The most common ankle injury is by far the ankle sprain where one or more of the ankle ligaments are partially or completely torn. There are 2 main injuries that can be sustained in an ankle sprain – a lateral sprain (injury to the lateral ligament complex which is made up of the Anterior TaloFibular Ligament, the Posterior TaloFibular Ligament, and the Calcaneofibular Ligament), or medial sprain (injury to the medial or deltoid ligament).
Sprains of the lateral ligament often occur due to an inversion/rolling your ankle injury during sport or miss-stepping. The medial sprains usually occur with over-pronation of the heel/eversion of the foot. Ankle sprains are the 2nd most common sporting injury and have a high recurrence rate due to poor or incomplete rehabilitation.
Ligament Injury Grading
Ligament injuries are graded by the severity of the ligament tissue damage as follows:
Grade 1 microscopic tearing of the ligament with no visible injury (macroscopic)
Grade 2 macroscopic (visual) tearing of fibres of the ligament
Grade 3: partial tear of the ligament
Grade 4 complete rupture of the ligament
Pain in the area of the Achilles tendon is most commonly due to an Achilles Tendinopathy. That is a failure of the tendon matrix and structure due to mechanical loading beyond the capabilities of the tissue, often combined with compression. Often a change in training load or type, change of shoes, tight calf muscles and poor foot biomechanics contribute to the problem. Often patients have been told they have a heel spur at the insertion of the Achilles Tendon, and whilst this may be true, it is the pulling of the tendon and resultant calcification at the insertion that causes the spur. The spur itself is not necessarily painful, it is the tendon that is the painful and problematic structure.
The Healing Process
It is important to understand that tendons do not heal with rest, they get weaker and ultimately the problem becomes worse. They also do not heal if overloaded, again they will become aggravated and then deteriorate. The solution is the promotion of healing, controlled loading (as opposed to complete offloading and rest) and slow, graded, specific tendon loading protocols. Our physios are experts at correctly assessing the current tolerable tendon load and designing an appropriate program to get your tendon healing.