The ankle: A user’s guide

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HOW YOUR ANKLE WORKS ON THE RUN

Your ankle both drives you forward and minimises impact forces. ‘When your foot hits the ground, the ankle’s dorsiflexion – when your toes move closer to the shin – acts as a kind of shock-deferral device,’ says physiotherapist Paul Hobrough of Physio and Therapy. ‘Along with your knees and hips, the ankle allows the body to absorb multiple times your body weight. Then, stabilising muscles and the elastic recoil of your Achilles tendon enable the ankle’s next phase, known as plantar flexion, in which your toes move away from your body, to propel you forward and upward again. ’The ankle also works in tandem with your foot to allow impact-absorbing pronation (inward roll of the foot). ‘A locking mechanism within the tarsal bones in the foot creates a stiff foot and ankle for maximum drive forward,’ says Hobrough. ‘Pronation takes place when this mechanism unlocks, allowing the foot to absorb the ground force with the least possible impact.’


HOW TO KEEP IT IN WORKING ORDER

The joint’s complex, delicate biomechanics mean ankle injuries are common in runners. Here’s how to ensure they don’t keep you sidelined:

SPRAIN

‘These injuries tend to damage lateral or external ligaments,’ says Alessandro Marconato, rehabilitation physiotherapist at the Isokinetic clinic. ‘Grade-one injuries just overstretch the ligament, with no actual tear; grade twos are partial tears and a grade three is a complete rupture.’

Treatment: ‘It’s vital in the first 24 hours to control pain, swelling and inflammation,’ says Marconato. This is achieved through rest, ice, compression and elevation (or RICE, every runner’s favourite acronym). ‘Depending on the damage, it may be beneficial to wear a brace to protect the ligament. Pain permitting, early mobilisation in extension and flexion of the foot from the ankle is important to maintain a good range of motion. Do this by pointing your toes, then flexing them. If it’s possible without pain, weight bearing is recommended, working towards normal walking technique. Seek expert advice when you reach this point so you don’t cause further damage through improper walking form.’

Prevention:‘Strength, balance and neuromuscular control are central to rehabilitation,’ says Marconato. ‘The gluteal muscles and the peroneal muscles (connecting the tibia and fibula in the lower leg) are particularly important. It’s essential to work on muscle activation and neuromuscularcontrol exercises so you’re able to switch on these muscles.’


ACHILLES TENDINOPATHY

‘This overuse injury is the most common cause of posterior ankle pain,’ says Marconato. As well as pain, this kind of ankle injury can cause swelling and stiffness. Overpronation, weak calf muscles and a reduced range of upward flexion are among the most common causes, says Marconato.

Treatment: ‘Rehabilitation starts with symptom control, which means reducing activity and controlling pain through RICE,’ says Marconato. ‘It’s also essential to recover the range of movement, and you can do this by stretching the calf muscles – both the soleus and gastrocnemius muscles.’ How? Stand with your heels hanging over a step. Drop one heel, hold for 30 seconds, switch sides and repeat three times to stretch the gastrocnemii. Then repeat the exercise, but this time with a bend in your knee to stretch the soleus. ‘The calf muscles will be weaker than they are on the non-affected limb, so it’s vital to regain strength,’ says Marconato.

Prevention: You can begin building strength (to prevent injury or as part of your treatment) by using a resistance band. Sitting on a chair, loop a resistance band around your foot. Keeping hold of the other end, point and flex the foot 20 times. Rest, then repeat three times. ‘Progression is key,’ says Marconato, ‘so move on to bodyweight exercises such as calf raises.’


OTHER TENDINOPATHIES

These include peroneal tendinopathy, tibialis posterior tendinopathy and tibialis anterior tendinopathy. ‘They are a common set of overuse injuries that affect the ankle’, says Marconato, affecting, respectively, the outside, inside and front of the ankle. ‘They tend to arise from bad mechanics, such as overpronation, or from running up and down hills. The affected tendon maybe tender or painful to the touch, and painful while the muscle is tested.’

Treatment: ‘As with an Achilles injury, first control symptoms with RICE, then work to increase range of movement, correct biomechanics and strengthen your muscles. And add some balance or proprioception training,’ says Marconato.

Prevention: ‘When you’re working on gluteal strength, coordination and balance are key,’ says Marconato. ‘Use wobble boards and unstable surfaces and progress to squatting exercises.’ To build the gluteal strength that will prepare your body for wobble-board squatting, start with deep standing squats, focusing on engaging the glutes as you drive upwards. Start with three sets of 10-15 squats.

Want to avoid these injuries? Check out our four simple steps to injury-proofing your ankles.