The Peroneal tendons run down the outside of the ankle joint and attach to bones in the ankle and foot. Inflammation of these tendons commonly occurs when the ankle is repetitively rotated outwards. This may occur when running in old, overused running shoes or running on a slope.
Pain will be slow onset and may be perceived as a burning feeling on the outside of the ankle joint. Swelling and tenderness to touch may also occur. Pain may increase when the foot is brought upward (dorsiflexion) and inward (inversion). Pain will also be felt when the foot is pushed outward against resistance. Associated calf and ankle joint tightness may also be experienced.
Anterolateral Impingement Syndrome:
This chronic problem occurs following repeated lateral ligament sprains of the ankle, especially the anterior talo-fibular ligament. Impingement, causing degradation of the cartilage and bone at the front of the outside aspect of the ankle joint, will occur due to acute injury to the bone and subsequent tightening of the soft tissues surrounding. Symptoms include pain over the front of the ‘lateral malleolus’, (the bony protrusion on the outside of the ankle) and a clicking or catching feeling on the outside of the ankle. Pain will increase with weight bearing and pulling the foot upwards and outwards.
Lateral Ligament Strain:
The lateral ligament is actually three ligaments and is located on the outside of the ankle joint (PICTURE). Injury to these ligaments is probably the most common ankle injury. This tearing of the lateral ligaments commonly occurs during a quick change of direction, especially on an uneven surface, such as on rocks or sand. This injury is common in all team sports and commonly occurs upon landing on an uneven surface such as another player’s foot.
During this injury the ankle will commonly roll inwards and backwards, overstretching the ligaments on the outside of the foot. Sharp pain on the outside of the ankle and an inability to weight bear are common early symptoms followed closely by swelling and bruising extending down into the foot. Immediate ice compression and elevation is recommended If proper rehabilitation of the ankle including strength and balance training are not undertaken post injury this injury can easily become repetitive and chronic.
Sinus Tarsi Syndrome:
The sinus tarsi is a small ‘canal’ in the bone on the outside of the ankle joint. It contains small ligament whose function is to hold part of the outside aspect of the ankle joint together. Injury to the ligaments in this space may occur during inward rolling of the ankle joint or from overuse, usually in those with ‘flat feet’. Pain will be present to the front of the outside of the ankle and may be hard to locate.
Pain may worsen when changing direction during running, running in a circle on the affected side, or running on an uneven surface. It may also be painful and stiff to turn the ankle inwards (inversion) and outwards (eversion).
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.
Circles (roll the board around without touching the ground)
1. Range of Motion
- restoring normal range of motion will allow proper function of the ankle.
- try exercises such as pointing and bending the foot, as well as turning the foot inwards and outwards. Try tracing letters the letters of your name with the foot.
2. Calf Raise
3. 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 foot
balance wobble board
4. Further wobble Board Exercises
Forward and Backward (Rock forward and back)
side to side rock
- 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.