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Ankle Injuries


**Before we get into this, I want to say that ankle injuries are incredibly common and can be caused by MANY things! I will just be covering some of the more common injuries.**


First up, lets have a short and simple anatomy lesson on the ankle, because there is a lot of stuff that's going on there!

Bones:

The ankle joint is formed by three bones; the tibia and fibula of the leg, and the talus of the foot:

The tibia and fibula are bound together by strong tibiofibular ligaments. Together, they form a hinge shaped socket, covered in cartilage. The body of the talus (ankle bone) fits snugly into the cavity formed by the tibia and fibula.



Ligaments:

The medial ligament (or deltoid ligament) is attached to the medial malleolus (a bony prominence projecting from the tibia). It consists of four ligaments, which fan out from the malleolus, attaching to the talus, calcaneus and navicular bones. The primary action of the medial ligament is to resist over-eversion of the foot (rolling in).


The lateral ligament originates from the lateral malleolus (a bony prominence projecting from the lateral aspect of the distal fibula). It resists over-inversion (rolling out) of the foot, and is comprised of three distinct and separate ligaments:

Anterior talofibular, Posterior talofibular, and Calcaneofibular


Tendons:

Flexor Hallucis Longus (FHL) tendon --The FHL muscle is designed to assist with movement of the ankle, foot and big toe. The role of the FHL muscle is to allow the foot to point at the ankle and the big toe, and allows the foot to roll in at the heel. This lets us to perform activities such as: running, jumping, hopping and rising onto the toes. 

Achilles Tendon -- The Achilles is the biggest mover when it comes to pointing your foot. The role of your Achilles is to, when flexed, point the foot, and to stop the foot from to much dorsiflexion. This is what lets us run, jump, and rise onto the toes. More below on Achilles ruptures

**There are many more tendons, however these are the ones that I will be covering!**


Movements:

Dorsiflexion – Flexing your foot or pulling your toes towards your shin.

Plantarflexion – Pointing your toes.

Inversion - Foot rolling out to pinkie toe.

Eversion - Foot collapsing or rolling in to big toe.


 

*Injuries*


Sprained Ankle


What is a Sprained Ankle?

A sprained ankle is the most common ankle injury there is, and it occurs when your ankle ligaments are overstretched. Ankle sprains vary in their severity, from mild a"twisted ankle" or a"rolled ankle" through to severe complete ligament ruptures, or even broken bones. 


What are some of the causes?

A Sprained Ankle can occur simply by rolling your ankle on some unstable ground. This can often happen when awkwardly planting your foot when running, landing unbalanced from a jump or stepping onto an irregular surface.

The most common ligaments to be affected by an ankle sprain are the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL).


Treatment

Unfortunately, a sprained ankle can increase your risk of re-injury as much as 40-70%, but the correct post-injury rehabilitation plan can significantly decrease the risk!  

There are essential treatment aims that need to be covered to effectively rehabilitate your sprained ankle and prevent recurrence. Depending on the severity of your sprain, this should be tackled with a team. your doctor, physiotherapist, and any other movement specialists you need. P.S Pilates is a fantastic way to continue your rehabilitation and PRE-HAB your body alongside your physio!


The key steps you will go through in your Rehabilitation

1. Pain Relief & Control Inflammation

2. Regain Full Range of Motion

3. Strengthen your Ankle and Calf Muscles

4. Restore Balance and stabilization

5. Restore Normal Function

6. Speed & Agility

7. Sport-Specific Skills

8. Return to Training

9. Return to Competition

10. Continue Maintenance to reduce risk of re injuring! Including work on the OTHER ankle!


Ankle Tendon damage (Tendonopathies)


What is a Tendonopathy?

Your muscles or tendons can become injured or inflamed as a result of overuse or trauma. Inflammation of the tendon(s) is called tendonitis. They can also tear, rupture, or sublux (pulled out of place out of place). Medically tendon injuries are known as tendonopathies.


What are some of the causes?

Achilles rupture: Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton. 

Achilles tendonitis: Over-training or unaccustomed use, A sudden change in training surface Flat (overpronated) feet, High foot arch with tight Achilles tendon, Tight hamstring and calf muscles, Toe walking (or constantly wearing high heels), Poorly supportive footwear, Hill running, Poor eccentric strength.

Plantar Fasciitis: Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles.

It is also common in individuals with Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis. Click here to see my full post on Feet.


Treatment

Treatment for your tendonopathies can vary from injury to injury, and cause to cause.

For any ruptures, make sure you are cleared by your doctor and physiotherapist to continue rehabilitating your body using other modalities. A good general rule for tendon inflammation, work to loosen the muscle attached to the tendon, eg the calf and hamstring for Achilles tendonitis, as well as build muscle on the supporting and partner muscles, eg the arch of the foot, and front of the leg. Scroll up to see treatment for ankle sprains for the key steps!


Ankle Fracture


What is an Ankle Fracture?

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are fractures of your fibula, which can be a side effect of an ankle sprain. These are generally less troublesome than if you experience a talar dome fracture with your actual ankle joint. Potts fracture is a major fracture of your tibia and fibula simultaneously.


What cause Fractures?

Ankle sprains, trauma, and impact.


Treatment

All suspected fractures need to be accurately diagnosed and professionally managed by your health professional to avoid long-term foot and ankle issues. If an ankle fracture is suspected you need get an Xray and potentially referred to an orthopaedic surgeon.


Ankle Arthritis


What is Arthritis?

While there are over 100 different kinds of arthritis, the 3 most common types are what I'm going to cover today.

Osteoarthritis: The joints show signs of wear and tear. Joint cartilage becomes worn and thin, bony spurs grow in response to joint stress, and joint motion lessens. In advanced stages, osteoarthritis can be painful, limiting and depressing.

Rheumatoid Arthritis: An autoimmune disease that causes inflammation in your joints. The main symptoms are joint pain and swelling, but can cause morning stiffness, depression, tiredness, and rheumatoid nodules.

Psoriatic Arthritis: A painful inflammation in and around your joints. It usually affects people who already have psoriasis, a skin condition that causes a red, scaly, rash on your elbows, knees, back, rear and scalp. However, some people develop the arthritic symptoms before the psoriasis, while others will never develop the skin condition.


Treatment

Sadly treatments for arthritis include, but are not limited to, medication and in extreme cases surgery, including joint replacements. This does not mean that there's nothing we can do! We can continue to support proper function in the joint, support the inflamed joint via strengthening supporting muscles while also loosening any tightness. This can be done in your Pilates classes, with physiotherapists, alongside chiropractors, acupuncturists, you name it!



Mental health


In all cases, no matter what part of you is injured, no matter what degree its injured too, take the time to assess your mental health throughout your recovery. There are lots of times where depression can take over while working to rehab the body. Don't get discouraged. you can do this!

You also have to treat fear. Once an injury has happened, there will always be some fear of it happening again. Fear is a good thing, it keeps us safe. However do not let it control you! A great example of this was actually my first client, and my big school project, aka my mother! She had been rehabilitating a hip replacement and was afraid to mount her horse, not only with her new hip, but her "good" one also. This was fear that was stopping her from getting back up on her horse, not a physical block. And you know what they say. No matter how hard the fall, you gotta get back in the saddle.


I wish you all well in your recovery!

Katya MacDonald.

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