the toes”; heel planted on the ground, patient sitting, forming big O’s in the air with the big toe, and (2) gastroc/soleus presses; patient standing on low-2 inch-platform with the balls of the feet, heels hanging, and raise the body upward. 20 repetitions 2-3 times a day for each. It is VERY IMPORTANT to remember that the patient MUST exercise in the pain-free range of motion.
INVERSION SPRAIN: The patient is running down the court and plants his/her foot to turn abruptly inward, or away from the foot plant. The patient ‘ROLLS OVER’ the outside of ankle and tears any or all of the five constraining ligaments. Another scenario is the patient jumping in the air and landing with the inside of the foot on someone else, causing a similar injury. The foot is forcibly inverted, causing ligament damage.
TREATMENT: The assessment of the severity of the injury is similar to the “high ankle sprain.” If the swelling and discoloration of the injury is instant and extensive, x-ray immediately.
(A) Next, begin ice applications, on and off repeated.
(B) As soon as possible, get the doctor to realign the ankle bones, leg bones, and, if necessary, the foot bones, or metatarsals. All these may be displaced, and full strength with rapid healing will be hindered by failing to re-position these joints correctly.
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(C) Support the newly realigned tarsals by using both heel locks using white or zonas tape AND low-die taping using zonas or Elastikon, usually 2”. When working with professional athletes, always ask their preference in how firm the tape job should feel. You can modify their requests, but make sure they know what you are thinking, or they will likely bail on you. They usually know their bodies, and ankle injuries are common.
(In case you are not sure what these terms mean, heel locks are pieces of tape that run from outside of the leg under the heel and up the inside. Get them on as tightly as the patient will allow. Low-die tape is a cross-over figure eight around the ankle and leg that supports the navicular, or arch, bone while holding the cuboid down next to the cuneiforms. Careful, do not tape too low in back over the Achilles tendon. Hurts.)
SINUS TARSI TRAUMA: Pain in front of the ankle, right at the point of flexion, may be due to swelling of the sinus tarsi. This area is the top of the talus bone, generally. The weight of the body sits on it. A shearing injury such as sudden stops or landing wrong after jumping can move the talus forcibly forward or backward. Sometimes, this movement irritates the sinus tarsi tissue, resulting in limiting pain. The pain can sometimes be duplicated by asking the patient/athlete to hold the foot flat on the ground and bend the knee far forward, like doing a soleus stretch.
TREATMENT: Assessment is similar to the other ankle injuries. Re-positioning of the talus with relation to the far end of the tibia must be done carefully, or the injury will be aggravated.
(A) Ice the painful area repeatedly as described above.
(B) Tape the ankle as with the eversion injury.
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REHABILITATION: Ligament injuries heal slower than less dense tissue, like membranes, joint capsule, or muscles. However, if the joints involved are not aligned, and re-aligned if necessary, throughout rehabilitation, these can become chronic injuries with acquired scar tissue. The athlete/patient MUST be made aware that quick, timely attention and early onset of exercises will greatly support a successful recovery. Anything less will invite disappointing results and may lead to an otherwise unnecessary surgical repair.
The keys to successful rehabilitation are:
ICE DAILY, REPEATED APPLICATIONS WITH INTERMITTENT STRETCHING
EXERCISES, 2-3 SESSIONS DAILY, WITH MOVEMENT RESTRICTED TO THE PAIN-FREE RANGE OF MOTION
PROPERLY APPLIED TAPING.
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