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Ankle complaints

When spraining the ankle, one or more ankle ligaments are often stretched or torn. In the Netherlands, most ankle injuries occur during football, both with and without contact with an opponent. The most commonly affected ankle ligament in a sprain is the ligamentum talofibulare anterius (ATFL), the anterior ankle ligament. This ligament catches the strain first during inversion trauma (tilting the foot inwards). In more severe injuries, other ankle ligaments may also be damaged, depending on the degree of stress during the trauma.

Bone fractures and additional injuries

In 5-20% of ankle traumas that end up in the emergency room, there is a bone fracture. During a physiotherapy examination, if a fracture is suspected, the Ottawa Ankle Rules, a guideline to assess whether additional imaging, such as an X-ray, is needed.

Another possible injury after inversion trauma is damage to the syndesmosis, a firm fibrous structure connecting the tibia (tibia) and fibula (fibula). The syndesmosis plays a crucial role in the stability of the ankle joint. Injury to this structure occurs in 11-18% of inversion traumas and significantly prolongs recovery, as the tibia and fibula must stay together for a stable ankle.

For ankle ligament injuries without bone fractures or syndesmotic injuries, pain usually subsides significantly within two to three weeks. For some, however, long-term symptoms, such as instability, remain. This instability where the ankle regularly "sags," is more common in people who have had a previous ankle injury. This highlights the importance of a proper rehabilitation programme to prevent new injuries.

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Cause

Ankle injuries are among the most common injuries and can be roughly divided into acute ankle complaints and long-term ankle complaints. The ankle is a complex joint that is stressed daily by activities such as walking, running and jumping, making it prone to injury.

Acute causes, such as a sprain or sprain often occur due to a sudden tilt of the foot during a jump. Think of this as a slip or during sports such as football or running. This can lead to overstretching or tearing of the ankle ligaments which can cause swelling, pain and instability. In more serious cases, direct trauma such as a fall or collision can result in broken bones or damage to tendons and the ankle capsule.

Chronic causes, such as overuse from repeated movements or prolonged strain, are common in athletes and people with physical occupations. This can lead to tendonitis, irritation of the capsule or cartilage damage. Moreover, ankle instability after previous injuries can increase the risk of repetitive injuries, even during everyday activities. Understanding the cause is essential for effective treatment and recovery.

Table of contents

Common Ankle complaints

Complex ankle fracture

Only, Lower leg
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Inversion trauma

Only, Joint

In inversion trauma, you sprain the ankle, so to speak.

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Achilles tendon rupture

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A complete rupture of the Achilles tendon often occurs during explosive movements where there is a sudden application of a lot of force,...

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Achilles tendinopathy

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Overuse of the tendon

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Achilles tendon problems in runners

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Achilles tendon complaints are a common problem in people who are active in sports ...

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Risk factors

Several factors increase the risk of ankle injuries:

  • Previous injuries: People who have had a previous ankle injury are at higher risk of recurrence due to reduced stability or muscle strength.
  • Wrong footwear: Unstable or poorly supported shoes can contribute to injuries, especially in sports with a lot of lateral movement.
  • Hard or uneven surfaces: Walking or running on hard, smooth or uneven surfaces increases the risk of sprains.

Gradations of ankle injuries

  • Most cases involve damage to the anterior ankle ligament; the talofibular ligament anterius;
  • The other ankle ligaments calcaneofibulare ligament and posterior talofibulare are affected in 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 any problems within 1 to at most 2 weeks.

Grade 2 Here, there is a partial tear of the ankle ligaments. This is particularly characterised by severe swelling and bluish discolouration 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 discolouration 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 on this. The reason is 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 sliding 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!

Various ankle injuries

Sprain/strain

Stretching or tearing of the ankle ligaments, often the ligamentum talofibulare anterius (ATFL). Severe rupture of one or more ankle ligaments.

Syndesmosis injury

Damage to the fibres between the tibia (tibia) and fibula (fibula). Characterised by pain above the ankle, often longer recovery than in a common sprain.

Peroneal tendon injuries

The peroneal tendons are located along the outside of the ankle and play an important role in stability. Injuries to these tendons, such as inflammation, overuse or a tear, are common in people with chronic ankle instability, repeated sprains or long-term repetitive strain.

Achilles tendon injury

The Achilles tendon is the largest and strongest tendon in the body and connects the calf muscles to the heel bone. Achilles tendinopathy results from overuse, often during repeated intense activities such as running or jumping. This condition can lead to pain, stiffness and sometimes swelling at the back of the ankle, especially during start-up movements or during loading.

Bone fractures

Fractures, such as of the fibula or tibia, often occur due to direct trauma or a wrong landing after a jump. This type of injury is accompanied by severe pain, swelling and the inability to bear weight on the affected leg. In some cases, there is a visible deformity.

Cartilage damage (osteochondral lesions)
Cartilage damage in the ankle joint often results from a sprain or severe sprain, damaging the cartilage. This can lead to persistent pain, swelling and stiffness in the joint, limiting movement.

Bursitis (bursitis)
Bursitis around the ankle joint occurs due to overuse or irritation. This injury is not common and, for this reason, can often be missed. In this, ultrasound is able to form a correct diagnosis when in doubt.

Instability of the ankle
Chronic instability often occurs after significant ankle injuries. Symptoms include frequent ankle twisting, swelling and feeling insecure when moving. Proper rehabilitation is essential to restore ankle stability and function.

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 (upper leg) with the fibula (calf bone) and the 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 that 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. Tyres, 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.

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 cut down with chronic instability, surgery can be an added value in most cases. It must then be clear what the reason for this persistent ankle injury is.

Ankle injury physio in Tilburg Physio Fitaal

A serious ankle injury can be unpleasant, especially after surgery. Our specialists will guide and motivate you as much as possible during this process. Fysio Fitaal works with specialists in the field of sports rehabilitation. The combination of expertise, extensive facilities and passion for sports means that you have come to the right place. Make an appointment soon for an effective ankle injury physio in Tilburg!

The different phases in our ankle injury physio

A successful ankle injury physiotherapy in Tilburg consists of several stages and steps. Good strength, stability and control are 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 damaged tissue in the affected area and making room for new. This phase is characterised by pain, swelling, blue discolouration, warmth and inability to bear weight. In this phase, it is especially important to rest. The physiotherapist mainly advises on policy and expectations of recovery. In addition, some exercises may be given to restore the mobility of the ankle joint.

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

In the remodelling phase, the newly created connective tissue is remodelled as the name suggests. 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 remodelling, the body ensures that tensile strength of the fibres becomes stronger to cope with 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 builds up must become. We do this in several stages from basic strength to sports-specific training.

Physical tests during our ankle injury physio

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

Making an appointment at FysioFitaal

Fysio Fitaal offers specialised physiotherapy with a personalised approach. Whether you are recovering from an injury, have sports-related complaints or are working on your health preventively, our team of experts is there for you. With years of experience in sports rehabilitation, ultrasound diagnostics and post-operative care, we help you move forward effectively.

We work from multiple locations in Tilburg, always close by for professional and accessible physiotherapy. Fill in the contact form and we will contact you soon. Together, we will work on your recovery!
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