Ankle vs Foot injuries

Ankle vs Foot injuries can be common in sports people, particularly those involved in change-of-direction sports. Foot injuries are somewhat less common, however are still seen in many different types of athletic and physical activities.

Where do ankle injuries occur? 

The bones of the ankle include the talus, tibia, and fibula. There are also a number of ligaments that act to support the bones and provide stability.

The classical “Ankle Sprain” or inversion ankle injury usually disrupts 1 or more of these ankle ligaments, although more severe injuries can damage the bones.  More often than not, the ligaments on the outside of the ankle are disrupted. But, depending on the severity and type of injury mechanism, other structures can be damaged too. Generally speaking, if these bones or ligaments are damaged the pain is felt above the level of your top shoelaces.

Sign of an ankle fracture not to be missed; 

• Inability to weight bear/ stand at time of injury or in Emergency Department
• Bone pain/tenderness up to 6cm above the bony part on the inside of ankle
• Bone pain/tenderness up to 6cm above the bony part on the outside of ankle
• Inability to move the ankle through its normal range of motion

Your Physiotherapist can refer you for X-Rays or an MRI if required.

Ankle injuries are often managed using a period of rest/immobilisation with gradual return to weight-bearing activities.  Most ankle sprains can tolerate weight-bearing in earlier phase of injury (with appropriate guidance). Although, if there is significant disruption to the joint, articular surface, or the joint between the shin bones (Tibio-Fibular joint / Syndesmosis) it may need a few weeks longer.

A key factor in returning to sport or physical activity is reducing risk for recurrence using Physiotherapy methods such as therapeutic exercise, taping or braces.

Where do foot injuries occur? 

There are 26 bones in the foot, with multiple adjoining ligaments between them. Considering this, it’s no wonder there are many structures that can be damaged if the foot is stressed in the wrong way.

Foot injuries usually occur from trauma / impact when the foot is in a plantarflexed position (toes pointed down). Generally speaking, if these bones/ligaments are damaged, the pain is felt anywhere below the level of your shoelaces or into the toes. If the damage is done on the plantar surface (bottom of the foot) it is far more likely that surgery is needed, in addition to a lengthy period of non-weight bearing.  As you can imagine, putting weight through an injured bone or ligament will prevent it from healing – similarly to pushing on a bruise.

X-Rays can miss fractures in the foot, which is another reason why they can sometimes be difficult to manage effectively. Your Physiotherapist may recommend that you get an MRI to detect fractures within the foot that an X-Ray has not picked up on.

Signs of a foot fracture not to miss:  

• Swelling into the toes and middle of foot
• Bruising on the plantar foot surface
• Injury involving plantarflexed (pointed toes) foot position
• Bone pain/tenderness on the inside or outside of the midfoot (where the mid-lower shoelaces run)

Foot injuries are also often managed using a period of rest/immobilisation with gradual return to weight-bearing activities.  To do this – methods involving taping, braces, moonboots or plaster casts may be required in addition to targeted therapeutic exercises.

What does this mean for me?

Regardless of where your injury has taken place, most ankle vs foot injuries can be managed effectively with accurate diagnosis and ankle sprains treatment from a Physiotherapist. This also includes those that go on to require surgical management.

A key factor in managing these injuries is determining whether or not a period of non-weight bearing is required.  In this case a moonboot or crutches may be needed. Conservative management may involve a period of non-weight bearing/ immobilization, gait retraining, in addition to careful rehabilitation exercises and return to work/ sport/ activity guidance. Your Physiotherapist might refer you to the Podiatrist for long term support.

Even if a foot/ ankle injury does need surgery, rehabilitation and gradual return to activity is crucial. Therefore, having a Physiotherapist support you during this process can be incredibly useful.