Anterior Impingement Syndrome (‘Footballers Ankle’):
This problem is caused by the opposing bones in the ankle joint repetitively coming into contact with each other at the front of the ankle when the foot is bent upwards, or ‘dorsiflexed’. This constant contact causes an inflammatory reaction in the outer layer of the bone and sometimes, cartilage damage. Impingement occurs when the ligamentous ‘capsule’ surrounding the joint is tight.
This tightness of the joint capsule is usually caused by poor rehabilitation following ankle injury, or chronic ankle injury. Pain will be felt as a dull ache and will be made worse during such activities as running, walking downhill or steps or during a lunge on the affected leg. Stiffness in the ankle joint will also be experienced.
Tibialis Anterior Tendonitis:
This problem is an inflammation of the tendinous part of the muscle that primarily pulls the foot upward, or dorsiflexes. The tibialis anterior tendon will commonly become inflamed, causing a tendonitis when the muscle is overloaded such as repetitively running downhill or steps.
It may also occur secondary to ankle joint tightness. Pain and a creaking feeling may be felt when bending the foot up or ‘dorsiflexing’. There may also be pain and tenderness at the front of the ankle joint and tightness in the muscle at the front, on the outside of the shinbone.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R – Rest
I – Ice
C – Compression
E - Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.
Strengthening programs should only be commenced when:
- The injury is not painful to touch.
- The injury is not painful in the morning.
- The injury is not painful to stretch.
- The injury is not painful with light to moderate exercise.
Exercises should be 3 sets of 8-12 repetitions.
Wobble Board Exercises – Balance 1 leg
for an advanced exercise, try balancing on the board with one leg only
2. Balance exercises
- Balance and coordination need to be restored. Proprioception is the awareness of one’s own body position and is important in balance and coordination
- Proprioception exercises help to re-educate the ankle so that it can be protected against future sprains. Wobbleboard exercises and balancing tasks are good examples. Try the exercises with your eyes closed to really test your proprioception and balance
- External supports such as braces and taping may also improve proprioception by stimulating the skin receptors about the ankle joint.
Balance on one leg
Wobble Board Exercises – Circles
rotate tilt around in a circle, try not to touch the ground
Wobble Board Exercises – balance only
- Stand with feet even on the board
- Try to balance steadily, without the edges of the board touching the ground
- Balance only
Wobble Board Exercises – Side to side
tilt board side to side, try not to touch the ground
Wobble Board Exercises – Forward and Back
tilt board forward and back, try not to touch the ground
- Stretches to be held for three sets of 20 to 30 seconds.
- A light warm-up such as walking or exercise bike for five to ten minutes, should be undergone before stretching
- Stretches should be held just at the first point of tension.
- Stretching should be slow and gentle and no excessive tension or discomfort should be felt during stretching.
- Stretches can be done to help treat an injury but should also be done before and after exercise.