Ankle/Foot Disorders

Runner holding her sore ankle

Our Jacksonville, Florida physical therapy practice offers Australian orthopedic manual therapy, focusing on effective assessment and treatment of the ankle-foot complex.  Our manual therapy approach is based on the work of legendary Australian physiotherapist Geoff Maitland.  This approach is clinically proven to be a safe and effective way to restore ROM and alleviate pain.  Multiple randomized clinical trial research studies have shown that Australian manual therapy plus exercise improves function, decreases pain, and necessitates less physical therapy visits than exercise alone for ankle-foot disorders.  We also offer our patients “mobilizations with movement” (MWMs) via legendary physiotherapist Brian Mulligan.  MWMs have been clinically proven to restore ankle motion and improve functional outcome measures for ankle-foot disorders.

We treat a variety of foot disorders including but not limited to:

  •  Acute and chronic ankle sprains
  • Distal tib/fib disorders (high ankle sprain)
  • Post-op ankle/foot rehab
  • Plantar fasciitis
  • Bunionectomy pain
  • Post-op Morton’s neuroma pain
  • Achilles tendonitis
  • Running injuries
  • Sports injuries
  • Adverse neural tension of ankle/foot

Ankle Sprains

Fig. 6

Among musculoskeletal injuries, the incidence of ankle sprains is between 15% and 20% of sports injuries.   There are an estimated 23,000 ankle sprains each day in the US – 1 per 10,000 individuals.  30% of individuals who suffer initial ankle sprains will develop longstanding or chronic instability.  Ankle sprains can be either acute sprains, which can be further classified into three grades depending on the severity of the injury, or chronic instability.  Among all ankle injuries, ankle sprains are the most common and account for approximately 80% of all ankle disorders.

Important Ankle Ligaments

Three ligaments – the Anterior talofibular ligament (ATFL), Calcaneofibular ligament (CFL), and Posterior Talofibular Ligament (PTFL) at the lateral aspect – support the ankle joint, which is a hinge joint that allows the foot to flex up and to point the toes down.  The ATFL is the weakest of the 3 ligaments and the most commonly injured in a lateral ankle sprain.

Fig. 1

 Clinical Evaluation

Detailed history and careful physical examination are crucial for diagnosis and management of ankle sprains, as they reveal the severity of the ankle sprain the patient has experienced. The ligament injury can be assessed by observing swelling and weight-bearing ability. Therefore, a thorough history is essential to evaluate the ankle injury.  It can help identify a whole set of important diagnostic clues, such as:

  • The patient’s ability to walk after the injury, which helps to grade the level of injury.
  • The patient’s injury mechanism, which can help guide the ankle sprain examination.
  • The fact of whether the same ankle was injured before or not, because patients who have undergone ankle sprains are prone to being re-injured.

Patients who may have undergone ankle sprains should be physically examined by various methods such as checking the patient’s ability to bear weight, visual and hands-on inspection, injury-specific physical diagnostic tests, and palpation.


Conservative approach is first treatment of choice.  Acute ankle injury can be managed conservatively using various by RICE protocols of immobilization and specialized physical therapy

RICE protocol

The acronym stands for the four main procedural methods of treatment of the ankle: Rest, Ice, Compression and Elevation, which can be performed in the first 2-3 days.
  • Patients are provided with crutches to help them walk until they can walk normally. Weight-bearing is limited to light weight-bearing.  As part of cryotherapy, ice immersion is recommended for up to 20 minutes every 2-3 hours.
  • To apply compression, the patient is provided with a flexible bandage to reduce swelling.
  • To facilitate a reduction in swelling and for better venous and lymphatic drainage, the injured ankle should be elevated at a level higher than the heart.

Mild ankle sprains can be managed by using cryotherapy  or ice therapy.  In the inflammatory stage of the acute ankle injuries, non-steroidal anti-inflammatory medications can be used instead.


Ankle injuries of Grade I do not need immobilization since they can be treated well by using a flexible or elastic wrap for a few days.  However, Grade II ankle injuries are likely to require support by using a flexible wrap and a splint for the first few days until they are pain-free.  In Grade III, controlling the range of the patient’s motion is recommended.  Patients are also recommended to use an ankle rigid support or a plaster cast to reduce pain and injury during a short period (1 week) of immobilization.  Casting, however, has been shown to yield inferior functional results by many authors compared with orthosis and early weight-bearing.

Though many patients prefer cast immobilization, experts suggest starting physiotherapy or physical therapy as early as possible for the following reasons: to give time for the ice application to control pain and swelling; to improve and maintain the range of motion; and to minimize the risk of stiffness and muscle wasting, two factors which can delay the patient from returning to their usual activities.

Physical Therapy

lady performing ankle stability exercise

Ankle Stability Exercise

After ankle injury, physiotherapy treatment has a highly positive effect, and in addition can help patients perform normal activities and prevent the possibility of chronic instability of the ankle.  To prevent recurrence, the physiotherapy program should last between 4 and 6 weeks.  Our specialized program consists of hands on manual therapy techniques, balance training, strength training, as well as neuromuscular re-education.  This approach is research proven to be the fastest way to relief and to improve function.  Most patients will start to report relief after only 1-3 visits!

Surgical Approach

Acute ankle injuries are almost always managed by non-operative methods. A previous study revealed that patients who underwent acute surgical treatment took longer to return to work.  Also, studies revealed that surgery was not helpful in reducing additional complications, costs and risks.  Previously, in ankle sprains of Grade I and Grade II, the emphasis was placed on early application of Rest, Ice, Compression, Elevation (RICE) guidelines, while ankle sprains of Grade III might require surgical intervention.  However, evidence of benefit by surgical intervention has not been forthcoming. Regardless of severity, current 2016 research indicates surgery for acute ankle sprain is not recommended anymore.


Meticulous diagnosis and treatment is highly likely to determine prognosis. Prognosis is also affected by many factors such as the history of ankle instability and associated lesions. In the opinion of most experts, the most important prognostic factor for acute ankle sprain is the efficiency of the physiotherapy program


  • Acute ankle sprain is a very common injury which comprises 80% of all ankle injuries.
  • Acute ankle sprain affects almost exclusively the lateral ligamentous complex including ATFL followed by CFL, while PTFL is rarely of clinical significance.
  • The injury is mostly produced by excessive inversion and plantarflexion of the ankle.
  • Careful history taking and physical examination is crucial to guide imaging assessment, management and prognosis..
  • Starting a physiotherapy program as early as possible is essential to control pain and swelling, to improve and maintain the range of motion, and to minimize the risk of stiffness and muscle wasting, which are the two decisive factors which delay patients from returning to their normal activities.
  • Cast immobilisation has a limited role and should be considered only in cases of fractures and inability to weight-bear.
  • Regardless of severity, surgery for acute ankle sprain is not recommended anymore.

Ankle Sprain Information on Youtube