An individual with an ankle injury would usually have a general physiotherapy management which aims at the following:
• Reducing the joint swelling
• Decreasing pain
•Improving gait and balance
• Improving joint mobility
• Increasing muscle strength
Initial stage of the injury
The initial focus of management is to reduce the pain and swelling which develops around the ankle joint. You will also be educated on how to protect the ankle from reinjures.
During the first few days, you need to place ice over the ankle for about 20 minutes to reduce the swelling and pain in the joint. You can make an ice pack by wrapping ice cubes in a plastic bag and towel. Gently place the ice pack on your injured ankle. You may reapply for 20 minutes every couple of hours throughout the day. Do not place the ice cubes directly on your ankle as this may cause burns on your skin.
You can also make use of supportive devices such as an ankle brace to protect your ankle joint but you may not be able to step on your injured ankle.
Therapeutic exercises
Exercises are started after a couple of days when pain has reduced slightly. These involve stretches, strengthening exercises, range of motion exercises, body awareness and balance exercises.
Stretches
These exercises prevent the ankle joint from becoming stiff as it heals and maintains the flexibility in the injured joint.
Towel stretch
• Sit on a bed with your injured leg stretched out in front of you. Wrap a cloth or towel around the ball of your foot and gently pull the cloth/towel toward your body without bending the knee. Hold the position for 20 seconds and repeat 5 times.
Calf stretch
• Stand facing a wall with both knees slightly bent and the injured ankle slightly behind your other foot. Place both hands on the wall and gently move forward towards the wall, you will feel a mild stretch at the back of your leg. Hold the position for about 20 seconds and relax. Repeat throughout the day.
Ankle range of motion exercises
• Sit comfortably or lie down. Gently move your foot towards your body, then away from you and finally to the left and right. You can repeat throughout the day to improve the movement in your ankle joint.
Strengthening exercises
Weakness in the muscles around the ankle joint creates instability and may predispose the joint to reinjury. These exercises also depend on the severity of the injury. The exercises can be performed with a resistance band to improve the strength in the affected leg.
• A: Lie on a bed with one end of the resistance band tied to your injured ankle and the other end tied to a stable object away from your body. Ensure that your knee is not bent. Gently move your foot towards your body and maintain the position for 10-15 seconds and relax. You may repeat as often as you can tolerate. Ensure that the movement doesn’t cause you pain.
• B: Lie on a bed with your knees outstretched and one end of the resistance band tied to your foot with the other end tied to a stable object behind you. Gently bend your foot away from your body and hold the position for 10-15 minutes. Repeat as often as you can tolerate.
Heel raises
Stand against a wall and gently rise up on your toes. Hold your position for about 10 seconds and gently lower your heel down to touch the floor. Ensure that you place your weight in both legs as you balance on your toes. Repeat 5 times.
Body awareness and balance exercises
These are exercises to assist your injured muscles and joint to ‘relearn’ its position in both stable and unstable environment. This is an essential exercise to aid you to return to your daily activities.
Single leg balance
Stand without any support and attempt to balance on your injured foot. Commence with your eyes open and then try to carry out the exercise with your eyes closed. Hold the position for 30 seconds. Repeat as often as you can tolerate.
Wobble board
Stand on the wobble board while holding onto a chair for support as you try to balance on both legs, then only on the injured ankle for 20-30 seconds each day. As your balance improves, try and balance without holding onto the chair.
