Make grum­bling joints a thing of the past with our ex­pert tips to avoid in­jury

Trail Running (UK) - - Contents -

We ex­am­ine the most com­mon causes of an­kle pain, how to treat it, and steps you can take to avoid fu­ture in­juries

Your an­kle is hugely im­por­tant when it comes to run­ning, pro­vid­ing sta­bil­ity, mo­bil­ity and pro­tec­tion – all in a mat­ter of mil­lisec­ond.

What is the an­kle joint?

The true an­kle joint is the ar­tic­u­la­tion be­tween the dis­tal (fur­thest away) ends of the tibia and fibula, and the top of the talus. When com­bined with the sub­ta­lar joint – the ar­tic­u­la­tion of the talus with the cal­ca­neus (heel bone) – the an­kle joint com­plex is a multi-di­rec­tional hinge that pro­vides adap­ta­tion, shock ab­sorp­tion, sta­bil­ity and propul­sion across a wide range of un­der­foot con­di­tions.

How does it work?

With its six dif­fer­ent ar­tic­u­lat­ing sur­faces, the an­kle joint com­plex is ex­traor­di­nar­ily clever and per­fectly evolved for off-road run­ning. A net­work of ten­dons and lig­a­ments con­nect the dif­fer­ent parts of the joint to each other and to the leg mus­cles, al­low­ing us to stay up­right when we’re run­ning at speed over con­tin­u­ally chang­ing ter­rain; while at the same time help­ing to gen­er­ate the propul­sive forces that keep us mov­ing for­ward. Stretch re­cep­tors, both un­der and within the skin, con­stantly mon­i­tor the an­kle’s po­si­tion – a process known as pro­pri­o­cep­tion – help­ing to en­sure none of these struc­tures be­come over­stretched and there­fore dam­aged.

Com­mon an­kle in­juries

In­ver­sion sprains – the clas­sic ‘twisted an­kle’ where the an­kle rolls out­wards and the sole of the foot in­wards – are very com­mon in sport. A 2009 study by

Fong et al says an­kle sprains ac­count for 14% of all sports in­juries, with in­ver­sion sprains ac­count­ing for 80% of all an­kle in­juries. Other causes of an­kle pain can in­clude tib­ialis pos­te­rior tendinopa­thy (an overuse in­jury on the in­side of the an­kle), im­pinge­ments and stress frac­tures. Trail run­ners are at par­tic­u­larly high risk of in­ver­sion sprains due to the con­stant­ly­chang­ing na­ture of the ter­rain, di­rec­tion and pace.

The most likely mo­ment for a sprain to hap­pen is dur­ing down­hill run­ning with the foot and an­kle in a plan­tarflexed po­si­tion – as if you’re point­ing your toes. In this po­si­tion the foot it­self is at its most sta­ble, with the mid­foot locked and ready for im­pact; but the an­kle joint is at its most un­sta­ble, not ex­pect­ing to be weighted un­til the foot has landed and flat­tened. Once the foot is flat it un­locks, act­ing as a flex­i­ble shock-ab­sorber, while the an­kle joint locks ready to guide the body over the foot. If you tread on a rock or a root with the foot and an­kle in a plan­tarflexed po­si­tion, the an­kle joint buck­les and rolls out­wards, of­ten re­sult­ing in an in­ver­sion sprain. Try ‘twist­ing’ your an­kle first with your foot flat and then stand­ing on tip­toe and you’ll quickly get the idea. It’s also pos­si­ble to roll the an­kle in­wards and the foot out­wards, but this type of in­jury is much less com­mon. In­juries through ei­ther forced plan­tarflex­ion or dor­si­flex­ion can also oc­cur, for ex­am­ple if you put your foot down a hole while run­ning, but again these are rare. Dur­ing an in­ver­sion sprain, dam­age can oc­cur to the ten­dons, lig­a­ments, mus­cles and nerves sur­round­ing the an­kle joint com­plex and, less fre­quently, to the bones and car­ti­lage. Most com­monly, over­stretch­ing of the lat­eral lig­a­ments – those that con­nect

the leg bones to the foot bones on the out­side of the foot – causes tear­ing and even rup­ture. De­pend­ing on the sever­ity of the in­jury you might ex­pe­ri­ence pain, swelling, bruis­ing and loss of func­tion in the joint. Less com­monly, a frac­ture of the end of the fibula or 5th metatarsal, dam­age to the joint car­ti­lage, or more ex­ten­sive in­jury may oc­cur.

Usu­ally, sprained an­kles re­cover with time with­out any spe­cific in­ter­ven­tion, but if you’re con­cerned about your symp­toms or sus­pect a frac­ture it’s im­por­tant to seek med­i­cal ad­vice.


Most an­kle sprains heal well with a lit­tle time and care. Mi­nor sprains may not even re­quire much rest, but make sure you aren’t com­pen­sat­ing for your in­jury and over­load­ing an­other struc­ture. Ap­ply­ing ice and sit­ting with your foot el­e­vated may help at first, par­tic­u­larly if there’s a lot of swelling. It’s im­por­tant to keep the an­kle mov­ing to aid re­cov­ery and pre­vent stiff­ness – try draw­ing cir­cles and let­ters in the air with your toes. Be guided by pain in your ac­tiv­i­ties, stop­ping if things be­come too un­com­fort­able ei­ther dur­ing or af­ter ex­er­cise. Some peo­ple find tap­ing or ban­dag­ing in the short-term help­ful for pro­tect­ing the in­jured area. Re­mem­ber that soft tis­sue in­juries such as ten­don and lig­a­ment sprains of­ten take many months to com­pletely heal, so pa­tience, a gen­tle re­turn to ac­tiv­ity and good re­ha­bil­i­ta­tion are key.


The great­est risk fac­tor for an an­kle in­ver­sion sprain is a pre­vi­ous in­ver­sion sprain, so good re­ha­bil­i­ta­tion is es­sen­tial in help­ing to avoid fu­ture in­juries. Early on, tape or an an­kle brace may help to pro­vide pro­tec­tion and sup­port to dam­aged stretch re­cep­tors while the in­jury heals. Try to stop tap­ing as soon as you feel com­fort­able, be­cause it may in­ter­fere with re­ha­bil­i­ta­tion.

As soon as you feel able, be­gin bal­ance train­ing. Start by stand­ing on one foot on a flat sur­face, work­ing up to an un­sta­ble sur­face such as a cush­ion or wob­ble board. Clos­ing your eyes in­creases the dif­fi­culty, while sin­gle-leg squats and heel raises build bal­ance and strength. Us­ing a Ther­aBand around your foot to pro­vide re­sis­tance dur­ing non-weight­bear­ing foot and an­kle move­ments is a great way to specif­i­cally strengthen in­jured lig­a­ments.

It goes with­out say­ing, but the more reg­u­larly you can in­cor­po­rate re­hab into your sched­ule the quicker and more thor­ough your re­cov­ery will be.

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