This injury guide identifies the common causes of a foot and ankle injury; symptoms, treatments and rehabilitation. Jump to section: Sprained Ankle Broken Ankle Snowboarders Ankle Metatarsal Fracture Lisfranc Joint Injury (midfoot injury) Tibialis Posterior Pain Sprained Ankle What is a sprained ankle? There are around 50,000 ankle sprains every day in the UK. In the acute phase, an ankle injury is associated with pain and loss of function. 25% of people with an ankle sprain are unable to go to school, college or work for more than a week. The ankle is one of the most common sites for a sprain. When an ankle is sprained, the ligaments are overstretched or torn. Ankle sprains can be graded according to their severity: Grade I (mild) — mild stretching of the ligament complex without joint instability. Grade II (moderate) — partial rupture of the ligament complex without joint instability. Grade III (severe) — complete rupture of the ligament complex with instability of the joint. Rapid and appropriate treatment is needed to ensure a quick recovery from an ankle sprain. Delayed or inappropriate management can slow down the recovery and healing process. Physicool cooling and compression bandage is ideal for both first aid and to help the recovery and rehabilitation process. Many people will have twisted their ankle at some point, but if the ankle becomes swollen or inflamed, then it will most likely be a sprain. Sprained ankle symptoms Swelling Pain at the point of injury Bruising Tenderness Inability to put weight on the ankle What causes a sprained ankle? As with most injuries of this kind, a sprained ankle usually occurs because of a sharp shift in movement when your foot is planted on the ground, causing the ligaments to stretch or tear. Invariably, the ankle turns inward whilst the foot turns outward. This can be due to: A sudden impact e.g. during contact sports like rugby Suddenly twisting or ‘going over’ on the ankle, may be caused by walking or running on uneven surfaces Falling or tripping How to treat a sprained ankle Weight should not be put on an ankle injury until a medical professional has advised that it is ok to do so. A healthcare professional will be able to recommend the most suitable pain relieving medication. The PRICE approach is recommended. Protection – protect the sprained ankle from further injury – using a support bandage if appropriate Rest – stop the activity that caused the sprain, and rest the injured ankle. Avoid activity for the first 48 to 72 hours after injury Ice – for the first 48 to 72 hours after the injury, apply a cooling therapy such as Physicool Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further Elevation – keep the injured area raised and supported on a pillow to help reduce swelling Sprained ankle rehabilitation Proper treatment and exercises are very important for ankle injury recovery. If not healed correctly, the joint may become unstable, leading to chronic pain and making your joints weak and susceptible to further injury. Physicool provides the key stages of PRICE in a single reusable bandage, providing protection, cooling and compression for the ankle sprain to help reduce swelling and pain whilst aiding the healing process. A Physicool bandage can be applied to the sprained ankle for as long as needed without the associated risks of ice based treatments. When to seek medical advice Seek medical advice before weight bearing on a sprained ankle. Sometimes the symptoms of a sprain can be similar to those of a fracture. An X-ray will determine the extent of the injury and appropriate treatment. If your ankle sprain does not improve with home treatments (rest, cooling therapy, over the counter medications), you should seek the advice of a medical professional. Broken ankle What is a broken ankle? A broken ankle occurs when the ankle goes beyond a twist or sprain and the bone is actually fractured. A fracture can be a break in one bone (which could still be walked on) or several bones (which force the ankle out of place). Symptoms of a broken ankle Sprains and fractures are very similar in their symptoms, which is why a fracture can only be diagnosed with an X-ray. Symptoms include: Sudden and severe pain Swelling Bruising Stiffness Inability to walk What causes a broken ankle? As one of the most common bone and joint injuries, the causes are multiple: Tripping or falling Landing awkwardly Walking or running on uneven surfaces Sudden impact Twisting the ankle Rolling the ankle Broken ankle recovery If a broken ankle is stable, surgery may not be required. An X-ray will show the severity of the fracture. Doctors usually treat the injury through immobilisation using a cast, giving a recovery time of six to eight weeks. Antibiotics, anti-inflammatories and cooling therapy are also essential for a timely recovery follwoing a broken ankle. Snowboarders Ankle What is snowboarder’s ankle? Snowboarder’s ankle is the term given to a fracture of the talus bone, found on the side of the ankle, above the heel bone. Snowboarders ankle has been given it’s name due to its prevalence in the snowboarding community. Snowboarder’s ankle is different from a regular twisted ankle or sprain, due to the persistence of the pain and swelling. Symptoms of snowboarder’s ankle Persistent pain Persistent swelling Trouble walking What causes snowboarder’s ankle? Snowboarder’s ankle injury is commonly caused by a twisted ankle during a session in the snow. Early diagnosis is important to help reduce the likelihood of joint degeneration. Tripping or falling Landing awkwardly Sudden impact How to treat snowboarder’s ankle Treatment for snowboarder’s ankle is fairly straightforward. Cold therapy to prevent swelling Immobilisation Plastic cast Surgery (in extreme cases) Protection, rest, ice, compression and elevation (PRICE) is the most recommended approaches for the management of snowboarder’s ankle. The aim is to minimise haemorrhage, swelling, inflammation and pain, to provide the best conditions for healing to take place. Metatarsal Fracture What is a metatarsal fracture? Metatarsal fracture, located in the forefoot, is a common foot injury amongst footballers and other sportsmen. A broken metatarsal is often painful, but not typically disabling. Indeed, the injuries invariably heal without any need for surgery. Symptoms of metatarsal fracture Pain in the foot Swelling Bruising Interference with walking What causes metatarsal fracture? Metatarsal fractures are generally caused by direct trauma, excessive rotation or overuse. Because there isn’t much soft tissue protecting the top of the foot, bone injuries in the area are very common. A metatarsal fractures is often caused by a player accidentally kicking the sole of an opponent’s boot, or by an opponent stepping on a player’s foot in football. Metatarsal fracture treatment Treatment of metatarsal fracture will depend on the severity of the injury. If the fracture is due to direct trauma and the fracture fragments are well aligned then the treatment is immobilisation in rest. Weight can’t be shouln’t be beared on the foot for 6 – 8 weeks. Cooling therapy should be applied directly after a metatarsal fracture is suspected to reduce the pain and inflammation. The patient should be transferred to an emergency department to be x-rayed and diagnosed by a doctor. Wrapping a Physicool size A bandage around the injury for 30 minute increments will significantly reduce the pain and swelling. Physicool can be applied for as long and as often as is needed. Lisfranc Joint Injury (midfoot injury) Lisfranc injury, or midfoot injury, occurs when the bones in the midfoot are broken or the ligaments are torn. The severity of the injury can vary, depending on its complexity. Lisfranc injury can be misdiagnosed as a simple sprain, particularly if the injury was sustained through a twist or fall. However, the injury can be far more serious, taking many months to heal, and perhaps requiring surgical treatment. Lisfranc joint injury symptoms Pain at the top of the foot Swelling Bruising at the top and bottom of foot Pain that becomes more intense with standing or walking What causes Lisfranc joint injury? Lisfranc joint injury can be caused by a common twist or fall. It is considered a ‘low-energy’ injury, typically seen in sports such as football and basketball. Injury often occurs when a person stumbles over the top of their foot when it’s flexed downwards. More severe cases, however, are a result of direct trauma, such as a high fall, leading to fractures or dislocations. How to treat Lisfranc joint injury Less severe injuries can be treated non-surgically. Anti-inflammatories Cooling therapy (Physicool) Crutches Surgery (severe injury) Protection, rest, ice, compression and elevation (PRICE) is one of the most recommended approaches for the management of Lisfranc joint injuries. The aim is to minimise haemorrhage, swelling, inflammation and pain, to provide the best conditions for healing to take place. Tibialis Posterior Pain What is tibialis posterior pain? Tibialis posterior pain is one of the most common problems of the foot and ankle. It manifests when the posterior tibial tendon becomes swollen or torn. Consequently, the tendon may no longer be able to provide balance and support for the arch of the foot, leading to flatfoot. Symptoms of tibialis posterior pain Pain on inside of the foot and ankle, where the tendon lies Pain accentuates with activity Pain on the outside of the ankle Trouble walking Swelling Heel bone may shift What cause tibialis posterior pain? An acute injury – for instance, a fall – can tear the tendon or cause it to swell. Overuse of the tendon can also cause it to tear. Those who do high-impact sports, such as basketball or football, are more susceptible to tears in this area. Upon swelling or tearing, the foot arch will begin to collapse over time. Tibialis posterior pain treatment In most patients, symptoms shouldn’t last longer than three months with appropriate non-surgical treatment. Protection, rest, ice, compression and elevation (PRICE) is one of the most recommended approaches for the management of sprains. The aim is to minimise haemorrhage, swelling, inflammation and pain, to provide the best conditions for healing to take place. The PRICE approach is recommended by NHS Choices: Protection – protect the injured area from further injury – using a support bandage if appropriate Rest – stop the activity that caused the injury, and rest the injured joint or muscle. Avoid activity for the first 48 to 72 hours after injury Ice – for the first 48 to 72 hours after the injury, apply a cooling therapy like Physicool Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further Elevation – keep the injured area raised and supported on a pillow to help reduce swelling Physicool provides the key stages of PRICE in a single reusable bandage, providing protection, cooling and compression for the foot to help the healing process. A Physicool bandage can be applied to the injury and the cooling effect recharged by spraying Physicool Coolant directly onto the bandage whilst it is in position. Physicool is a unique cotton bandage impregnated with a patented liquid which draws heat away from the affected tissues by rapid evaporation. While the deep tissues are being cooled, the simultaneous compression effects of Physicool modify the inflammatory response to soft tissue damage which helps promote healing. References De Bie RA, de Vet HC, van den Wildenberg FA, Lenssen T, Knipschild PG. The prognosis of ankle sprains. Int J Sports Med1997;18:285-9. www.nhs.uk/Conditions/Sprains Struijs, P. and Kerkhoffs, G. (2007) Ankle sprain. Clinical Evidence. BMJ Publishing Group Ltd