Soft tissue injuries of the ankle

Ankle sprains with pain around the outside of the ankle are one of the most common injuries seen around the foot and ankle.

Some common symptoms that can be easily managed are:

• Pain – Use regular pain relief, if needed. Your GP or pharmacist can advise you on this.
• Swelling – Generally worse in the first 2 – 3 weeks but can last longer than this.
• Bruising – Can last 2 – 3 weeks and may spread into the foot or lower leg.
• Difficulty taking weight through your leg – You may need to reduce your activity levels initially but aim to keep moving around gently.

It often takes at least 6 – 8 weeks for symptoms to fully settle after a significant ankle sprain. Returning to higher activity levels and sport may take longer. These time frames may be dependent on following early advice and rehabilitation.

First 48 hours

Protection

• It is important to protect your ankle in the early stages from further stresses. This will allow the healing process to take place effectively.
• Depending on the severity of your injury, this may involve the use of splinting or casting and the use of crutches – the professional attending you will decide whether any of these are needed.

Rest

• Resting the ankle helps the soft tissues to heal, and keep swelling and soreness to a minimum.
• You may need to modify your activity and walking depending on the severity of your injury – you will be given specific advice for your ankle on the level of rest needed. Some people feel more comfortable initially to walk on their toes with their knee bent. It is important to gently exercise to try and get the heel to the floor and your knee straight as soon as you are able.

Ice

• This can help to limit the swelling and pain in your ankle.
• Place crushed ice or a bag of frozen peas wrapped in a damp towel on the injured area, ideally every three hours after the injury; for up to 20 minutes each time.
• Check the skin regularly as ice can burn. Continued use may be required as your activity levels increase and you wean from any walking aids provided.

Elevation

• The foot and ankle swell quickly after injury due to gravity.
• Raising the leg will help to improve swelling and should be done immediately after an injury.
• You should raise the ankle above the heart frequently, throughout the day.
• Your swelling may go up and down as you become more active and spend more time with your foot down. It is important to continue elevation to help manage this until it settles.

After 48 hours

• The ankle should be less swollen and more comfortable to stand on. At this point, you should aim to get your heel on the floor with your knee straight.
• As your pain and swelling decreases, you will find that you may be able to wean from your crutches. This, in turn, may cause your swelling and discomfort to increase, so continued use of ice and elevation may be required.
• Start the exercises below as pain and swelling allows 48 hours after your injury. They may involve movements which cause discomfort over the injured area. Whilst it is important to move the ankle to prevent stiffness, do not push into pain as this can overstretch healing tissue.

Exercises

Weight transference

Stand on both feet with your heels on the floor and knees straight. Practice moving your weight from side to side through the injured ankle.

Active ankle movement

Sit with your legs out in front of you. Move your ankle up and down within limits of pain. Repeat little and often.

Calf stretch with towel

Hook a towel around the end of your foot and gently pull it towards you. Hold for 20 – 30 seconds and release.

Repeat 5 – 6 times and perform every two hours. Do this exercise both with your knee straight and bent.

Pointing your foot

Grasp the end of your foot with your hand. Use your hand to help your foot to point downwards. Repeat 5 – 6 times and perform every two hours, you should only feel a gentle stretch.

If you have little or no swelling, you have recovered your movement and you can walk without limping / pain you are ready to progress to the following.

Gastrocnemius stretch

Stand in front of a wall with the affected leg behind you, injured leg in front, and lean hands onto the wall for support. Point your toes forward and lean onto the wall to feel a stretch down the back of your calf. Hold the stretch for 20 – 30 seconds. Repeat 5 – 6 times every two hours.

Soleus stretch

Stand in front of a wall with your affected leg in front of you, with your toes facing forwards. Push your knee forward to stretch the muscle at the back of your leg. Make sure your heel stays on the floor. Hold the stretch for 20 – 30 seconds. Repeat 5 – 6 times every two hours.

Calf raises

Whilst standing on both legs, raise yourself up onto the balls of your feet as high as you can and then lower with control. Repeat to fatigue.

Balance

Once you are able to stand only on the affected leg, you need to start regaining your balance.

Practice standing on your affected leg with the aim to increase the number of seconds you can do until equal or better than your unaffected leg.

Following an ankle soft tissue injury, structures that help stabilise the ankle can become weak and can cause ankle instability. This may lead to recurrent injuries or sprains; therefore, it is important that you follow the exercises to improve the balance reactions and stability, in order to minimise the risk of further injury.

Driving, work and sport

• Returning to driving and work will depend on your individual injury, and what your occupation is.
• We recommend before returning to driving that you can perform an emergency stop without hesitation and discomfort, and inform your insurance company.
• As you return to work, you may find that your swelling and discomfort increases. This is usually because as activity increases, the ability and time to elevate and place ice on the area, decreases. This change may be a more significant if you do a manual job.
• Before returning to sport, make sure you have no pain or swelling. You should be able to stretch your gastrocnemius and soleus equal to the other side, can perform single leg calf raises to equal height and repetitions compared to the unaffected side, and have equal ability to balance. Return to sport should be with graded return; for example, returning to light jogging and training before taking part in a match.

If you have any concerns regarding your recovery, please see your GP.