Foot rehabilitation after ankle bending

The ankle joint as part of the foot region allows for the transition from the lower leg to the foot itself and large loads are transmitted through this region every day, and often these loads, depending on the situation we are in, are too large for anatomical structures that maintain ankle stability. According to statistics, ankle joint injuries are one of the most common injuries in general, both outside sports and in sports, and are the cause of about 20-30% of sports injuries per year. Acute ankle sprain accounts for 85% of all ankle injuries and is also the most common sports injury.

Anatomical structures of the ankle

The upper ankle joint is the connection between the lower leg, tibia and fibula with the ankle bone. Dorsal and plantar flexion movements are performed with the ankle joint.

The lower ankle joint consists of two parts, the back and the front which is the connection of the ankle with the tarsal part of the foot.

There are active and passive ankle stabilizers as well.

What is ankle sprain?

Ankle sprain is an injury to the ligaments that support the ankle, and usually occurs when the ankle is twisted, and the foot is turned inward (foot inversion) or outward (foot eversion). A sprain can involve a variety of types of ankle injuries, from a simple ligament injury to more complex intra-articular fractures. It is mainly an injury of the ligaments, and most often an injury of the lateral ligament complex of the ankle (lateral distortion)

COMMON CAUSES

Playing sports that include landings such as gymnastics, basketball, ballet, athletics, and volleyball increases the risk of ankle sprains. Examples of situations that can lead to ankle sprains due to a sudden change in foot position and large forces acting on the ligament ligaments are:

  • sudden fall
  • awkward landing or bouncing
  • a clumsy step in high heels
  • walking or exercising on an uneven and unstable surface
  • going down the stairs
  • when slowing down if longer steps are used

Types of ankle spraining:

Lateral ankle distortion is one of the most common injuries in athletes, accounting for about 25% of all sports injuries. It is caused by excessive inversion of the foot, and results in injury to the lateral ligament.

Medial ankle distortion is a less common form of ankle injury caused by eversion and external rotation of the foot, resulting in medial ligament injury.

High ankle distortion or syndesmosis injury occurs due to excessive and sudden force during plantar or dorsal ankle flexion and can often occur in combination with medial ankle distortion. The anterior ligament is most often injured, while injuries of the posterior ligament are somewhat less common.

REHABILITATION

The treatment of ankle sprains depends on the severity of the injury. Many people treat injuries at home unless there are more severe symptoms and a more serious clinical picture.

If it is a sprained ankle ligament or a far more severe ankle injury, physical therapy will speed up the course of treatment. Results are usually achieved within 2 to 8 weeks, depending on the severity of the injury.

In case of mild injuries, return to normal daily activities is expected within 10-15 days of the injury. If it is a more serious injury, it takes 6-8 weeks.

Therapeutic procedures used in rehabilitation in case of ankle sprains are:

LYMPHATIC DRAINAGE

Lymphatic drainage is a therapeutic procedure that uses very light pressure and long, gentle, and rhythmic strokes on the skin to improve lymph flow.

PRICE METHOD

  • Protection – reducing load on the injured leg if walking is painful and avoiding further risky activities that may worsen the condition.
  • Rest (rest) – does necessarily mean to lie motionless, but reducing active movement of the joint to the limits of pain.
  • Ice – application of ice packs to reduce swelling and hematomas and relieve pain. Ice is always applied over a layer of dry cloth (gauze or towels) for no longer than ten minutes. It is important to emphasize that cooling must be repeated every two to three hours during the day, but not during sleep.
  • Compression – Most commonly applied is an elastic bandage that wraps from the root of the toes to above the middle of the lower leg.
  • Elevation – placing the foot in an elevated position 10 to 25 cm above the level of the heart.

THERAPEUTIC EXERCISES

Once the reduction in swelling and pain is achieved, work should begin towards strengthening the joint with strength, mobility and proprioception exercises. Therapeutic exercise is one of the main treatments that help to restore mobility after ankle sprains. A physiotherapist can prescribe the right exercises for you at the right stage of healing to get you back to optimal mobility quickly and safely. Before performing any exercise program, consult your doctor to make sure the exercise is safe for you.

Once the reduction in swelling and pain is achieved, work should begin towards strengthening the joint with strength, mobility and proprioception exercises. Therapeutic exercise is one of the main treatments that help to restore mobility after ankle sprains. A physiotherapist can prescribe the right exercises for you at the right stage of healing to get you back to optimal mobility quickly and safely. Before performing any exercise program, consult your doctor to make sure the exercise is safe for you.

Proprioception exercises

Proprioception is the body’s ability to sense the position of a joint in space. When you close your eyes, you can feel the position of your body without looking at what position your body is in. Proprioception also helps control the position of your body. Good proprioceptive training can prevent the ankle from getting into a position where there is a greater chance of injury.

Examples of proprioception exercises:

  • Balance on one leg. Try standing on one leg for 10-30 seconds.
  • Repeat the number standing on one leg with your eyes closed.
  • Plate balance and throwing the ball: while maintaining balance on the balance plate, throw a small ball (2kg) with your partner.
  • Plate balance and half-squat: Maintaining balance on the balance plate perform 10 slow, controlled half-squats.
  • Stepping on the balance plate: place the balance plate (either a soft pillow or a foam pad) 15-20 cm higher than the starting position. Step 10 times.
  • Stepping on the balance board: place the balance board (either a soft pillow or a foam pad) 15-20 cm lower than the starting position. Step 10 times.
  • Lateral plyometrics: perform a sidestep down then a step up.
  • Jumping on one leg: jump forward and concentrate on landing.
  • Jumping on one leg from place to place: jump from place to place on the floor.
  • Reactive jumping from place to place put numbered marks on the floor and as your partner dials the number, jump on it.

When it comes to severe injuries, surgery is required. Today, surgical treatment is reserved only for patients who still have problems after the treatment.

N.R.
14.06.2022.