Continuing with the anatomical series this month we look at the ankle joint complex. The ankle or talocrural joint is a hinge style joint that is comprised up of three individual bones. The three bones are the ends of the tibia and fibula, and the underlying talus. The tibia or the shin bone is an important weight bearing bone and the fibula, the smaller bone on the outside of the lower leg, is a non-weight bearing bone important for muscle attachment and lower limb stability. Sitting below the ankle joint is the subtalar joint which is the articulation of the talus and the underlying calcaneus (heel) bone.
The ankle joint allows for up and down movement of the foot and the subtalar joint allows for side-to-side movement of the foot. These joints allow us to walk, run, jump, and perform a range of actions. To add to the stability of the ankle there are several ligaments that surround the ankle and subtalar joints, binding the bones together to restrict excessive joint movement.
The ankle is a common site of injury, and with the outside of the ankle being more unstable than the inside, it is more prone to problems. The three ligaments on the outside of the ankle, the ATFL, CFL, and to a lesser degree, the PTFL, are often injured with a rolled ankle. The ankle rolls outwards and the foot rolls inwards which can exceed the structural capacity of the ligaments to withstand the stress and leads to spraining of the ligaments and joint. Associated with an ankle sprain can be bony bruising on the inside of the ankle as the bottom of the tibia and talus are jammed together.
Rehabilitation following an ankle sprain initially involves the traditional Rest, Ice, Compression, and Elevation method. Physiotherapy management will focus upon reducing the swelling, restoring joint range of motion, and returning walking pattern back to normal. Furthermore, strengthening of the calf and peroneal muscles, which prevent the ankle from rolling out, is paramount. Following an ankle sprain, proprioception is impaired. Proprioception is the ability to sense the position, location, orientation and movement of the parts of the body. As a result, balance based exercises such as the wobble board and single leg exercises are important to rehabilitate the ankle prior to return to normal activities