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Ankle Injuries

Ankle injuries are among the most common injuries in sport. ‘Ankle sprain’ (which is a mechanism rather than a diagnosis) is the most common injury in virtually all epidemiological studies. Being the first part of the kinetic chain to withstand the impact of running, twisting, pushing off and landing, the ankle and foot must, within fractions of a second, distribute the impact higher up the chain in complex flexion, extension, eversion and inversion movements of the talo-crural joint and supination and pronation at the mid-foot. The faster the movement, the more important is the balancing act and proprioceptive function of the ankle. In contact sports, such as soccer and rugby, direct impact injuries from studded shoes or opponents’ legs are very common.


In principle, training should include strength and flexibility training in flexion, extension (dorsi-flexion), pronation and supination and proprioceptive training on wobble boards or trampettes and functional training,
including running, side-stepping, jumping and landing exercises. Temporary strapping or bracing may be
needed. A functional ankle-scoring system adapted to the sport in question can be used to evaluate when
rehabilitation is complete and return to sport is safe, by comparing the injured and non-injured sides.


Injuries to the lower leg or immobilisation of the ankle joint often lead to atrophy of the lower leg muscles and reduced power output in ankle plantar flexion with straight knee (m gastrocnemius) and with flexed knee (m soleus, m tibialis posterior, m flexor hallucis longus, m flexor digitorum longus) and in dorsi-flexion (m tibialis anterior and m extensor digitorum). The lower leg muscles are of vital importance for activities like jumping, running on hard surfaces and most ball sports. Strength training of the calf muscles can be performed with toe raises in standing or sitting positions, with both straight and flexed knees.

Muscle endurance can be trained by cycling with the pedal under the forefoot, with a high saddle (m gastrocnemius), with a low saddle (m soleus and other deep flexors), with a step machine, on a treadmill or in a cross-trainer.

Flexibility can be achieved by stretching of the calf muscles and is performed standing, with a flexed knee for m soleus and other deep flexors or a straight knee for m gastrocnemius. Proprioceptive training can be done with classical ballet training at a barre or by using a more demanding standing surface, such as a wobble board. This training is essential, as different parts of the Achilles tendon and the calf muscles are being trained during different parts of the ankle movement. Functional training of the calf muscle should be done individually depending on the patient’s needs.

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