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Ankle injury physio in Tilburg.

When you sprain your ankle, you often tear or strain one or more ankle ligaments. In the Netherlands, most ankle injuries occur on the soccer field. This happens with or without an opponent nearby. With an ankle ligament tear, the talofibular ligament is usually affected first. This is the ankle ligament that sits most forward anatomically. This is where the first strain occurs during a sprain. Depending on the severity of the injury, the other ankle ligaments will also be injured. Are you looking for the right ankle injury physio in Tilburg? At Fysio Fitaal we are specialized in sports injuries.

In 5-20% of all cases that come to the emergency room with ankle injuries we speak of a bone fracture. Should an ankle fracture be suspected during the first physical therapy appointment, we use the Ottawa ankle rules. This is a means of assessing whether there is a reason to request an x-ray. Further injury that can occur as a result of inversion trauma is injury to the syndesmosis. This is a structure of fibers that runs from the tibia to the fibula. This syndesmosis is very important in the stability of the ankle joint. In theory, the syndesmosis holds the tibia and fibula together. In approximately 11-18% of all inversion traumas, there is injury to the syndesmosis. When there is injury to the syndesmosis, recovery takes significantly longer. In general, the duration of recovery depends on several factors. When no other structures are affected, the greatest decrease in pain occurs within the first two weeks. A small group maintains symptoms for a longer period of time. Often these are complaints of instability, by this we mean the feeling when you sink through your ankle. Ankle injury is more likely if you have had a previous injury to your ankle. A good ankle injury physio in Tilburg is therefore crucial and will help prevent a new injury.

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Anatomy and function of the ankle joint

A joint is a place in the body where several bone parts come together. In the ankle, this is the tibia(femur) with the fibula(calf bone)and talus(ankle bone). We also call this joint the upper ankle joint. Between these bone parts is cartilage which has a very smooth surface so it can move smoothly. To control the ankle joint properly, there are different types of ligaments in and around the ankle. On the inside and outside are ligaments that provide passive stability. Tires, bones, capsules and the position of joints provide passive stability you have no control over. Active stability is controlled by muscles and tendons. So you do have control over this. Active and passive stability together determine how strong a joint is. After a diagnosis of an ankle injury, it is essential to get the right physio in Tilburg.

Diagnosis of ankle injury

Most cases involve damage to the anterior ankle ligament; the talofibular ligament anterius;
The other ankle ligaments calcaneofibulare ligament and posterior talofibulare are affected with a more severe ankle injury;
Some cases also involve damage to the syndesmosis, which is a structure that connects the fibula to the tibia.

A distinction is made between mild, moderate and severe ankle injuries when there is no fracture.

Grade 1 is only a strain. The ankle is usually tender for a few days but often recovers without problems within 1 to 2 weeks at most.

Grade 2 Here there is a partial rupture of the ankle ligaments. This is characterized in particular by severe swelling and blue discoloration within a few days.

Grade 3: Here we are talking about a complete tear of one or more ligaments. The risk of an ankle injury is highest here. Consider a fracture of one of the bone parts or damage to the syndesmosis. Often significant swelling and blue discoloration within a day. Walking will also be difficult or even impossible here.

Immediately after suffering an ankle injury, it is often not possible to make a statement about the severity. Within 3-5 days we can already make a better statement about this. The reason is the swelling and topicality. Because of the pain, many tests are not reliable. If there is pressure pain on the outside of the ankle along with an enlarged drawer then for 90% there is a chance that it is damage to the ankle ligament(s). Do you want effective ankle injury physio in Tilburg? Then make an appointment at Fysio Fitaal soon!

Common ankle injuries

Inversion Trauma

Inversion trauma, often the result of spraining the ankle, puts strain on the talofibular ligament anterior. This type of ankle injury can cause swelling, bruising, and in some cases difficulty walking. Without adequate strengthening after trauma, there is a high risk of recurrence. Early physical therapy intervention is essential for recovery, focused on regaining strength and stability to prevent future injuries. For more details, read Inversion Trauma.

Achilles Tendinopathy (Achilles Tendon Irritation)

Achilles tendinopathy manifests as pain and stiffness in the Achilles tendon, often caused by overuse. This problem develops gradually and is characterized by pain that worsens after activity. The condition may occur in the middle of the tendon or at its attachment to the heel bone. Effective treatment often involves a combination of rest, appropriate loading, and targeted exercise therapy, with a focus on strengthening and gradually building the load capacity of the tendon. We do this during our ankle injury physio in Tilburg.

For more information, visit the page Achilles tendinopathy.

Achilles tendon rupture

Achilles tendon rupture often occurs during activities that require sudden force from the calf muscles, such as soccer or sprinting, and may be accompanied by acute pain as if kicking the ankle. Risk factors include degeneration of the tendon, especially in men between the ages of 30-40. Diagnosis and treatment of this ankle injury vary depending on severity, ranging from conservative methods such as RICE (rest, ice, compression, elevation) and physical therapy to surgery for complete ruptures.

For more details, visit the Achilles tendon rupture page.

Achilles tendonitis in Runners

Runners often experience Achilles tendon pain, beginning with pain or stiffness above the heel bone, which may disappear quickly. This can lead to reduced mobility and inflammation. Factors such as the quality of footwear, training surface, and body weight play a role in the development of these symptoms. The importance of proper warm-up, choosing the right footwear, and adjusting training intensity is emphasized to prevent and treat symptoms. We will give you all the necessary tips to fix and prevent this ankle injury during our physio in Tilburg.

For detailed information, visit our page, Achilles tendonitis in Runners.

Heel spur - Plantar fasciitis

A common ankle injury that causes pain at the bottom of the heel. It is especially common in people between the ages of 40-60 and can result from overuse, such as increasing sports activities or wearing unsuitable shoes. Symptoms include severe pain when walking or standing for long periods of time. Treatment consists of exercises, pain-cushioning measures, and sometimes adjusting footwear.

For more information, visit Heel spur - Plantar fasciitis.

Heel Spur Pain in Runners

Heel spur injuries are a common challenge for runners, characterized by pain under the heel. These symptoms often arise from overuse or inappropriate footwear. An effective approach includes rest, appropriate training, and specific exercises for strengthening and flexibility, complemented by wearing appropriate footwear to minimize heel strain. A common ankle injury that calls for the right physio in Tilburg.

For more information, visit Heel Spur Pain in Runners.

Physical testing during our ankle injury physio in Tilburg

There are a number of tests described to gain insight into your ankle injury:

Front drawer
The front drawer is a test to test the slack of the ankle ligaments. The person lies supine on the treatment couch. The foot and ankle come outside the treatment couch. The examiner includes the person's heel and with the other hand the tibia is fixed about 10cm above the joint. The foot is allowed to point forward 10-15 degrees for maximum relaxed position of the joint. After this, the examiner pulls the foot forward in relation to the tibia. The test is positive when the foot can move more than 1cm forward relative to the unaffected side.

Squeeze test from syndesmose
The person sits on the treatment couch with hanging legs. The examiner grasps the lower leg on both sides. The examiner starts at a higher position of the lower leg and squeezes the shin and fibula toward each other. The examiner grabs different points closer and closer to the ankle joint. With severe syndemic injury, the bone parts give way from each other which will produce recognizable pain for the person. This is how we get a picture of your ankle injury.

Exorotation click test
The person sits with the legs suspended from the treatment couch. With one hand, the examiner holds the lower leg in the same position. With the other hand, the examiner holds the foot in a neutral position while the foot is turned outward. With recognizable symptoms, the test is positive. What type of ankle injury is present depends on the location of the pain experienced. On the front side, there may be syndesmotic injury. On the inside, the inner ankle ligament may have damage. If the pain is felt on the outside, then it speaks of injury to the outside of the ankle.

Surgical intervention or conservative treatment

An ankle injury is not operated on in the vast majority of cases;
Sometimes when there is persistent instability, surgery can offer a solution;
In some cases, there is a complex fracture that needs to be repaired.

In people who are highly active and would like to play a sport where you have to jump, turn or cowl with chronic instability, surgery can be an added benefit in most cases. It must then be clear what the reason for this persistent ankle injury is.

The different phases in our ankle injury physio in Tilburg

A successful ankle injury physical therapy in Tilburg consists of several stages and steps. Good strength, stability and control is necessary to safely return to your sport. Both after a surgical procedure and with a conservative policy.

After an ankle injury where there is damage to tissue, in this case the ankle ligaments or other structures of the ankle, several phases of tissue repair take place. Immediately after it occurs, the inflammation phase starts. Here, the body goes to work clearing out damaged tissue in the affected area and making room for new. This phase is characterized by pain, swelling, blue discoloration, heat and inability to bear weight. During this phase, it is important to rest especially. The physical therapist mainly advises on the policy and expectations of recovery. In addition, some exercises can be given to restore the mobility of the ankle joint.

The inflammation phase takes about 7-9 days on average and progresses into the proliferation phase. In this phase, new connective tissue is produced. This tissue is not yet strong enough and should therefore not be subjected to heavy loads. During the transition from the inflammation phase to the proliferation phase you will notice that complaints such as blue discoloration, pain, etc. will decrease. You will also be able to exercise more and you will gradually have less trouble with your ankle injury.

In the remodeling phase, the newly created connective tissue is remodeled as the name implies. Thus, collagen tissue (laid out in proliferation as type 3) is transformed to type 1. The difference is that type 1 collagen tissue is much stronger than type 3 tissue. Under pressure and tensile forces demanded of the various connective tissue structures in remodeling, the body makes sure that tensile strength of the fibers becomes stronger to absorb as many forces as possible. This makes that in this phase of our ankle injury physiotherapy in Tilburg the load capacity increases but also really built up must become. We do this in several stages from basic strength to sport-specific training.

Acute phase:
At this stage of our ankle injury physio in Tilburg, we particularly focus on symptom reduction. There is often swelling, pain and reduced mobility of the ankle joint. Manual techniques with exercises to increase mobility are most commonly addressed in this phase.

Strength and stabilization phase:
This phase involves more of a build-up in strength. Stabilizing exercises are also included. General fitness may also be worked on in between.

Sport-specific phase:
The final phase of our ankle injury physical therapy in Tilburg focuses particularly on maximum strength, jumping power and explosiveness. This is all necessary to quickly change direction within your sport. We also work toward competitive fitness so that you can continue to perform under fatigue. The quality of movement must remain good under these conditions. The chance of suffering another ankle injury is many times greater under fatigue.