Ankle sprains and ankle fractures are a common part of physiotherapy practice. A repeated sprain can give difficulty walking on uneven surfaces or a chronic ankle pain problem. The subjective examination from the physio explores how the injury occurred, the amount of trauma involved, how much pain developed and whether the patient walked about afterwards. They may have attended an accident emergency department and been reviewed with an x-ray.

The pain levels after injury indicate important things about the joint. High levels of pain or pain not subsiding normally could imply a fracture and the physiotherapist will ask for a medical review. This injury should give pain in certain areas which point towards the damaged parts of the ankle anatomy. The physio will test these structures later in the examination.

Special questions are asked about the past medical history and previous injuries, any drugs the patient is taking, their appetite level, whether they are losing weight, their sleep quality and pain in the morning, their bladder and bowel normality and any relevant family history. This is to clear the patient of any serious underlying condition so that treatment can be safely performed.

The Objective Examination

Changes in the ankle such as colour, swelling or circulation are noted and then ankle movements are assessed without weight on the joint, including dorsiflexion (pulling the ankle upwards), plantarflexion (pushing the foot down), eversion (turning the foot outwards) and inversion (turning the sole of the foot inwards). The physiotherapist assesses ankle movements as pain limits movement and the readiness of the patient to engage in rehabilitation.

Manual testing of the ankle muscle strength by the physiotherapist indicates any muscle damage around the ankle. The physio tests the patient up on a couch or gets the patient to perform exercises up on their feet. Passive movement of the joint, where the physio moves the ankle and uses gentle stretching of the joint in each direction to test the structures of the joint. Palpation of the joint structures is used to find which structure is to blame.

Treatment protocols for Physiotherapy

For pain and swelling ice is used to reduce swelling, with range of motion exercises, a compression dressing such as an ankle sleeve and gait correction. If the problem is severe, a walking aid may be useful. If stiffness is the problem, with some pain, joint mobilizations may be used to loosen the joint.

The physio may use manual therapy for joint stiffness or pain and this allows the physiotherapist to improve the joint gliding movements and allow more normal joint mechanics. This reduces joint stiffness, loosens up the joint and eases pain, allowing weight bearing exercises to start. Static exercises are used initially whilst holding on, progressing to active exercises without support.

In proprioception or the sense of joint position the brain monitors the position of the ankle, quickly coordinating the muscle response to prevent risky positions. Rehab involves balance work by standing on one leg and progressing to working with balance on a wobble board. Balance and coordination are retrained until the joint can perform well on rough ground and in running and jumping. Good movements, little pain, good strength, normal balance and walking mean that the ankle has recovered.