Ankle and foot are very complex area of the body. Multiple joints together make an ankle joint and foot has a lot of bones forming different joints. Moreover, the joints in the foot and ankle are very small. The ankle and the foot have to bear the entire weight of the body when you we are standing, walking or running. The impact on these joints is really huge with jumping or any such kind of high intensity activity.
In any kind of sports injury rehabilitation, the most common issue with the ankle is sprain or strain. Most commonly, the ankle is sprained with inversion stress. Ankle sprain, strains and other soft tissue injuries can occur as a grade 1, grade 2 or grade 3 tear. Grade 1 and grade 2 are partial tearing of ligaments supporting the ankle joint. Grade 3 is complete tear of anterior talofibular ligament and calcaneofibular ligament. Grade 1 and grade 2 tear are treated conservatively and are the most common form of ankle injury in athletes. Grade 3 tear is treated surgically as the torn ligament has to be treated.
Due to grade 1 or 2 tear, athlete faces a lot of difficulties like immobility, difficulty in balance, decreased range of motion of ankle joint, muscle inhibition, sprain and strain treatment, ,treatment of chronic pain, restricted ambulation. Any high intensity activity, like jumping is not safe with partial tear as it could lead to complete tear of the ligament. Sprains have to be treated in three phases: 1. Protection Phase, 2. Controlled Motion Phase and 3. Return to function phase.
Phase 1 includes the RICE treatment (rest, ice, compression and elevation). This phase is very important to reduce effusion and inflammation. Phase 2 includes controlled motion of the ankle joint. Patient is guided to keep the ankle in a splint and perform non-weight bearing movements. Joint mobilization and cross-friction massage should be included in phase 2 treatment. Patient can perform range of motion movements of the injured ankle (sprains, strains and other soft tissue injuries, sprain and strain treatment or chronic pain treatment, sports injury rehabilitation) and toe exercises of the same foot for maintaining the circulation. In phase 3, patient can progress to weight bearing exercises as tolerated and still use crutches if needed. Patient can gradually progress to full weight bearing exercises and then high intensity exercises.
Ankle is very unstable joint and thus, the muscles supporting the ankle joint should be strengthened properly. Even after the injury, the athlete’s ankle should wrapped or taped and proper shoes should be worn to maintain the stability of the injured ankle.