Total Care Facebook Total Care Instagram Total Care Linkedin Total Care Youtube

Ankle Sprains

What is a sprained ankle? – Blog By Kara Giannone

An ankle sprain occurs when your ankle ligaments are overstretched. They can vary greatly in severity from a minor “rolled ankle” to a complete ligament rupture with or without bone tendon or muscle injury. They are graded as 1, 2 or 3 depending on the severity.

 ankle-sprain-1

Anatomy of the ankle

The ankle, referred to as the talo-crural joint or true ankle joint, consists of three bones – the tibia, fibula and talus and is responsible for plantarflexion and dorsiflexion of the ankle. The subtalar joint lies underneath the true ankle joint and is the articulation between the talus and calcaneus. It assists the talo-crural joint in inversion and eversion. Most ankle sprains occur from an inversion mechanism of injury (rolled in).

anatomy

The most commonly injured ligaments of the ankle are the lateral ligaments which sit on the outside of the ankle. These include the anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament. The ligament on the inside of the ankle is called the deltoid ligament which is much stronger and hence more difficult to injure.

anatomy3

High ankle sprains refer to injury to the inferior tibiofibular ligaments and syndesmosis which bind the tibia (shin bone) and fibula (calf bone) together above the ankle. A high ankle sprain is a much more debilitating injury, requiring a longer recovery time.

What causes an ankle sprain?

Ankle sprains occur most commonly by a sudden twisting or rolling action of your ankle often on unstable irregular surfaces. The ligaments affected is determined by the direction the foot rolls. The most common ankle sprain is the ligament on the side which occurs when the foot is turned in as shown below.

Certain factors can put a person at greater risk of spraining their ankle including poor footwear, previous injury, reduced strength, poor biomechanics or poor balance receptors.
rolled-ankle

What are the symptoms of a sprained ankle?

  • The mechanism of rolling your ankle is a clear indicator that you are likely to have sprained your ankle
  • You may hear a popping or cracking sound at the time of injury
  • The injured ligaments will be quite tender to touch in that initial phase
  • Swelling and bruising
  • Generalised ankle pain
  • In the cases of a severe ankle sprain, you may have difficulty walking and may require the use of crutches to mobilise.

How is a sprained ankle diagnosed?

Physiotherapists will take a thorough history and conduct a comprehensive clinical examination to effectively assess and diagnose ankle sprains. Furthermore, to exclude certain fractures or ligamentous injuries, it may be required to refer for imaging like a X-RAY, MRI or CT scan.

 

Management of an ankle sprain

A person who sprains their ankle is up to 70% more likely to re-sprain their ankle without the correct post-injury rehabilitation.

In the initial 72 hours post injury, it is essential to use the principles of R.I.C.E – This include rest, ice the affected area every 2 hours for 20 minutes, compress the ankle with a compression bandage and elevate in order to manage pain and swelling.

Physiotherapy is crucial in the management of ankle sprains. It is important in managing pain and improving range of movement, strength, proprioception, balance and assist in return to your pre-morbid level of activity.

Physiotherapy treatment may include:

  • Education
  • Gait re-training
  • Biomechanical correction
  • Exercise prescription including sport specific training
  • Taping
  • Soft tissue massage
  • Mobilisations
  • Sport specific training
  • Electrotherapy and more!

 

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray, we specialise in accurate assessment, management and return to sport or level of activity for clients presenting with ankle sprains. 

Book an appointment today for your assessment!

Blog post by Kara Giannone

What is Sever’s Disease?

SEVER’S DISEASE

Sever’s disease or “calcaneal apophysitis” is a common condition affecting children. It is characterized by an insidious onset of heel pain that usually worsens rapidly. It can be develop in any child but more commonly affects physically active children, and is more common in boys. It develops just before puberty and is most often seen in girls aged 9-11 and boys aged 10-12.

Despite being a fairly common condition, many parents are unaware of the signs and symptoms, the management on the condition and the long term prognosis for their child. This blog will help explain the condition and pathways of management used by physiotherapists.

What is Sever’s Disease?

Sever’s Disease is inflammation and subsequent pain in the growth plate or “epiphyseal plate” in the heel of the foot. Growth plates are found at the ends of developing bones and contain cartilage cells that form into adult bone. This process occurs during a growth spurt in children and is how their bones grow.

severs

When this process is occurring the growth plates are weaker as they have not fully formed into adult bones. In this period of rapid growth, a child’s bones grow faster than their muscles causing them to be become tight. In the instance of sever’s disease the calf muscle and Achilles tendon is pulled tight resulting in pain and inflammation where it attaches to the weakened bone on the heel.severs2

Signs and Symptoms

  • Pain in the heel area or achilles tendon on one or both feet
  • Pain during and/or after exercise
  • Worsened by impact activities like running, jumping, landing
  • Worsens with exercise often improves with rest
  • Swelling at the heel and can be sore to touch
  • Calf muscle tightness
  • Limping or walking on toes

Factors that can contribute to developing Sever’s

  • Being physically active
  • Wearing inappropriate shoes during sport
  • Playing sport on hard surfaces
  • Pronated feet
  • A flat or high arch (both cause tightening of the Achilles tendon)

Diagnosing Sever’s Disease

A physiotherapist or podiatrist can usually diagnose Sever’s from asking questions and a simple assessment of the foot.  An x-ray is not necessary but can show changes to bone to help diagnose and also rule out other possibilities like a fracture.

Treatment

Initial management:

  • Rest from activity until pain resolves
  • Ice post exercise or end of day
  • Stretching for calf muscle and achilles
  • Wearing well fitting supportive footwear
  • Heel lift in shoes to offload the tight Achilles tendon
  • In more severe cases when bone is heavily disrupted your child may be prescribed a cam boot by their physiotherapist or podiatrist. These are worn for a few weeks to limit weight bearing through the foot and allow the bone and growth plate to properly heal

Once symptoms have settled your child can return to activity gently. Your physiotherapist will usually advise you to begin with lighter activity and progress to higher impact activity to ensure the growth plate is not aggravated causing a flare up of symptoms.

Prognosis

Once the child’s initial rapid growth slows, symptoms generally resolve with no long term effects. Flare ups can occur over months during puberty but are only self limiting, meaning they are temporary and will settle with rest. If the child continues to overload the foot with activity and “push through the pain” there is a risk of malformation of the growth plate into adult bone, however this is uncommon and if treated properly will not result.

Does your child have Severs? Book in with our team at Total Physiocare now!

Blog post by our Physiotherapist Briony Barry