The ankle is comprised of 3 separate joint and is arguably the most important joint in the lower limb.

Motion in the ankle allows the rest of the lower limb / body to move over the foot as it progresses from heel to toe during normal walking and running, thus facilitating ‘straight-line’ mechanics of the entire lower limb. Motion in the subtalar joint of the ankle also provides us with shock absorption at heel strike and allows the foot to adjust to uneven ground.

Ankle sprains are extremely common and generally occur when someone ‘rolls’ on their ankle damaging ligaments of the region and range in severity from simple strain to complete tear of the ligament. The majority of ankle sprains resolve quickly however in some cases pain and disability can persist even for a number of months. There are a number of causes of this ‘difficult ankle’ syndrome including synovitis (joint inflammation) which can develop if return to full weight-bearing after a sprain is too early or has been forced.

Functional instability of the ankle can occur with repeated ankle sprain or if the ankle doesn’t heal adequately after a bad sprain. This can be due a combination of the ligaments being lax (‘stretched out’) and muscles around the joint failing to support the joint.

Other common ankle injuries include bony and soft tissue impingement syndromes, fractures of the tibia / fibula, and tendon problems such as tibialis posterior tendinosis.

Poor proprioception; our unconscious awareness of body movement and position; is a common underlying cause of injury to the ankle. Little sensors / receptors built into the tissues of our body (joints, muscles, and ligaments) detect movement and send information about its direction and speed to our brain which in turn uses this information to plan and coordinate movement. Injury to tissues with these built in receptors mean that the brain has ‘less information to work on’ and fails to activate muscles when appropriate, for example to ‘right’ the ankle when it is about to ‘roll’. Proprioception exercises are used to ‘retrain’ this pathway from receptor to brain.

Subtle changes to foot shape and structure (‘skeletal drivers’) such as external tibial torsion, forefoot / rearfoot varus, and Hallux limitus drive excessive pronation of the foot disrupting the normal heel to toe mechanism. This is especially relevant with tendon injuries and ankle impingement problems. Gait analysis performed by an experienced Podiatrist is required to identify these issues and to determine whether a combination of orthotic devices or running shoe advice is needed.

Treatment of most ankle problems involves physiotherapy including manual therapy to mobilise restrictions in range of movement where appropriate, but the focus is always on using specific exercises to restore strength in relevant muscles, improve proprioception, and to eliminate any biomechanical dysfunctions identified.