Ankle Joint – Injuries, Complications, and Rehabilitation

Ankle Joint – Key Information

The ankle joint enables foot movement and is one of the most injury-prone joints. Even a small misstep or improper foot alignment can lead to injury. The ankle comprises the superior (talocrural) joint, responsible for dorsiflexion and plantarflexion, and the inferior (subtalar) joint, which allows inversion and eversion. Mechanisms of ankle damage depend on the direction and magnitude of force, so it is crucial to assess the extent and severity of the injury and implement appropriate treatment. Ankle braces provide essential joint stabilization and support rehabilitation. Untreated ankle injuries can lead to serious complications; because foot alignment affects the entire lower limb, abnormalities may cause uneven load distribution during gait, potentially triggering knee or hip injuries.

Osteoarthritis of the Ankle Joint

Ankle osteoarthritis affects as many as 80% of young, active individuals—unlike other joints, where osteoarthritis predominantly affects older adults. It usually results from prior injuries, such as fractures or chronic instability.

Symptoms include:

• Swelling and deformity of the ankle joint
• Gradual loss of range of motion
• Pain during movement, progressing to pain at rest
• Secondary lower-limb issues due to altered gait biomechanics

One common treatment is joint immobilization—facilitated by ankle braces—to reduce pain and allow normal daily activity. In addition to orthopedic support (braces or specialized footwear), anti-inflammatory and decongestive rehabilitation therapies and appropriate pharmacological treatments are recommended. In some cases, a total joint prosthesis may even permit running.

Ankle Sprain

An ankle sprain, which involves damage to the joint capsule, most often affects the anterior talofibular and calcaneofibular ligaments. It occurs from sudden plantarflexion combined with inversion (e.g., running on uneven terrain, landing awkwardly, or in vehicle accidents).

Symptoms include:

• Bruising and tenderness at the injury site
• Sharp pain, typically on the outside of the ankle
• Instability and limited range of motion

Treatment depends on the severity of the sprain. Mild sprains require movement restriction, an elastic band, and ice packs. More severe sprains need immobilization with a stabilizer, ankle brace, or cast for about three weeks. Full recovery is achieved through rehabilitation, manual therapy, deep tissue massage, and prescribed mobility exercises.

Ankle Dislocation

An ankle dislocation is a serious injury involving complete loss of contact between the tibia/fibula and the talus. The ankle’s deformity results from the talus being forced out of the mortise formed by the tibia and fibula. Braces and stabilizers are also essential here. Dislocations can occur in traffic accidents, falls, sports, or on slippery surfaces.

Symptoms include:

• Visible joint deformity and abnormal foot position
• Severely limited motion and intense pain
• Swelling
• Numbness or paleness of the foot due to nerve or vessel compression

After diagnosing a dislocation, the joint surfaces must be realigned to as close to their anatomical position as possible. Correct realignment brings immediate relief; the limb is then immobilized with a stabilizer or ankle/foot brace for 6–8 weeks. Many cases, however, require surgical treatment followed by 3–6 months of rehabilitation.

Ankle Fractures

Fractures around the ankle result from forced movement that damages one or more malleoli. Ligament injuries and tibiofibular syndesmosis damage often accompany such fractures. They typically occur in accidents or certain sports. Bone fragments can avulse when ligaments pull on bone during sprain or dislocation—known as avulsion fractures.

Symptoms include:

• Pain radiating to the foot or knee, especially when walking
• Swelling and bruising around the fracture
• Sometimes joint deformity
• Restricted or, less commonly, increased joint mobility

Treatment varies by severity. Non-displaced and avulsion fractures require six weeks of immobilization with the foot in neutral position, often using an ankle brace or stabilizer. Complex, multi-fragment fractures need open reduction and internal fixation with plates and screws, Kirschner wires, tension-band screws, Herbert screws, or external fixation. Rehabilitation begins with weight-bearing on crutches, strengthening lower-limb muscles, restoring proprioception, and increasing joint range of motion.

Ankle Joint Instability

Ankle instability arises from weakening of the joint’s supporting structures—muscles and ligaments—often due to inadequately healed injuries or neurological disorders affecting proprioceptors.

Symptoms include:

• Involuntary foot rotations, especially during sports or on uneven ground
• Pain and tenderness in the joint
• Swelling

Treatment is complex due to varied underlying issues. Surgery is often required, and severe cases may necessitate grafts from other tendons or ligaments. During recovery, some patients need temporary immobilization with an ankle brace. Weight-bearing with crutches may begin after three weeks, along with passive and active mobilization exercises. Subsequent weeks focus on exercises to enhance joint stability, muscle strength, and ligament endurance. Convalescence can last up to 12 weeks.

Achilles Tendon Injury

Achilles tendon injuries encompass any structural damage to the tendon, typically caused by sudden or uneven force distribution during physical activity. Degenerative changes, metabolic or rheumatological disorders, and overuse can also contribute.

Symptoms include:

• Partial tears: chronic pain and swelling that worsen with activity
• Complete ruptures: localized pain, swelling, and a palpable gap at the rupture site; often occurring during sports or work when the back leg experiences force, accompanied by a

Conservative treatment for partial or chronic tears includes analgesics, anti-inflammatories, and sometimes tendon injections with growth factors and/or hyaluronic acid to stimulate healing. Surgical repair involves debridement of degenerative tissue and tendon suturing, followed by joint and foot immobilization and rehabilitation.

Ankle Joint—Prevention and Risk Factors

Those at higher risk for ankle and foot injuries include people with high physical activity levels, overweight individuals, and diabetics due to increased load on the joint. Approximately 6% of young, active people experience ankle injuries. Sports such as basketball (40% risk), soccer (30%), and volleyball (20%) carry elevated risks.

Comprehensive prevention includes responsible sports practice, adherence to medical advice (especially for metabolic or rheumatological disorders that weaken tendons), proper footwear with supportive insoles, gradual training intensity increases, thorough warm-ups, post-exercise recovery, and a balanced diet.

Ankle Joint Rehabilitation

Rehabilitation is essential alongside immobilization for ankle injuries and diseases. Common physiotherapy techniques include manual therapy to improve joint mobility, neuromobilization to enhance nerve function, and laser therapy to reduce inflammation, stimulate tissue regeneration, and accelerate soft-tissue healing. Shockwave therapy delivers acoustic waves that relieve pain and improve blood circulation and tissue repair. Ultrasound relaxes muscles and reduces swelling. At appropriate stages, targeted mobilization exercises are introduced. Full rehabilitation can take several weeks to months, depending on injury severity.

Ankle Brace — How It Works and How to Wear a Stabilizer

Ankle braces come in various shapes to optimally immobilize the joint according to injury type and severity. A proprioceptive brace enhances proprioception with a compressive weave. A ligament brace maintains anatomical positioning with elastic straps. A shell-style brace provides rigid support and compression to reduce swelling. A boot-style brace is used postoperatively or after severe injuries, offering adjustable compression to limit swelling and relieve pain. Always wear an ankle brace as prescribed by your physician; for preventive support in sports, consult a physiotherapist.

Ankle Brace — Advantages and Disadvantages

Compared with a cast—especially for long-term immobilization—an ankle brace reduces thrombosis risk, allows earlier rehabilitation, and avoids heparin injections. Built-in air bladders permit adjustable compression as swelling decreases, ensuring optimal fit. A boot-style brace’s curved, anti-slip sole enables natural gait and toe protection with three-level adjustment. Braces are lightweight, comfortable, and removable for hygiene—unlike casts. However, ill-fitting or improperly worn braces can impair circulation or fail to stabilize the joint. Always follow your physician’s guidance (orthopedist, neurologist, physiotherapist, rheumatologist, or traumatologist) when choosing a brace for preventive, therapeutic, or corrective purposes.

Other Types of Ankle Braces

Braces increasingly replace plaster casts for musculoskeletal injuries. Their versatile design also suits postural deformities and congenital conditions. In rheumatological or neurological disorders, braces reduce pain and prevent joint deformity progression. Elastic braces are popular in sports prevention. Stabilizers can support virtually any body part:

• Spinal braces address traffic injuries and posture correction (kyphosis, scoliosis).
• Upper-limb braces immobilize the wrist, elbow, or shoulder after falls, sports injuries, or occupational overuse (tennis/golfer’s elbow).
• Lower-limb braces support the knee and ankle in sports and daily activities, since sprains or fractures can occur from awkward foot placement.