Ankle Joint injuries contribute substantially to the total injury burden in field and court based sports.

  • Gaelic Football 11%
  • Hurling 9%
  • Elite level soccer 14%
  • Elite level rugby 5.6%-6.8%

Knowing and understanding the epidemiological data on the sporting population/groups you work with, allows the practitioner to put into place evidenced based injury reduction programs to help reduce the number of these injuries. Be aware of the extent of the potential problem, so you can be proactive in the management of the playing group

  1.  The mechanism of injuries can be broken into two sub-groups: contact vs non-contact.
  • Contact:
    • In soccer there are two main contact mechanisms
      • player-to-player contact with impact by an opponent on the medial aspect of the leg just before or at foot strike, resulting in a laterally directed force causing the player to land with the ankle in a vulnerable, inverted position
      • forced plantar flexion where the injured player hit the opponent’s foot when attempting to shoot or clear the ball.
  • Non-Contact:
    • An inverted position of the ankle joint at initial contact is a particularly vulnerable position and has been identified as a key characteristic feature of lateral ankle sprain injury mechanisms.
      • Kinematic and kinetic studies have shown an increase in internal rotation of the ankle joint on initial ground contact and an increased internal rotation moment on the ankle joint.

Mechanism of injury is vitally important to know when getting subjective information of the patient. It will identify the structures that are most vulnerable to structural damage and thus help you narrow down your objective testing.

  1.     Ankle joint injuries are extremely poorly managed. They are often not taken seriously as some other injuries, with studies shown that median return to play time post first time ankle sprain 3 days and recurrent sprain 1 day. While this is only one study finding, it does highlight how both clinicians, patients and player management don’t often take ankle sprains as serious as some of the work that Dr. Eamonn Delahunt and Dr. Cailbhe Doherty have highlighted. Their work has shown that up to 40% of ankle sprains will still experience symptoms one year on. Take your time with these injuries, and make sure your patients don’t take them too lightly.
  2. It’s not just a structural injury.

This point can’t be emphasised enough.

Deficits in static balance, postural control, gait and landing mechanics have been highlighted at both 6 and 12 months post ankle sprain, in bilateral limbs. This highlights the central changes that occur as well as the structural issues.

  • Challenge the uninjured limb during the initial acute stage.
  • Develop and recreate an ankle strategy in static balance once tolerated, as these patients display a dominant hip strategy post ankle sprain.
  • Improve foot positioning that are related to the patient’s sport/hobbies
    • Use marching drills/ladders/cutting and change of direction drills. Video analysis can be really helpful to provide feedback.

Ankle Seminar

  1. Outcome measures.

This is something that we all fall down on when working in a busy clinic. We often are happy enough that our eyes tell us the best picture. It is important to use valid and reliable outcome measures to see progress for both yourself and the patient. How else will we be able to know if our treatment interventions are positive or not?

  • For the ankle joint some useful measures
    • FAAMadl or FAAMsport
    • Cumberland Ankle Instability Questionnaire
    • Knee to Wall as a measure of Dorsiflexion
    • Balance Error Scoring System (BESS)
    • Star Excursion Balance Test (SEBT)
    • Jump Mat
      • Using contact time for Fast SSC plyometrics
        • Under 0.250 milliseconds (See work by Eamon Flanagan and Tom Comyns)

Thomas Divilly