Key Principles of Ankle Injury Management

  • Accurate diagnosis is crucial. A thorough clinical examination and appropriate imaging (X-ray, MRI, or ultrasound) help identify the extent of the injury.
  • Early intervention minimises complications such as chronic instability or persistent pain.
  • A multidisciplinary approach involving general practitioners, physiotherapists, orthopaedic specialists, podiatrists, and orthotists enhances outcomes.
  • Rehabilitation and prevention focus on restoring mobility and preventing re-injury through targeted therapy and patient education.

Common Ankle Injuries and Their Management

Sprains

Sprains involve ligament injuries caused by excessive stretching or tearing. Types include inversion sprains (lateral ligament), eversion sprains (medial ligament), and high ankle sprains (syndesmotic ligaments).

Management includes the RICE protocol (rest, ice, compression, elevation) during the acute phase. Moderate to severe cases may require immobilisation with braces. Rehabilitation through physiotherapy focuses on proprioception, balance, and strengthening exercises. Persistent instability may require surgical assessment.

Strains

Strains involve injuries to muscles or tendons surrounding the ankle, either acute (from trauma) or chronic (from repetitive stress).

Treatment includes activity modification, load management, and tendon-specific strengthening exercises in physiotherapy. Insoles or braces may offload the affected area to aid recovery.

Fractures

Ankle fractures can range from simple stable fractures to complex bimalleolar or trimalleolar injuries. Stress fractures are common in athletes from repetitive overuse.

Stable fractures are managed with immobilisation in a cast or boot, followed by physiotherapy. Unstable fractures may require surgical fixation with subsequent rehabilitation. Orthotic devices can support alignment and aid long-term recovery.

Dislocations

Dislocations occur when bones in the ankle joint are displaced, often alongside ligament tears or fractures.

Treatment includes immediate reduction to realign the joint, immobilisation, and referral to orthopaedics. Post-reduction rehabilitation focuses on restoring mobility and strength.

Tendon Injuries

Common tendon injuries include tendonitis (inflammation, often in the Achilles or peroneal tendons) and tendon tears (partial or complete ruptures).

Management involves rest, eccentric exercises for tendon strengthening, and orthotic supports such as heel lifts to reduce stress on the tendon. Complete ruptures may require surgical repair.

Chronic Ankle Instability

Chronic instability arises from unresolved ligament damage or repeated sprains, leading to a "giving way" sensation.

Rehabilitation involves neuromuscular re-education, balance training, and strengthening. Bracing during high-risk activities and surgical reconstruction for severe cases are effective solutions.

Cartilage Injuries

Cartilage damage, such as osteochondral lesions, often results from trauma or repetitive micro-injuries.

Non-surgical treatments include weight-bearing restrictions, physiotherapy, and joint mobilisation. Severe cases may require surgical interventions like arthroscopic debridement or cartilage repair.

Nerve Injuries

Common nerve injuries include tarsal tunnel syndrome (posterior tibial nerve compression) and peroneal nerve injury (from trauma or pressure).

Treatment focuses on nerve gliding exercises, addressing biomechanical contributors, and using orthotic devices to relieve pressure. Surgical decompression may be necessary for severe cases.

Arthritis

Ankle arthritis includes osteoarthritis (degenerative changes) and rheumatoid arthritis (autoimmune inflammation).

Conservative management involves pain relief, physiotherapy, and orthotics. Advanced cases may require surgical options like arthrodesis or ankle replacement.

The Role of Different Specialists

General practitioners handle initial diagnosis, pain management, and referrals. Physiotherapists focus on rehabilitation through targeted exercises and manual therapy. Orthopaedic specialists manage surgical interventions for fractures, ligament repairs, or severe instability. Podiatrists address biomechanical issues and chronic conditions, while orthotists design and fit orthotic devices to support recovery and prevent re-injury.

When to Refer

  • Severe fractures, dislocations, or high ankle sprains requiring surgical intervention.
  • Persistent instability despite conservative treatment.
  • Recurrent injuries or chronic pain unresponsive to standard care.
  • Arthritis or nerve-related conditions affecting mobility.

Conclusion

Effective management of ankle injuries relies on accurate diagnosis, timely intervention, and multidisciplinary collaboration. Medical practitioners play a pivotal role in guiding patients through recovery, whether by offering conservative treatment, prescribing rehabilitative exercises, or facilitating surgical care. By tailoring treatment to the individual and leveraging the expertise of a broader healthcare team, optimal outcomes can be achieved for every patient. You can view Algeos Fracture Boot products here. 

Product Range Links:

Ankle Support and Braces

Drop Foot Braces

Achilles Tendonitis Insoles

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