Friday, 11 September 2015

Ankle Pain

Ankle pain is a wide term that includes many causes which predispose to the pain in the ankle joint, however some of the common causes of ankle pain may include fracture, tendon inflammation, arthritis, gout, ligament injuries and the list goes on….

But the most common and predominant cause of ankle pain, include injury to the ligaments that surround the ankle joint which could otherwise be called ankle sprain or ligament sprain.

What are ligaments??

Ligaments are band of tough elastic tissue around our joints. They connect bone, give our joints support, and limit their movement.
So, when there is an excessive movement to the joint, the ligaments gets stretched or eventually tears which leads to ligament sprain.


Similarly when excessive stretch is put to the ligaments of the ankle which could either be caused due to faulty alignment of the foot, walking patterns on different terrains or sudden ankle twist as in the case of sport injuries can cause ankle sprains.

There are medial (Inner side) ligaments (deltoid) and the lateral (outer side) ligaments that surround the ankle joint. The most common injury is at the lateral ligament is less common which is caused due to outward rotation of the foot (Eversion).

                There are 3 grades of sprains depending upon the severity of injury.

The most commonly affected ligament is the anterior talo-fibular ligament & gets affected due to injury resulting in inward rotation (inversion) of the ankle.
A less common type of ankle sprain occur due to outward rotation (eversion) of ankle & injuries the deltoid or medial ligament.
Foot arch is responsible for supination (High arch) & pronation (Flat Feet) throw ankle more outer
border or inner border of foot respectively. Chances of inversion ankle sprain in supinator which is more common & eversion ankle sprain in pronators are more.


  • Trauma or fall is the most common cause.
  • Weak musculature.
  • Increased laxity &/ reduce stability of ligaments.
  • Walking in high heels or footwear with inappropriate platform.
  • Walking or running on uneven surface.
  • Faulty foot alignment.
  • Impaired balance.
  • Pain & swelling over ankle.
  • Inability to bear weight over affected limb.
  • Stiffness in the joint.

The most basic approach is to follow the PRICE protocol. This abbreviation stand for the following:

P- Protection- which can be attained by use of brace while walking or standing activities. Selection of the brace should be according to the grade or level of ankle sprain. 

R- Rest- which is required for allowing healing. If the patient attempts to walk with the present injury then the chances of further damage are high.

I- Ice pack- This helps in reduction of inflammation & helps in draining out of the end product which helps in pain reduction.

C- Compression- which also can be achieved by the use of braces that provide adequate support.

E- Exercise- which is the most important aspect. 
  •  Physiotherapy for the ankle sprain includes strengthening of the weakened muscles around the ankle joint. Muscles around the ankle joint plays a very important role in maintaining the integrity of the ankle joint).
  • Balance Training
  • Proprioceptive Training

Similarly as mentioned earlier, the type of the foot (Flat Feet / High Arch) also plays a very important role in stability. Depending on the type of Arch, shoe modifications with proper insoles and firm ankle grip is important to prevent re-occurrence of the Ankle Sprain.

Apart from the above if the cause of ankle sprain is faulty foot alignment then it is necessary to administer appropriate treatment for the cause or consult podiatrist.

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