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Common Ankle Injuries in Football Players

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Introduction

The ankle is one of the most commonly injured regions in football, with its complex structure and high functional demands making it prone to both acute and chronic injuries. From rapid directional changes to explosive movements and heavy contact, football players are exposed to a wide range of stresses that can result in various ankle pathologies.

This article explores the common ankle injuries seen in football players, detailing their causes, symptoms, and management strategies to help players, coaches, and medical staff better understand and address these issues.

Anatomy of the Ankle: A Brief Overview

The ankle joint consists of two primary articulations:

  1. The Talocrural Joint: Involving the tibia, fibula, and talus, this joint facilitates plantarflexion and dorsiflexion.
  2. The Subtalar Joint: Between the talus and calcaneus, it allows inversion and eversion.

Stability is provided by:

  • Ligaments: Including the lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular), the deltoid ligament on the medial side, and the syndesmotic ligaments.
  • Muscles and Tendons: Such as the peroneal tendons, tibialis anterior, and Achilles tendon.

Common Ankle Injuries

Ankle injuries are among the most frequently encountered issues in football, owing to the dynamic and high-impact nature of the sport. These injuries can range from acute sprains and fractures to chronic conditions like tendinopathies and osteoarthritis. Below, we explore the most common ankle injuries in football players, detailing their causes, symptoms, and management strategies to help prevent long-term complications and facilitate a return to play.

1. Ankle Sprains

Types of Ankle Sprains

Ankle sprains are the most common acute ankle injury in football and are classified as follows:

  1. Lateral Ankle Sprain (Inversion Sprain):
    • Cause: Rolling the ankle outward, causing overstretching or tearing of the lateral ligaments, particularly the anterior talofibular ligament (ATFL).
    • Symptoms: Swelling, bruising, and pain on the lateral side of the ankle, difficulty weight-bearing, and reduced range of motion.
    • Management: Acute management follows the PRICE protocol (protection, rest, ice, compression, and elevation), followed by progressive rehabilitation focusing on strength, proprioception, and balance.
  2. Medial Ankle Sprain (Eversion Sprain):
    • Cause: Rolling the ankle inward, damaging the deltoid ligament.
    • Symptoms: Pain and swelling on the medial aspect of the ankle.
    • Management: These are less common but often require longer recovery times than lateral sprains due to the strength of the deltoid ligament.
  3. High Ankle Sprain (Syndesmotic Injury):
    • Cause: Rotation of the foot relative to the leg, often during tackles or twisting movements.
    • Symptoms: Pain above the ankle, especially during weight-bearing or when squeezing the tibia and fibula together.
    • Management: High ankle sprains require longer recovery times and may necessitate immobilisation or, in severe cases, surgical intervention.

2. Ankle Impingement

Ankle impingement occurs when soft tissues or bony structures are compressed, causing pain and restricted movement.

Types of Ankle Impingement

  1. Anterior Impingement (“Footballer’s Ankle”):
    • Cause: Repeated dorsiflexion, leading to bony growths (osteophytes) at the front of the ankle joint.
    • Symptoms: Pain at the front of the ankle during dorsiflexion, reduced range of motion, and occasional clicking or locking.
    • Management: Conservative treatment includes rest, physiotherapy, and joint mobilisations, while severe cases may require arthroscopic surgery to remove bony spurs.
  2. Posterior Impingement:
    • Cause: Compression of soft tissues or bony structures (e.g., an os trigonum) at the back of the ankle during plantarflexion, common in players who perform repetitive kicking.
    • Symptoms: Pain at the back of the ankle, particularly during plantarflexion.
    • Management: Rest, strengthening, and in some cases, surgical excision of the os trigonum.

Read Also

Common Knee Injuries in Football Players

3. Ankle Osteoarthritis

Cause

Chronic repetitive stress or previous injuries (such as severe sprains or fractures) can lead to cartilage degeneration in the ankle joint, resulting in OA.

Symptoms

  • Persistent pain and stiffness, particularly after activity.
  • Swelling and reduced range of motion.
  • Crepitus (grinding or clicking sounds).

Management

  • Conservative: Includes physiotherapy to maintain mobility, strengthening exercises, and footwear modifications.
  • Advanced Options: Steroid injections, viscosupplementation, or, in severe cases, surgical options such as ankle fusion or replacement.

4. Sever’s Disease

Cause

Sever’s disease, or calcaneal apophysitis, is a growth plate injury in the heel bone and is common in young football players during periods of rapid growth.

Symptoms

  • Pain at the back of the heel, worsened by activity.
  • Tenderness on palpation of the calcaneus.
  • Limping or difficulty running.

Management

  • Rest, ice, and reducing physical activity.
  • Heel pads or orthotics to offload the Achilles insertion.
  • Gradual return to sport once symptoms resolve, coupled with stretching of the calf muscles.

5. Achilles Tendinopathy

Achilles tendinopathy is a degenerative condition affecting the Achilles tendon, which connects the calf muscles to the heel.

Cause

Repetitive overload, poor biomechanics, or sudden increases in training intensity.

Symptoms

  • Pain and stiffness in the tendon, particularly in the morning or after activity.
  • Swelling or thickening of the tendon.
  • Pain during push-off movements.

Management

  • Early Phase: Load management, eccentric strengthening exercises, and isometric holds to reduce pain.
  • Advanced Phase: Progressive loading and plyometric exercises.
  • Adjunct Treatments: Shockwave therapy or injections (e.g., platelet-rich plasma) may be considered in persistent cases.

6. Stress Fractures

Stress fractures in the ankle, particularly in the tibia, fibula, or talus, occur due to repetitive loading.

Symptoms

  • Gradual onset of pain, typically worsening with activity and improving with rest.
  • Localised tenderness over the fracture site.

Management

  • Rest and activity modification.
  • Immobilisation or a walking boot in more severe cases.
  • Gradual reintroduction of weight-bearing activities.

7. Other Common Ankle Issues

Tendinopathies

  • Peroneal Tendinopathy: Pain on the outside of the ankle due to overload of the peroneal tendons.
  • Posterior Tibial Tendinopathy: Pain on the inside of the ankle, often associated with flat feet.

Ankle Fractures

  • Acute trauma can result in fractures requiring immobilisation or surgical fixation.

Ligament Instability

  • Repeated sprains can lead to chronic ankle instability, requiring intensive rehabilitation or surgical stabilisation.

Assessment and Diagnosis

Accurate assessment of ankle injuries is crucial for determining the severity of the injury and developing an appropriate treatment plan. The assessment may involve the following:

  • Medical history: Gathering information about the player’s symptoms, mechanism of injury, previous ankle injuries, and any relevant medical conditions.
  • Physical examination: The football physiotherapist will evaluate the ankle for tenderness, swelling, range of motion, stability, and specific signs of ligamentous injury.
  • Special tests: Specific tests, such as the anterior drawer test or talar tilt test, may be performed to assess the stability and integrity of the ankle ligaments.
  • Ottawa ankle rules: If there is tenderness on specific bony structures such as the medial or lateral malleolus (bony bit of the inner / outer ankle) or an inability to weight-bear for four steps or more, an x-ray may be required to check for an avulsion fracture.  
  • Imaging: Depending on the severity of the injury, further investigation may be needed such as x-ray or MRI imaging.

Treatment Options

The management of ankle injuries may include:

  • RICE (Rest, Ice, Compression, Elevation): Immediate treatment to reduce pain, swelling, and inflammation.
  • Immobilisation: Depending on the severity of the injury, a walking boot, or ankle taping may be used to provide support and immobilise the ankle during the initial healing phase.
  • Early mobilisation: Gradually reintroducing range of motion exercises and weight-bearing activities as pain and swelling decrease.
  • Physiotherapy: A structured rehabilitation program involving various exercises to restore ankle strength, flexibility, proprioception, and balance.
  • Functional exercises: Incorporating sport-specific movements and activities to prepare the player for a safe return to football.
  • Surgery: In severe ankle injuries, or cases that do not respond to conservative treatment, surgical intervention may be required.

Products that may help

Voltarol Gel – View this product on Amazon for more details

This can be applied to the injured part of the ankle to help reduce pain and inflammation.

Insoles – View this product on Amazon for more details

Insoles can provide extra foot padding and shock absorption which can provide some protection for the pain and discomfort from ankle injuries.

Anti-inflammatory patch – View this product on Amazon for more details

The Nurofen Joint and Muscular pain relief plasters continuously releases ibuprofen over 24 hours to target pain and inflammation at the site of pain. This can be an effective option for reducing the initial swelling from the ankle sprain injury.

Ankle Cool Sleeve Ice Pack – View this product on Amazon for more details

This ankle ice pack provides cold therapy and compression for the entire ankle area, providing pain relief and helping to reduce swelling. The ice pack contains gel to ensure longer lasting cold therapy and the ankle specific design also provides compression to the injured area.

Balance Cushion – View this product on Amazon for more details

The balance cushion is a useful piece of equipment to provide challenging proprioception exercises that help to improve stability of the ankle.

Ankle Support – View this product on Amazon for more details

The aim of ankle sprain rehabilitation is to regain full function of the ankle and hopefully return to training and games without needing an ankle strapping. However, in the initial stages after an ankle sprain, or cases of chronic instability, an ankle strapping is often required. This ankle support is a high quality option for football players.

Rehabilitation Techniques

Rehabilitation is essential for a safe return to football and as part of an ongoing management plan to prevent future injuries. A tailored program may include:

  • Range of Motion Exercises: Gentle movements to restore the ankle’s full range of motion.
  • Balance and Proprioception Training: Exercises to improve joint stability and prevent re-injury.
  • Strengthening Exercises: Focused on building muscle strength around the ankle joint.
  • Sport-Specific Activities: Gradual integration of football-specific drills into the rehabilitation program.

Conclusion

Ankle injuries are a significant concern in football, with the potential to impact performance and career longevity. Understanding the various injuries that can affect the ankle, from sprains and tendinopathies to OA and stress fractures, is vital for effective prevention and management.

Through proper training, conditioning, and recovery strategies, football players can minimise their risk of ankle injuries. Early recognition and appropriate treatment of injuries are crucial to ensuring a safe and efficient return to play. For footballers at all levels, working closely with medical professionals and physiotherapists remains key to optimising performance and preventing long-term complications.

Further Reading

Nery et al, (2016) – Foot and ankle injuries in professional soccer players: diagnosis, treatment, and expectations

Chen et al, (2019) – Ankle sprains: evaluation, rehabilitation, and prevention

Von-Rickenbach et al, (2021) – Achilles Tendinopathy: Evaluation, Rehabilitation, and Prevention

Kudas et al, (2016) – Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes

D’Hooge et al, (2022) – Anterior ankle impingement syndrome is less frequent, but associated with a longer absence and higher re-injury rate compared to posterior syndrome: a prospective cohort study of 6754 male professional soccer players

Disclaimer

The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.

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