Ankle sprains are a top injury seen in our Parnell physio clinic. It not only affects the sporting population but also the general public, however, when is an ankle sprain not an ankle sprain? Ethan Smith from our Parnell physio clinic writes this blog looking at some less common injuries that can occur in the ankle region.
A fracture is an important diagnosis to clear when assessing an ankle sprain. The most common areas for a fracture are the medial or lateral malleolus, navicular, or base of the 5th metatarsal. Using the Ottawa ankle rules helps to rule of a suspected ankle fracture and prevent the need for an X-ray. Fractures can also be quite subtle with minimal pain and might not even show on an X-ray. An avulsion fracture can present like this. Avulsion fractures occur when the ligament or tendon is pulled off the bone. Avulsion fractures are generally managed conservatively but should not be missed.
The sinus tarsi is a tunnel that runs between the talus and calcaneus bone. Sinus tarsi syndrome is classified as pain or injury to this region. It can be caused by a traumatic even such as an ankle sprain or an overuse/repetitive strain injury from standing or walking. It presents as pain and tenderness over the lateral ankle (in front of the lateral malleolus) and the patient may report a feeling or instability. Sinus tarsi syndrome is due to inflammation and infiltration of fibrotic tissue on the sinus tarsi space. Management includes anti-inflammatories, joint mobilisations, soft tissue work, strapping, orthotics to offload, and a gradual loading program.
The peroneals are two muscles that sit on the lateral aspect of the lower leg. The tendons run behind the lateral ankle bone and insert into the foot. The peroneal muscles play an important role in ankle stability and help stop the foot rolling outwards. Tendon damage can occur from a simple tear to a complete rupture. Pain is more located behind the lateral malleolus and the you may have weakness and/or pain with eversion (turning your foot put) movements. The tendon is also susceptible to tendinopathy. Generally, a tendinopathy is caused by a sudden increase in loading and comes on gradually rather than an acute incident. Tendinopathy is treated very similar to an acute tendon injury with soft tissue work, gradual loading of the area, mobilisations, and orthotics.
The talus is one of the main bones in the ankle joint. It is covered in a smooth cartilage surface that assists with movement. A talar dome lesion occurs when the cartilage and underlying bone become damaged. Also known as an osteochondral lesion. Damage can happen during an ankle sprain when the tibia or fibula makes direct contact with the talar dome causing damage to the cartilage. Patients often describe a deep ankle pain that lasts longer than a typical ankle sprain. You may also have occasional clicking and on-going episodes of swelling. Often advanced imaging such and CT scans or MRIs are required as this injury can be missed on an X-ray. Treatment depends on the severity of the lesion but both active management and surgical approaches can be taken.
Although most of these diagnoses are not very common however, we do see them in our Parnell physio clinic when treating ankle sprains. They are important to keep in the back of our mind when assessing you if have an ankle sprain. More importantly, for those who are not responding to conventional treatment it is worthwhile to have further investigations to work out why your pain is not settling. If you are having a niggly pain in the ankle after a sprain and it’s not settling, contact us today for an appointment.