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Weak ankles

Perhaps you are one of those unlucky people who has repeatedly gone over on your ankle. Is it always the same one, or can either give way when you lest expect it? Have you any idea whether it is because you inherited loose ankles or your ankle the result of old trauma?

Most muscles that control ankle movement are in fact found in the upper part of the calf and shin, nearer geographically to the knee joint than the ankle. Long tendons or sinews emerge from these muscles and run over the ankle inserting into the many bones of the foot. This design of leg muscles and tendons, where bulky muscles are at a distance and only slim tendons run across the joint makes for the lovely slim look of the ankle. The arrangement provides the ankle region with great movement but is not so good for local strength.

However, the shape of the bones of the ankle is such that the bones generally provide the strength component. The two bony bumps either side of the ankle are part of a stable bony arch hugging the top bone of the foot. This arch is further fortified by ligaments, joining the foot to the lower leg.

Ligaments are like passive reins or guide ropes that provide excellent stability in one direction of movement but not another. Turning awkwardly inwards on the ankle, known as an inversion strain can injure the most important ligament of the ankle, the lateral ligament. This ligament is made up of three bands, any of which can be injured, along with a short but vital ligament across the front of the lower leg. A simple strain causes a small amount of the fibres of the ligament to overstretch. If the inward turn is more severe, a percentage of the fibres may tear or completely rupture. Occasionally the end of one of the ankle bones may break off with the force of pull of a ligament strain. In this case surgery or at least some weeks in a leg cast may prove necessary

Generally a first time, simple ankle sprain will heal well with ice, rest and time. However, for repeated strains it is worth consulting a Chartered Physiotherapist to speed healing and ensure good scar formation of injured soft tissues. Physiotherapy will include rehabilitation to achieve an optimal result. Recurrent ankle sprains imply that the ligaments have sustained some permanent damage and that leg muscles have not regained sufficient strength to assist stability of the ankle, leaving the ankle poorly protected in the long term.

Rehabilitation concentrates on muscle strengthening and balance. Muscle strengthening targets muscles that support injured ligaments. More often than not the ankle joint gives way inwards, damaging the lateral ligament.

Muscles along the outside of the calf are designed to control and restrict the turning in movement. These muscles are meant to be able to forcibly turn the foot out and resist excessive inwards motion. To restore them to strength, work on strengthening the outward turn.

A simple exercise can be done in standing. With feet hip distance apart, loop a scarf or belt around both feet, taking up all the slack. Now turn your weak ankle and foot outwards, pushing against the resistance provided by the scarf. Hold the position for three seconds and repeat the exercise in three sets of ten. You can also do this sitting with your legs out straight in front of you. If you wish similar strengthening can be performed lying on one side, with the weak foot uppermost, turning it up towards the ceiling. Add an ankle weight around the centre of the foot and continue pushing into the resisted band.

Another approach can be done sitting in a chair at home, school or work. Place the side of your weaker foot up against the leg of the chair and push into the chair leg. This also strengthens the same muscle. Aim to do thirty repetitions, three times a day.

The second plank of ankle rehabilitation is to improve your balance so that you can stand as well on the weaker keg as the undamaged one. Balance training has two clever effects. The first is that research has shown that balance is compromised by ankle ligament damage and does not necessarily recover without specific training. If you repeatedly turn over on your ankle and have not done any balance training, this may explain why the problem has never fully cleared.

Further, in terms of muscle strengthening, muscles build up the more you load them. Balancing your whole body weight on one leg is a fair test of muscle strength and is also function specific. This means that you are appropriately training the leg muscle to carry full body weight, exactly as they must do every step we take.

A balance programme is as simple as it sounds. Start balancing on one leg for as long as you can. Count the time. Repeat the balance exercise frequently, trying to stay there for longer. When this becomes easy try shutting your eyes to further challenge the balance system. Progress to single leg balancing on a cushion on the floor when you are able.

For some, prescription orthotics are a useful component of ankle rehabilitation, coupled with decent supportive footwear.

Treat your weak ankle with some healthy exercise today and reap the rewards into the future.
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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