Physiotherapy and rehabilitation
Here we present in detail the most common ankle injuries. Every ankle pathology or injury has a description of general features, the cause of the injury, the characteristics of the symptoms, diagnostics, and the course of treatment.
Ankle instability syndrome or chronic ankle instability is a condition in which the passive stabilisation function of the ankle is affected due to laxity or injury to the ligaments. Typical symptoms include a feeling of constant instability, swelling of the joint, ankle roll, occasional pain, and difficulty walking or a changed walking pattern.
Recurrent ankle sprains are common. Ankle instability syndrome is strongly associated with deficits in ankle muscle strength, muscle asymmetries, and general insufficient functional capacity of the joint. A dysfunctional muscular condition creates conditions in which the ankle joint relies solely on static stabilisers for support, resulting in excessive load on the ligaments and susceptibility to injury.
Chronic ankle instability is the result of repeated sprains or inadequate rehabilitation of an ankle sprain. In the long term, chronic ankle instability represents a high risk factor for cartilage damage and osteoarthritis of the joint due to the greater likelihood of microtrauma.
If symptoms occur, a clinical examination by an orthopaedist and diagnostics using ultrasound (US) or magnetic resonance imaging (MRI) are essential. In the first phase of conservative treatment, measurement of muscle contractile properties using the TMG method is crucial.
As the first method of treatment, we recommend conservative kinesiotherapy treatments with an emphasis on training to improve proprioception and stabilise both ankle joints. Improving ankle muscle strength reduces the risk of recurrent sprains.
We recommend conservative kinesiotherapy treatments with an emphasis on training to improve proprioception and stabilisation of both ankle joints.
Improving ankle muscle strength reduces the risk of recurrent sprains. Surgical treatment is performed in cases of severe ligament injuries or excessive functional limitation of the ankle that conservative treatment does not remedy.
Surgery most often involves ligament reconstruction, scar removal, or suturing or shortening the ligament. After surgical treatment, it is crucial to perform postoperative training to strengthen the ankle muscles, which provide functional stabilisation to the joint, and proprioception training.
An ankle fracture refers to a fracture of the bones of both ankle joints that occurs due to an invasive ankle sprain, fall, or collision. The mechanism of a non-contact injury is practically the same as that of an ankle sprain. The most commonly fractured bones are the calcaneus and the talus; in the event of a fracture, there is immediate pain and swelling. Since, in addition to the fracture, there is often damage to the ankle ligaments, the symptoms usually appear as a sprain, so there is a risk that bone fractures are overlooked.
An ankle sprain is a more serious form of ankle injury in which the ligaments are stretched or deformed to the point where they can no longer maintain the joint in its functional anatomical position. In the case of an ankle sprain, there is an outwardly visible deformation of the joint. Ankle dislocation often accompanies fractures of the ankle bones and requires surgical treatment in most diagnoses.
When an ankle sprain occurs, it is essential to see a doctor and undergo appropriate diagnostics with an X-ray or magnetic resonance imaging (MRI). Once a fracture is diagnosed, the ankle is immobilised, and the immobilisation is followed by a protocol of special training to strengthen the ankle muscles, combined with mobility and balance training, thereby restoring function and stability to the ankle. We use instrumental physiotherapy to manage swelling.
Special training to strengthen the ankle muscles, combined with mobility and balance training, restores function and stability to the ankle.
Ankle sprains represent 45% of all lower extremity joint injuries. Ankle sprains are one of the most common musculoskeletal injuries in general, and they also have one of the highest rates of recurrence. In 20% of ankle sprains, the articular cartilage is deformed, and recurrent ankle sprains lead to chronic instability of the joint and, in the long term, osteoarthritis.
In most cases (85%), the external ligaments of the ankle are damaged. The most commonly injured ligaments in the event of an ankle sprain are the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL).
Depending on the intensity of the trauma, injuries to the external ankle ligaments are divided into three grades:
– ligament strain, minimal functional impairment, no bruising, weight bearing is possible
– partial ligament rupture, moderate functional impairment, moderate pain and swelling present, frequent bruising, full load bearing is difficult
– full ligament rupture, severe functional impairment with severe swelling and bruising, load bearing is not feasible
A major risk factor for ankle sprains is the shape of the congenital anatomical position of the arch of the foot. A high and/or shortened arch places the foot in an inward position, which exposes it to a greater likelihood of injury. The most common mechanism of ankle sprain is the foot simultaneously rolling inwards and twisting upwards, which is technically called an inversion ankle sprain with plantar flexion. Inversion trauma means that we use our own weight to create excessive force on the outside of the ankle, which causes a strain, tear, or rupture of the ligaments and muscles that perform lateral stabilisation.
If you suspect an ankle sprain, you should see a doctor and immediately undergo appropriate diagnostics (magnetic resonance imaging (MRI), X-ray or ultrasound). It is crucial to rule out more serious complications such as ankle fractures, ankle dislocations, etc. In most cases of more severe ankle sprains, an X-ray is performed.
In most cases, treatment for an ankle sprain is conservative. Surgical treatment is only performed in cases of concomitant complicated bone fractures, cartilage damage, or chronic joint instability. Treatment is based on the RICE principle (Rest, Ice, Compression, and Elevation) for the first 72 hours after the injury. In case of more severe symptoms, reduced load is ensured by using crutches. The acute phase after injury is followed by a phase of functional rehabilitation, which includes a specialised exercise programme, which is always superior to the first therapeutic phase for long-term treatment success.
Ligaments provide passive stability to the ankle when performing movements. Ankle ligament injuries are common and accompany most sprains to at least a minor extent. The most commonly injured ankle ligaments are the anterior and posterior talofibular ligaments (ATFL, PTFL), which connect the talus and the fibula, the calcaneofibular ligament (CFL), which connects the calcaneus and the fibula, the calcaneocuboid ligament (CCL), which connects the calcaneus and cuboid bone, and the deltoid ligament (DL), which connects the tibia and the talus.
Depending on the intensity of the trauma, injuries to the external ankle ligaments are divided into three grades:
– ligament strain, minimal functional impairment, no bruising, weight bearing is possible
– partial ligament rupture, moderate functional impairment, moderate pain and swelling present, frequent bruising, full load bearing is difficult
– full ligament rupture, severe functional impairment with severe swelling and bruising, load bearing is not feasible
In most cases, treatment for ankle ligament injury is conservative. Surgical treatment is only performed in cases of concomitant complicated bone fractures, cartilage damage, or chronic joint instability. Treatment is based on the RICE principle (Rest, Ice, Compression, and Elevation) for the first 72 hours after the injury. In case of more severe symptoms, reduced load is ensured by using crutches. The acute phase after injury is followed by a phase of functional rehabilitation, which includes a specialised exercise programme, which is always superior to the first therapeutic phase for long-term treatment success.
A heel spur is a term for a growth on the heel that is present in the form of a calcium deposit or bone spur or osteophyte. Heel spurs have an overall prevalence of 15%, and are more common in the elderly, with 35% of individuals in the 60–69 age group having heel spurs. A heel spur can also be asymptomatic, meaning it does not cause any pain, but it always needs to be treated with physiotherapy as it represents a risk factor for the onset of pain. A heel spur usually hurts on one side, although two thirds of patients also have a spur on the other heel, which they refer to as a problem with the other heel in the past.
A heel spur can grow up to 1 cm in size and can occur on the back of the heel (spina calcanei superior) as a result of overload of the Achilles tendon attachment point, or on the underside of the heel (spina calcanei inferior) as a result of overload of the plantar fascia attachment point. A plantar heel spur, on the underside of the heel, is a result of plantar fasciitis, and is the more common and commonly referred to “heel spur” by patients upon visit.
Risk factors for developing a heel spur include flat feet, being overweight, wearing high heels, sports overload, especially jumping and running, diabetes, and age. It occurs more often in women, athletes, elderly people between 60 and 69 years of age, and diabetics.
A heel spur has a characteristic pattern of symptoms, making it easy to distinguish from other pathological conditions that cause pain in the area of the calcaneus. The pain of a heel spur is sharp and intense, occurring mainly in the morning with the first steps, in the area of the calcaneus. A characteristic of heel spurs is that the pain disappears or decreases after walking a short distance. Heel spurs are characterised by post-static dyskinesia, meaning that after physical inactivity or rest, the heel always hurts intensely for the first few steps.
The symptoms of a heel spur depend on the size, shape, and location of the spur, but in most cases, the pain is strongest in the morning, as the plantar fascia shortens and expands at night. Symptoms also typically worsen when running and walking.
Heel spur is one of the pathological conditions that require a comprehensive conservative approach of physiotherapy and kinesiology. This means that if we only perform one type of therapy in isolation, we will not eliminate the heel spur. Comprehensive treatment includes extracorporeal shockwaves, TECAR therapy, laser therapy, manual therapy, and kinesiology training.
Treatment for a heel spur usually lasts between 16 and 24 weeks; however, if the heel spur has been present for more than a year, treatment is extended. To treat heel spurs, extracorporeal shockwave therapy is often performed in isolation, as it is the most effective method of “breaking up” or eliminating heel spurs, but it must be performed together with special exercises and manual therapy.
Treatment of heel spurs must include techniques to improve the quality of the connective tissue of the plantar fascia, which is achieved through exercises to strengthen the intrinsic muscles of the foot and endurance exercises for shin muscle strength.
At MEDICOFIT clinic, we use EMS focused shockwaves as the leading method of treating heel spurs, which are the most effective tool for heel spur rehabilitation in clinical practice – patients usually notice pain-relieving effects after their first therapy. Extracorporeal shockwaves break down the deposited calcium into smaller units, which are then absorbed and broken down in the surrounding tissue. Extracorporeal shockwave therapy must be performed in combination with special exercises to strengthen the arch of the foot, which we always consider at MEDICOFIT clinic.
Plantar fasciitis, or inflammation of the arch of the foot, is an acute inflammation that affects the heel and sole.
Individuals experience sharp pain in the heel or sole, occurring in the morning and when under load. Inflammation occurs due to repetitive stress (prolonged walking, standing, running) or a bone spur (heel spur).
Inappropriate treatment causes the acute inflammation to developed into chronic inflammation, leading to functional limitations that affect your entire musculoskeletal system.
The primary phase of treatment requires an expert physiotherapy diagnostic examination, during which we confirm that the cause of your problems is plantar fasciitis.
Heel or sole pain may be the result of differential diagnoses such as ankle ligament injuries, heel spurs, or stress fractures in the calcaneus. It is also important to determine the cause of the disease and eliminate it.
Through the process of taking a medical history, assessing the anatomical structure of your body, the origin and cause of the disease, describing symptoms and special tests, we create an individualised physiotherapy programme.
Physiotherapy treatment for plantar fasciitis includes a tailored kinesiology programme, which includes active and stretching exercises, with the aim of maintaining proper walking biomechanics, establishing muscle balance, and increasing flexibility.
The kinesiology programme is effective in combination with appropriate support technologies, such as kinesio taping, extracorporeal shockwave therapy, ultrasound therapy, laser therapy, and PERISO therapy.
The physiotherapist will suggest appropriate orthopaedic shoes or an orthopaedic insole for your foot.
