Ankle Injury Prevention & Treatment:  Balancing Ankle Stability, Mobility and Strength for Pain-Free Running

As runners we have all experienced or witnessed an ankle sprain.  Winter running is accompanied with a higher risk of ankle injury due to cold temperatures, icy, uneven roads and trails.  While the chances of spraining your ankle seem higher while bombing down an icy, rock-strewn descent, most ankle injuries occur when we least expect it.  Many runners have described debilitating ankle sprains as the result of a simple turn, twist, or unexpected change in terrain.  Occasionally the terrain itself plays no role whatsoever in the injury.  An ankle sprain may occur spontaneously if the intrinsic support structures of the ankle are compromised.  The information below will shed some light into the structures which work in harmony to allow us to run without spraining our ankles on every bend in the road or tail.

Ankle Anatomy and Function:
The ankle contains three main joints which function in different ways.  The talocrural joint consists of the tibia (main lower leg bone) and the talus of the ankle (forms the hinge of the ankle).  The talocrural joint allows us to pick up our foot and clear the ground during our running stride.  The subtalar joint is formed by the calacaneus (heel bone) and the talus.  Subtalar joint motion allows us to pronate (arch falls inward during weight bearing) and supinate (arch builds when pushing off) to accommodate for uneven running surfaces.  The subtalar joint also helps absorb shock during weight bearing.  The midtarsal joint (combined joints of the metatarsal bones and true ankle bones) allows our forefoot to move in the opposite direction as the rear foot to provide both mobility and torsional stability.

Ankle Stability:
Joints are not functional without the ligaments which connect the bones of the joint.  The ankle has a lattice work of ligaments which resemble a spider web.  Each ligament spans a joint and allows for mobility but “checks” or controls excessive motion.  Three ligaments are responsible for the bulk of running injuries.  On the medial side of the ankle is the deltoid ligament (collective name for a group of medial ankle ligaments).  On the lateral side of the ankle is the calcaneofubuar and anterior talofibular ligaments.  When we sprain our ankle, a ligament(s) is stretched by a force which exceeds its tensile strength to resist motion.  Ankle sprains are rated in grades (I or mild, II or moderate, III or severe).  While grade I and grade II sprains may be very painful, grade III sprains are more serious but may be pain free due to complete ligament rupture.

Ankle Mobility:
Why is ankle mobility so important?  On first inspection of the intricate ankle joints and stabilizing ligaments it would appear the ankle would be better off fused into a solid block!  Ankle mobility, however, is crucial to movement.  Running would not be possible without the subtle motion and balance corrections a healthy, mobile ankle provides.  Often while running or while running behind another runner I experience or witness a rapid ankle roll which does not result in an injury.  Without ankle mobility in the muscle and connective tissue (tendons, ligaments, fascia), however, an ankle sprain would likely have occurred.  Mobility in our ankle joints also permits accessory joint motion which decreases joint compression.  Excessive joint compression due to joint stiffness in the absence of joint mobility increases the risk of degenerative joint arthritis.

Ankle Strength:
Foot and ankle function is dependent upon muscular strength.  Running is not possible without voluntary and involuntary muscle contraction.  Although the majority of the muscles responsible for active ankle motion are located in the lower leg, their tendon attachments are located in the foot and ankle.  Foot and ankle endurance is a crucial component of injury prevention as long distance runners experiencing muscular fatigue have a greater risk of sustaining an ankle sprain if the muscular stability is compromised.  Due to the multiple plans of motion in the ankle, a multi-directional approach to strengthening in needed.  A comprehensive strengthening program for injury treatment and prevention includes all four planes of ankle motion utilizing both load-releasing and load-accepting techniques.  Understanding the dynamics of running is vital in prescribing a safe, functional ankle strengthening program.

Ankle Balance & Agility:
Intricate involuntary muscular contractions known as ankle balance reactions occur reflexively in milliseconds ever time our foot lands on an uneven surface.  An ankle injury disrupts ankle balance reactions which makes balance reaction training a key component of an ankle injury treatment and prevention program.  Balance and agility training for injury treatment and prevention must be done in weight bearing.  Challenging ankle balance and agility in a repetitious manner which includes speed and fatigue will reward the participant with miles of injury free road or trail running with increased running efficiency.
Watch for the first issue of the Sapphire Physical Therapy quarterly newsletter in December.
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John Fiore, PT