Conditions & Injuries: Ankle

Calf pain

Calf pain is felt in the muscle belly of your calf rather than the Achilles area. It is typically due to straining the muscle. You may have swelling in the area and you may have some bruising depending on the level of strain. You may need to have an ultrasound to check that you don't have any bleeding pooling inside the muscle as this can cause compartment syndrome or a blood clot (DVT).

Common causes

A calf strain is commonly caused by a sudden movement – usually trying to push off from your feet for either sprinting or jumping. You experience a sudden pain, after which it may be uncomfortable to put weight through the foot and difficult to walk normally.

How we treat calf pain

Initially, you may require some soft tissue release and gentle stretching to regain mobility in the calf. The physio will also give you a graduated strengthening programme to ensure that you don't overload the calf during recovery and gait re-education to reduce the likelihood of a developing a limping-style gait.

Average recovery time

Recovery time will depend on the severity of the strain.

Achilles tendon rupture

Many people describe their Achilles tendon tearing as hearing a loud gunshot, then feeling a loss of control and strength in their leg.There will be immediate swelling around your ankle and calf, and you can usually feel a gap in the tendon between your calf and your heel.

Common causes

Your Achilles tendon usually ruptures when you’ve pushed off suddenly with that leg, at the start of a sprint for example. Or if you’ve pushed down forcefully and unexpectedly on your heel, as you might if you stepped into a rabbit hole.

How we treat a ruptured Achilles

Conservative treatment involves immobilising your lower leg in an Aircast boot. Wedges will be used to keep your toes pointing downwards, giving the tendon time to heal. These wedges are gradually removed over 3 months. You can also have it surgically repaired. In some cases, if the ends of the ruptured tendon are far apart, surgery is your only option.

If you have surgery, you’ll start physio 2 to 3 weeks post-op and will be in a boot for 6 to 7 weeks. This will consist of manual therapy to reduce swelling and muscle tightness and increase ankle movement into plantar flexion/inversion and eversion, as well as gentle strengthening exercises. We’ll avoid flexing your foot to put unnecessary tension on the healing tendon.

Once you come out of the boot, we’ll devise a strength programme to take you from partial to full weight-bearing. The programme will be tailored according to the activities you want to get back to, and we’ll let you know at what stage it is safe to return to each activity to avoid reinjury or overloading other structures in your leg because of compensation. For example, you shouldn’t do any calf stretches until you can complete at least 10 heel raises that are comparable to those you can do on your uninjured leg.

Your programme will be a combination of exercises on land and in the pool, which is very beneficial when partial weight-bearing as you can practise standing-based exercises and walking without full weight bearing or overloading the repaired tendon.

Average recovery time

It can take 12 to 18 months to make a full recovery from a ruptured Achilles.

Read our article on Preparing for Achilles surgery

Achilles pain

Pain in your Achilles may occur where the tendon inserts into the back of your heel or in the lower part of your calf. It is usually caused by a condition known as Achilles tendinopathy. You may feel it when you push up onto your toes, when you have to hold your heel in a certain position, or when you land on your heel when running or jumping. It can be very painful, the area might be swollen and also painful to touch.

Common causes

The damage to the fibres of the Achilles tendon are often caused by overuse or overloading of the tendon. We often see this condition in long-distance runners and those who do jumping sports, but also in cyclists or walkers who have suddenly increased their distances.

How we treat Achilles tendinopathy

Initial treatment may include rest, ice, soft tissue release, stretching of your calf and modifying your activities to reduce the pain, as well as reducing the load on your Achilles with a brace or a wedge to raise your heel. We then devise a strengthening programme to gradually load the Achilles and strengthen the muscle groups above it that support the leg to avoid overloading the Achilles and causing the symptoms to return. As part of this we assess your gait and movement patterns to see why the Achilles tendon is being overloaded and how this can be avoided. This will inform our treatment approach.

Average recovery time

It will usually take about 6 weeks for the pain and swelling to go, but to avoid them coming back again you will need to do a strengthening programme of about 6 months.

Ankle arthroscopy

This surgery involves making two small incisions on either side of the ankle joint to assess the state of the joint, remove debris from within the joint, or repair it.

Common reasons for this surgery

An ankle arthroscopy is usually done if you have cartilage, bone fragments or bits of soft tissue that need to be repaired or removed from the ankle joint. If cartilage is being removed the operation may include a cartilage transplant, a stem cell transplant or creating micro-fractures in the ends of the ankle bone to encourage new cartilage to form.

How we rehabilitate after an ankle arthroscopy

Using manual therapy and a tailored exercise programme (including stretching, strengthening and proprioceptive exercises), we work with you to regain your full range of movement and strengthen the muscles around the ankle. This will stabilise the ankle and make it possible for you return to your activities as soon as possible. We also analyse your gait and movement patterns to identify and address any issues caused by compensatory movements that you may have developed in response to your ankle pain or stiffness.

Average recovery time

This depends on the reason for the arthroscopy. You may be fully weight-bearing immediately after surgery, or only be able to put your full weight on the ankle 6 weeks after surgery.

Read our article on Preparing for your surgery

Ankle fracture

A ‘broken’ ankle could involve a fracture of your calcaneus (heel bone), your talus (top of foot), or the ankle-end of your fibula (lower leg) or your tibia (lower leg – shin bone). You will usually hear a cracking sound when it happens.

Common causes

An ankle fracture can be caused by a fall, being hit by something, or your foot getting stuck while your body keeps moving. You should go to A&E to have it X-rayed if you think it might be fractured.

How we treat an ankle fracture

You may be put in a plaster cast or an Aircast boot to immobilise the ankle while the bones heal, or you may need surgery to pin and plate the bones back together if a part of the fracture is particularly severe or if it is displaced.

Bones take at least 6 weeks to heal, so you will not be able to put your full weight on your fractured ankle for at least that amount of time. If you’ve had the bones pinned, or plates inserted then you should be able to put your weight on it soon after your cast is removed, as these will give you extra support. Otherwise it should take you another 6 weeks to build up to bearing your full weight.

For both options, you should start physiotherapy at 6 weeks to slowly build up your strength and regain your range of movement in the ankle. This will include manual therapy, exercise programme initially in non-weight bearing and progressively into weight bearing. We can also use hydrotherapy. We’ll advise you on when it is safe to restart a new activity as we gradually help you build back to your full strength. We will also help you to regain your normal gait pattern and tailor a programme to return to sporting activities.

Average recovery time

It will take 12 to 18 months to make a full recovery as you’re likely to have stiffness in your ankle joint for some time, and immobilising your leg for 6 weeks will cause muscle weakness that you need to regain to return to your activity of choice.

Ankle fusion

In an ankle fusion surgery your surgeon will fuse either all 3 joints that make up your ankle, or a specific joint that may already be starting to fuse or have joint changes that are causing you pain. An ankle fusion is never a first option. You are likely to have had steroid injections and an ankle arthroscopy before having this surgery.

Common causes

The need for an ankle fusion could be a previous trauma that has not healed well, or down to degeneration of the joint, caused by arthritis, for example.

How we rehabilitate after an ankle fusion

Following your ankle fusion you will have been in a plaster cast for at least 6 weeks, followed by some time in an Aircast boot as you build towards bearing your full weight again. Your physiotherapy will focus on the joints, muscles and tendons above and below the fused joint to ensure they have full flexibility, as they will need to compensate for the joint that has been fused so that you can take part in certain sporting activities. We will help you regain your muscle strength, which will have been lost during your time in a cast. This will consist of manual therapy, an exercise programme, gait re-education and movement analysis.

We will also help you with adapting certain movements without overloading other structures to return your sporting activity.

Average recovery time

It usually takes 12 months to get back to full strength, but within 3 to 6 months you should regain full mobility in the joints that have not been fused and be able to walk and start certain types of exercise.

Read our article on Preparing for your surgery

Ankle sprain

An ankle sprain involves damage to the ligaments either on the inside or the outside of the ankle joint. You usually get swelling around the ankle and may have bruising over the injured area that may go over the heel and down to your toes. You may just feel uncomfortable walking on it, or it may feel extremely painful, depending on the grade of the sprain. It will also be painful to touch the injured ligament, and may feel unstable when doing certain movements.

A draw test (pulling the heel downwards) done by a physio or other medical professional may show more movement than usual of your ankle joint.

The most common ankle sprain involves damage to the anterior talofibular ligament (ATFL) which is on the outside of your ankle, just below and in front of the protruding bump you may think of as your ankle bone (i.e. the bottom of the fibula).

Common causes

Injuring the ATFL usually results from what is known as an inversion injury. That is the outside of the ankle rolling under the foot. This might happen when you fall off a pavement, stumble on uneven ground or when your foot is planted and you twist, as may happen when you’re trying to change direction on the court or pitch. Another common cause is when an external force pushes your leg outwards, as may happen when you’re tackled in rugby or football.

How we treat ankle sprains

For most ankle sprains your physio will work to manage the swelling, get full mobility back in the ankle and provide you with a graded strengthening programme to regain full stability around the ankle.

If you require surgery, which may be the case if you’ve had a high-impact injury or recurrent sprains, you won’t be fully weight-bearing until 6 weeks post-op and will be in an Aircast boot. We then work with you to regain your full range of movement and strength around your ankle using manual therapy.

Average recovery time

Ligaments take about 6 weeks to heal fully. A grade 1 sprain will usually settle down after a couple of days, while a grade 3 sprain may leave you with a feeling of instability in your ankle and can take up to 6 months to recover. If your sprain involves multiple ligaments and you need surgery it can take up to 12 months to be back to full strength again, although with most more serious ankle sprains you can get to running in about 3 months, and progress to sports that require side-to-side movements and sudden changes of direction at 6 months.

Ankle lateral ligament reconstruction

Lateral ligament reconstruction of the ankle is a surgical procedure that is done after a severe ankle sprain where you are unable to regain normal stability around the ankle with physiotherapy. This is typically when you've had a multi-ligament grade 3 tear and you are relying on the muscles across the outside of the ankle to maintain stability.

Common causes

Injuring the lateral ligaments of your ankle usually results from what is known as an inversion injury. That is the outside of the ankle rolling under the foot. This might happen when you fall off a pavement, stumble on uneven ground or when your foot is planted and you twist, as may happen when you’re trying to change direction on the court or pitch. Another common cause is when an external force pushes your leg outwards, as may happen when you’re tackled in rugby or football.

Rehabilitation after lateral ligament reconstruction

The surgeon will perform a procedure to reattach the ligaments to the bone. After the surgery you will be in a cast for two weeks to allow the ligaments to knit back together, and then in an Aircast boot. At this point, the ligaments won’t have fully knitted together, but to avoid stiffness in the ankle, the surgeon will get you to start physiotherapy. From 2 to 4 weeks you can turn the ankle outwards and pull the toes back towards you. From 4 weeks, you can point your toes, and from 6 weeks you can turn the foot inwards. This gradual increase in range of movement is ensure that you don't overstretch the repaired ligaments. During this time you will also increase how much weight you can put on the foot.

At 6 weeks, you have a review with your surgeon. If everything is recovering as expected, they will then advise you to slowly come out the boot as your physiotherapist feels is suitable for your recovery. After that, the physio will ensure that you regain full range of movement in the ankle with manual therapy and mobility exercises, and provide you with a graduated strengthening programme consisting of exercises on land and in the pool to get you back to your normal activities and the sports you want to do.

Average recovery time

Around about 3 months, as long as you've regained significant strength in the legs, you may be able to start a return-to-running programme. Then, from around 3 months, your physio will also start you on some gentle multi-directional exercises, moving towards more plyometric and dynamic movements at 6 months. This will ensure that you're ready to return to your sporting activity and reduce the likelihood of you restraining your ankle.

Read our article on Preparing for your surgery

Make an appointment today

Our helpful team is ready and waiting. We love helping people get back to doing what they love.

Contact us