Ankle Conditions

Learn more about the different conditions we treat.

Click the underlined treatments for more information

Ankle Sprain

Lateral ankle sprain occurs when the ankle rolls towards the outside of the foot, resulting in stresses on the lateral ligaments of the ankle. This can potentially cause one or more of the ankle ligaments to stretch, or leads to a partial / complete tear.

Three main ligaments at risk of partial tear or damage include: anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligaments.

Symptoms:

Depending on the severity of the injury, the signs and symptoms include:

Pain on the outside of the ankle
Presence of swelling +/- bruising along the outside of the ankle and foot
Restricted range of motion
The ankle may feel unstable / wobbly
Difficult in putting weight on
Popping sensation or sound at the time of injury

Cause and Risk Factors:

Sports that involves jumping and / or pivoting
Overused / Weak muscles supporting the ankle
Improper / unsupportive footwear
Prior ankle injury / sprain
Walking / exercising on an uneven surfaces

Management options:

RICE (Rest, Ice, Compression and Elevation) - recommended during the initial stage (24 - 48 hours) of an ankle injury (immediately after injury/sprain) to help with swelling
No HARM (Heat, Alcohol, Running, Massage) - recommended during the 1st 48 - 72 hours of ankle injury to allow recovery
Offloading with crutches if walking is difficult / painful
Compression ankle brace - to support ankle joint
Rehab protocol - to improve ankle mobility and strength, prevent recurrence and promotes long term ankle stability
Surgical options - patients with severe ankle sprain / chronic ankle instability

Achilles Tendinopathy

Achilles Pain

Achilles tendinopathy is a musculoskeletal condition that causes pain, swelling, stiffness and weakness of the Achilles tendon. Achilles tendon is the largest and strongest tendon in your body that attaches your calf muscles to your heel bone. When overused, the achilles tendon undergoes degenerative changes, leading to weaken tendon fibres and microtears. Achilles tendinopathy is the most commonly known overused injury, commonly found in runners and athletes who perform repetitive jumping movements such as ballet dancers.

Causes:

Improper footwear
Overuse / Sudden increase in intensity and frequency of training
Poor biomechanics
Muscle weakness / imbalance
Reduce flexibility, especially in the ankle
A change in training surfaces

Treatment options:

Address the contributing biomechanical factors with a biomechanical assessment
Orthotic therapy - addresses biomechanical issues
Strength training - increase and improve the tendon's tolerance to load
Improve joint and tendon flexibility by develop a habit of stretching once symptoms subsides
Manual therapy to decrease symptoms and address cause injury includes: low level laser therapy, shockwave therapy, myofascial release, joint mobilisations and taping.
Non-conservative therapy such as injection therapy or surgery will be considered after 3-6 months of conservative therapy without any symptoms improvement

Sever's Disease (Calcaneal Apophysitis)

Also known as Calcaneal Apophysitis, Sever's disease is an inflammation of the growth plate on the calcaneus. It typically affects children and adolescents between the ages of 8 and 13, more commonly seen in younger athletes.

Symptoms:

Tenderness at the base of the Achilles tendon during and after activities, especially those that requires repetitive stress from running or jumping
Mild swelling at the heel
Tendency to tip toe or limp to avoid putting pressure on irritated areas

Cause:

Sudden increases in frequency of sports training or other physical activities
Type of activities involving repetitive running / jumping
Training surfaces: hard surfaces
Poor biomechanics such as flat foot or high arched feet.
Tightness in the calf muscles and restriction in the ankle joint range of motion may also be a risk factor.
Improper footwear during training

Treatment options:

Over the counter anti-inflammatory medications - to help reduce pain and swellings
Activity modification - temporarily cease or reduce level of high impact of activities / activities that aggravates pain
Physical rehab - treat the cause of symptoms by stretching the calf muscles and strengthening the Achilles tendon
Load management - gradual return to activity once symptoms reduce / subside
Orthotic - over the counter or prescribed shoe inserts to address any biomechanical issues
Manual therapy to treat any localised pain and provide immediate and address cause injury includes: low level laser therapy, myofascial release, dry needling, joint mobilisations and taping.

Shin Splint

Also known as medial tibial stress syndrome, shin splint is a cumulative stress disorder on the tibia bone and the soft tissues attaching the bone.

Symptoms:

Dull ache or diffuse pain along the inside / either side of the shin bone
Pain onset with exercise and may dissipate with warming up as the muscles loosen up
Minor swelling may be present on the site of tenderness on the shin bone.

Cause:

High intensity and frequency of strenuous physical activities such as running, tennis, soccer, basketball and netball
Training errors - doing too much too soon
Running on uneven terrain, hard surfaces or on a decline
Biomechanical issues such as flat foot, rigid foot
Muscle weakness / imbalance in lower limbs
Poor / decrease flexibility
Inappropriate or worn out footwear

Treatment options:

Initial management includes rest, ice and elevate
Over the counter pain medication to manage symptoms
Activity modification - reduce activity frequency / intensity, change the mode of exercise to cross training activities (i.e. swimming, cycling)
Footwear modification
Orthotic therapy - address biomechanical issues
Strengthening and stretching exercises - to address muscle weakness of the lower limb, and increase mobility and flexibility
Physical therapy to reduce tissue stress includes dry needling and joint mobilisation

Peroneal Tendinopathy

Peroneal tendons (peroneal brevis and peroneal longus) are situated on the outside of the ankle behind the bone called fibula.

Peroneal tendinosis / tendinopathy is a thickening and swelling of the peroneal tendons due to inflammation. This is usually due to overuse injuries such as repetitive activities (i.e. running, dancing, activities that require repetitive use of the ankle) that irritates the tendons over a period of time. Peroneal tendinosis can also occur after an ankle sprain.

Signs and symptoms:

Generally, people with peroneal tendinosis have recently tried a new activity / increase in their activity level.
Patients usually experience pain around the back and outside of the ankle.
There usually is no history of a specific injury.

Causes:

Improper training
Rapid increase in training (i.e. Doing too much too soon)
Poor fitting shoes
High arch foot type

Treatment options:

Non-surgical treatment:
- Rest - As it is an overuse injury, this condition can usually heal with rest.
- Activity modification - Physical activities should be limited until the pain improves. Once symptoms resolves, it is recommended to slowly and gradually resume physical training based on your pain / discomfort level.
- Offloading device - ankle brace, CAM walker boot
- Orthotic therapy
- Physical therapy - to strengthen the tendons and muscles surrounding the ankle joint
- Manual therapy includes: ultrasound therapy, low level laser therapy, shockwave therapy, myofascial release, and joint mobilisations
Surgical Treatment is warranted if the pain does not subside over a period of time (over a year) with non-surgical interventions.