Ankle & Achilles Pain

We treat a wide variety of injuries to the ankle and the Achilles tendon at the clinic. Listed below are some of the more common ankle injuries and Achilles injuries.

Lateral ankle sprain

This is the most common type of ankle injury and involves damage to the ligaments on the outer side of your ankle. This is very common in most sports, but especially in netball, football, rugby, hockey and basketball. With moderate to severe ankle sprains it is common to have significant swelling and bruising afterwards, and it can be difficult to walk. You may be advised by your physiotherapist to have an Xray to exclude any fractures. Initially you will need to rest and protect the ankle, and adopting the R.I.C.E. principles is a good idea to limit swelling. From the initial stages of your injury, physiotherapy will be helpful for decreasing pain and swelling, regaining your movement and strength, and getting you back to normal walking. It is also important to retrain your balance and reflexes of the ankle so that you are strong and safe to return to sport. Physiotherapy treatment may include soft tissue and joint mobilisation, acupuncture, strengthening and stretching exercises, balance retraining and sport specific exercises.

Medial ankle sprain

This type of injury is less common and involves the ligaments on the inside of your ankle, This typically occurs in football or rugby players who kick an opposition player with the inside of their foot. The ligaments on the medial aspect (inside) of the ankle are larger and stronger than the lateral (outside), and although less commonly injured, they are a little slower to heal. As with lateral ankle sprains initial treatment is aimed at protecting the joint, and limiting swelling. As the pain improves your physio will mobilise your ankle to regain your movement, then advise you on the strengthening and balance exercises to get you back to normal as soon as possible.

Achilles tendinopathy

Tendons are tough bands of tissue that connect muscles to bones and therefore allow movement of your joints. Tendinopathy is what happens when these tendons become dysfunctional. The Achilles tendon is the largest tendon in the body and is commonly affected by this condition. There are several stages of tendinopathy which your physiotherapist will explain, and it is very important to seek treatment in the early stages as without appropriate advice and exercise your problem could become a lot worse later on in life. Initially, the tendon may become painful due to being overloaded to a point that is greater than it can handle, e.g. a particularly long and hilly walk/run or a hard game of netball. Given some rest and appropriate treatment, this type of injury should completely resolve, with little long-term effects. If this problem persists and training/exercise continues, it is possible that pathological changes can occur within the tendon, with changes to the way the collagen is structured in the tendon. In the long-term this can lead to a degenerative tendinopathy which becomes more difficult to resolve due to structural changes in the tendon. Your physiotherapist will assess what stage you are in and then design a treatment plan that is most appropriate for this stage. This may involve advice on the type of training you can do, specific exercises you can do to stretch and/or strengthen the tendon, soft tissue and joint mobilisation to free up the area, biomechanical assessment, and podiatrist referral. Once you can tolerate it, you will need to begin specific and graduated strengthening of the tendon so that it can withstand increased loads. Without a good exercise programme the pain is likely to return once you get back to training. Tendons are very susceptible to changes in load, and therefore need a relatively long time to adapt to the exercises that your physiotherapist will prescribe.

Achilles rupture

As well as being prone to tendinopathy, the achilles tendon can also completely tear or rupture during a sudden injury. This is most common in high intensity sports like rugby, basketball, netball, badminton or squash. Often it will feel as though you have been kicked in the back of the leg and then you will be unable to push off with your toes. There will be significant swelling, and your physio should be able to diagnose this problem from a few simple tests. An ultrasound scan can help confirm the diagnosis. You will need to be referred to see an orthopaedic surgeon as soon as possible who will decide whether to operate or not. Older and less active people are less likely to require surgery, but it is imperative to be diagnosed and treated early to have successful non-operative treatment. Regardless of whether you have surgery or not you will need to do a long period of rehabilitation to regain your strength, flexibility, endurance, and power in the leg. It is important to have your rehabilitation supervised by an experienced physio and you can expect it will take 6-9 months before you can return to sport.

High ankle sprain (syndesmosis injury)

These type of injuries are less common than lateral ankle sprains, but can be more debilitating and usually require more rehabilitation. They involve the strong ligaments and connective tissue between the bottom of the two lower leg bones, the fibula and tibia. This area is known as the ankle syndesmosis, and normally very little movement occurs here. This area can get injured in a slightly different way to the more common lateral ankle sprain – by either the foot getting twisted outwards when it is planted on the ground or trapped underneath something, or by an excessive force that bends the ankle into dorsiflexion (when the toes come upwards towards the knee). Pain and swelling is often more severe in patients with a high ankle sprain, and walking can be very difficult and painful at the point just above where your ankle joins your lower leg. Your physiotherapist may refer you for an Xray or further investigation to check that there has been no fracture or other more serious injury. It is important to ascertain the severity of injury early on as if these injuries don’t get picked up early on they can lead to more issues later on. With these injuries, it is often advisable to spend some time either on crutches on in a moonboot to let the injury heal. Your physiotherapist will guide you on this.

Tibialis Posterior tendinopathy

The tibialis posterior muscle is located on the inside of your shin, and it has several attachments into the small bones of your foot. It is a very important muscle as it helps to stabilise your foot and ankle over the rest of your body, and helps the arch of your foot to work effectively. Tibialis posterior tendinopathy is an injury to the tendon of the muscle, usually as it wraps around the bone on the inside of your ankle called your medial malleolus. It causes pain on the inside of your ankle and some patients experience crepitus (crackling or grating sound) and swelling in this area too. It is a common injury we see at the clinic. It is most commonly an overload injury, caused by repetitive excessive strain on the tendon that can ultimately result in small micro tears of the tendon. This can happen when there is a sudden increase in training intensity, such as running or sports involving jumping. Other contributing factors can include poor foot mechanics (such as flat feet), lower limb muscle weakness (such as the gluteal muscles), previous ankle or knee injury and poor footwear. Your physiotherapist will provide you with a treatment plan to address the issues that are contributing to your pain, to get you back to your normal function and desired activity level. Treatment may include stretching and strengthening exercises for the lower limb to improve muscle balance, load management strategies, footwear advice, acupuncture and manual therapy techniques such as massage and joint mobilisation.

Sever’s Disease

Sever’s Disease, also known as calcaneal apophysitis, is commonly seen in active children during times of most growth (boys 10-14 years and girls 8-12 years). It is a traction injury to the growth plate of the heel bone near where the Achilles tendon attaches. Symptoms can include limping, pain walking on tip toes and tenderness over the back of the heel. Your physiotherapist can assess any contributing factors to this condition and can provide a detailed treatment plan. This will often involve activity modification for the patient, pain relief strategies and exercises to improve flexibility and strength. It will almost always resolve over a period of time but this time can vary between patients depending on their activity level and how they manage the condition.

Ongoing ankle pain

Ongoing, or chronic ankle pain can be very frustrating and physiotherapy can often be useful in getting to the cause of the problem. Most ankle sprains will completely resolve, and return to normal if treated correctly. However occasionally ankle pain persists longer than it should, and it is important not to ignore these symptoms. Sometimes there can be a more serious problem than initially suspected such as a small fracture or damage to the cartilage of the ankle joint. If this is the case a specialist opinion should be sought. A more common reason for ongoing pain and stiffness is chronic inflammation of the soft tissue around the ankle joint, termed impingement or synovitis. This may be caused by trying to do too much in the early stages of your recovery, or going back to sport too quickly. Generally you will have reduced range of motion and pain in the front, side or rear of your ankle. You may have some visible swelling and the ankle will often feel stiffer in the morning. It is important to give the ankle some rest when you have this condition, as continuing to play sport through pain will prolong your recovery. Physiotherapy is effective at helping you regain your movement, strength and reducing your pain so that you can return to sport as quickly as possible. Your treatment will likely involve massage and joint mobilisation, stretching and a home exercise programme.

We treat a wide variety of injuries to the ankle and the Achilles tendon at the clinic. Listed below are some of the more common ankle injuries and Achilles injuries.

Lateral ankle sprain

This is the most common type of ankle injury and involves damage to the ligaments on the outer side of your ankle. This is very common in most sports, but especially in netball, football, rugby, hockey and basketball. With moderate to severe ankle sprains it is common to have significant swelling and bruising afterwards, and it can be difficult to walk. You may be advised by your physiotherapist to have an Xray to exclude any fractures. Initially you will need to rest and protect the ankle, and adopting the R.I.C.E. principles is a good idea to limit swelling. From the initial stages of your injury, physiotherapy will be helpful for decreasing pain and swelling, regaining your movement and strength, and getting you back to normal walking. It is also important to retrain your balance and reflexes of the ankle so that you are strong and safe to return to sport. Physiotherapy treatment may include soft tissue and joint mobilisation, acupuncture, strengthening and stretching exercises, balance retraining and sport specific exercises.

Medial ankle sprain

This type of injury is less common and involves the ligaments on the inside of your ankle, This typically occurs in football or rugby players who kick an opposition player with the inside of their foot. The ligaments on the medial aspect (inside) of the ankle are larger and stronger than the lateral (outside), and although less commonly injured, they are a little slower to heal. As with lateral ankle sprains initial treatment is aimed at protecting the joint, and limiting swelling. As the pain improves your physio will mobilise your ankle to regain your movement, then advise you on the strengthening and balance exercises to get you back to normal as soon as possible.

Achilles tendinopathy

Tendons are tough bands of tissue that connect muscles to bones and therefore allow movement of your joints. Tendinopathy is what happens when these tendons become dysfunctional. The Achilles tendon is the largest tendon in the body and is commonly affected by this condition. There are several stages of tendinopathy which your physiotherapist will explain, and it is very important to seek treatment in the early stages as without appropriate advice and exercise your problem could become a lot worse later on in life. Initially, the tendon may become painful due to being overloaded to a point that is greater than it can handle, e.g. a particularly long and hilly walk/run or a hard game of netball. Given some rest and appropriate treatment, this type of injury should completely resolve, with little long-term effects. If this problem persists and training/exercise continues, it is possible that pathological changes can occur within the tendon, with changes to the way the collagen is structured in the tendon. In the long-term this can lead to a degenerative tendinopathy which becomes more difficult to resolve due to structural changes in the tendon. Your physiotherapist will assess what stage you are in and then design a treatment plan that is most appropriate for this stage. This may involve advice on the type of training you can do, specific exercises you can do to stretch and/or strengthen the tendon, soft tissue and joint mobilisation to free up the area, biomechanical assessment, and podiatrist referral. Once you can tolerate it, you will need to begin specific and graduated strengthening of the tendon so that it can withstand increased loads. Without a good exercise programme the pain is likely to return once you get back to training. Tendons are very susceptible to changes in load, and therefore need a relatively long time to adapt to the exercises that your physiotherapist will prescribe.

Achilles rupture

As well as being prone to tendinopathy, the achilles tendon can also completely tear or rupture during a sudden injury. This is most common in high intensity sports like rugby, basketball, netball, badminton or squash. Often it will feel as though you have been kicked in the back of the leg and then you will be unable to push off with your toes. There will be significant swelling, and your physio should be able to diagnose this problem from a few simple tests. An ultrasound scan can help confirm the diagnosis. You will need to be referred to see an orthopaedic surgeon as soon as possible who will decide whether to operate or not. Older and less active people are less likely to require surgery, but it is imperative to be diagnosed and treated early to have successful non-operative treatment. Regardless of whether you have surgery or not you will need to do a long period of rehabilitation to regain your strength, flexibility, endurance, and power in the leg. It is important to have your rehabilitation supervised by an experienced physio and you can expect it will take 6-9 months before you can return to sport.

High ankle sprain (syndesmosis injury)

These type of injuries are less common than lateral ankle sprains, but can be more debilitating and usually require more rehabilitation. They involve the strong ligaments and connective tissue between the bottom of the two lower leg bones, the fibula and tibia. This area is known as the ankle syndesmosis, and normally very little movement occurs here. This area can get injured in a slightly different way to the more common lateral ankle sprain – by either the foot getting twisted outwards when it is planted on the ground or trapped underneath something, or by an excessive force that bends the ankle into dorsiflexion (when the toes come upwards towards the knee). Pain and swelling is often more severe in patients with a high ankle sprain, and walking can be very difficult and painful at the point just above where your ankle joins your lower leg. Your physiotherapist may refer you for an Xray or further investigation to check that there has been no fracture or other more serious injury. It is important to ascertain the severity of injury early on as if these injuries don’t get picked up early on they can lead to more issues later on. With these injuries, it is often advisable to spend some time either on crutches on in a moonboot to let the injury heal. Your physiotherapist will guide you on this.

Tibialis Posterior tendinopathy

The tibialis posterior muscle is located on the inside of your shin, and it has several attachments into the small bones of your foot. It is a very important muscle as it helps to stabilise your foot and ankle over the rest of your body, and helps the arch of your foot to work effectively. Tibialis posterior tendinopathy is an injury to the tendon of the muscle, usually as it wraps around the bone on the inside of your ankle called your medial malleolus. It causes pain on the inside of your ankle and some patients experience crepitus (crackling or grating sound) and swelling in this area too. It is a common injury we see at the clinic. It is most commonly an overload injury, caused by repetitive excessive strain on the tendon that can ultimately result in small micro tears of the tendon. This can happen when there is a sudden increase in training intensity, such as running or sports involving jumping. Other contributing factors can include poor foot mechanics (such as flat feet), lower limb muscle weakness (such as the gluteal muscles), previous ankle or knee injury and poor footwear. Your physiotherapist will provide you with a treatment plan to address the issues that are contributing to your pain, to get you back to your normal function and desired activity level. Treatment may include stretching and strengthening exercises for the lower limb to improve muscle balance, load management strategies, footwear advice, acupuncture and manual therapy techniques such as massage and joint mobilisation.

Sever’s Disease

Sever’s Disease, also known as calcaneal apophysitis, is commonly seen in active children during times of most growth (boys 10-14 years and girls 8-12 years). It is a traction injury to the growth plate of the heel bone near where the Achilles tendon attaches. Symptoms can include limping, pain walking on tip toes and tenderness over the back of the heel. Your physiotherapist can assess any contributing factors to this condition and can provide a detailed treatment plan. This will often involve activity modification for the patient, pain relief strategies and exercises to improve flexibility and strength. It will almost always resolve over a period of time but this time can vary between patients depending on their activity level and how they manage the condition.

Ongoing ankle pain

Ongoing, or chronic ankle pain can be very frustrating and physiotherapy can often be useful in getting to the cause of the problem. Most ankle sprains will completely resolve, and return to normal if treated correctly. However occasionally ankle pain persists longer than it should, and it is important not to ignore these symptoms. Sometimes there can be a more serious problem than initially suspected such as a small fracture or damage to the cartilage of the ankle joint. If this is the case a specialist opinion should be sought. A more common reason for ongoing pain and stiffness is chronic inflammation of the soft tissue around the ankle joint, termed impingement or synovitis. This may be caused by trying to do too much in the early stages of your recovery, or going back to sport too quickly. Generally you will have reduced range of motion and pain in the front, side or rear of your ankle. You may have some visible swelling and the ankle will often feel stiffer in the morning. It is important to give the ankle some rest when you have this condition, as continuing to play sport through pain will prolong your recovery. Physiotherapy is effective at helping you regain your movement, strength and reducing your pain so that you can return to sport as quickly as possible. Your treatment will likely involve massage and joint mobilisation, stretching and a home exercise programme.