BEAT ANKLE PAIN
Make grumbling joints a thing of the past with our expert tips to avoid injury
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.