Sprained ankle

Tissues commonly affected

Sprained ankle happens at least once to almost everyone; occasionally it can ruin the rest of your life.

Lower leg injuries often occur when there is weakness of one or more muscles on the side of the lower leg, commonly one of the Peroneus muscles. Normally these muscles should prevents the ankle from twisting, most commonly inwards, called inversion.

The talus bone moves mainly in one mode, called dorsi and plantar flexion; up and down. When an ankle is sprained, the bone subluxates within its socket, see below, causing jamming. This is what causes the severe, sharp pain of a sprain.

The talus may remain partly locked for years, if not correctly freed with the appropriate adjustment, changing the whole movement pattern of the foot, knee and hip. At chiropractic coalface 2 you can read about how the Dutch national marathon champion had to stop running because of knee pain that was directly caused by an untreated ankle sprain.

The talus sits on top of the calcaneus, or heel bone, in what is known as the subtalar joint. Can you also see the ankle mortice in the pictures below?

There are so many bones and joints, with so much pain potential.

The joint or, ankle mortise, as it is called, is formed between two leg bones, the tibia and the fibula and the talus.

The talus fits snugly into a socket formed by the tibia and the fibula, moving like a hinge and allowing the foot to move up and down, supported by an array of ligaments.

Trauma is probably the most common cause of ankle joint pain, but other conditions like a flat foot, or an arthritic hip that change the gait could also be a factor.

Very serious injuries can happen to this complex as you can read about in this ankle joint pain casefile.

The more common fractures are of the ends of the long bones, the tibia and fibula. However, fracture can occur of any of the ankle bones.

Whenever there's enough force to break a bone, assume that there have been torn ligaments too.

How reliable are xrays? A missed fracture can have terrible consequences for the ankle. Scroll down for this case of avascular necrosis.

Careful correction of any ankle mortise and subtalar joint subuxations is a very important, and oft neglected, part of the successful treatment of a sprained ankle.

Ankle mortise and Subtalar joints


There are ligaments on both sides of the ankle that hold the bones together. They give the joint stability. They connect bones together while tendons connect muscles to the osseous structures.

In an inversion sprained ankle, the most common injury, usually it is the ligaments on the outer side that are stretched and occasionally ruptured. Bruising is a sign that there has been some tearing of the tissues.

Should that correction of the subluxations in the ankle not be done, it leads to vital changes to the biomechanics of the foot. This is usually the underlying cause of chronic pain, plantar myofascitis and more difficult to predict changes in the knees, hips and spine.

Yes, that arthritic knee may be the result of an old ankle injury that wasn't properly cared for.

An ankle guard may be useful during the healing phase of the damaged ligaments. Research shows that small movements of the joint, rather than total immobilization as in a cast, for example, promotes faster healing in the treatment of a sprained lower limb.

The trend today is towards a boot that limits movement, provides pressure to reduce swelling, but can be removed for icing, bathing and gentle non weight bearing exercises.

Crutches may be vital for a period in a serious injury. However, keep the ankle mobile and moving, gently if it's swollen and sore, by doing the alphabet exercises. Soon something coming up on YouTube for you, but for the moment just wriggle the joint about whilst you are sitting.

A strong recommendation; if you know your ankle is not getting better, get a scan. Fractures of the one of the tarsal bones lurk and are often missed on plain xrays, sometimes with very serious consequences.

Muscles of the ankle

There are also many tendons that cross the ankle to move the foot and the toes. Tendons connect muscle to bone, enabling you to move your foot.

The muscles usually affected lie on the outer side of the lower leg. There are three of them called the peronei group, plus a few others, mainly for moving the toes.

The contraction of Peroneus Brevis may be so sudden and severe, in attempting to prevent inversion ankle sprain, that it ruptures off its attachment to the bone. This is called a Jones fracture and immobilisation in a cast is essential.

Sprained Ankle Treatment @ Chiropractic Help

  • Displaced bones are often associated with sprained ankle, usually the Talus bone, the Calcaneus bone and the Cuboid bone. Correction of these subluxations is an essential part of the treatment of a sprained ankle. For more about the immobilisation arthritis that comes from uncorrected subluxations. Chiropractic subluxation ...

  • The ankle ligaments may be associated with ankle sprain, with stretching and possible tearing of these ligaments. Swelling and bruising are common findings. Rupture is uncommon.

  • Muscle and tendon sprain may also occur. The achilles tendon and the muscle on the outer part of the leg are most frequently involved in ankle sprain.
  • Less commonly, bones may be fractured in a sprained ankle. Most usually the knobby on the outer side of the ankle (the lateral maleolus) and the end of a bone on the side of the foot may be involved. They are the attachments for the ligaments and tendons of the ankle which are often stronger than the bone itself (aka an avulsion fracture ). Immobilisation is then essential, and occasionally a pin or plate may be necessary if a fracture has occurred in your ankle sprain. It doesn't take much imagination to guess this is a job for a good orthopaedic surgeon ...

There is some interesting research that magnetic care may help in the healing of ankle fractures and sprained ankle.


  • ICE should immediately be applied after a sprain of the ankle. This can best be done with an ice block immediately over the effected painful area.

  • COMPRESSION may be important if it starts to swell. This is done with a compression bandage which should be professionally applied, but needs to be loosened regularly to allow movement of the joint (which has been shown to promote healing) and so that ice can be applied.
  • ELEVATION is necessary if more extreme swelling occurs.
  • X-RAY may be important to rule out fracture. It will then need to be cast for 6 weeks. A crack may not show up immediately, so the X-ray may need to be repeated after 10 days if fracture is still suspected.

  • CHIROPRACTIC HELP management of this very painful condition is particularly successful because it addresses subluxation of bones that usually occurs, and looks for the underlying cause which may be in the low back or sacro-iliac joint. Remember, it is the weakness of a muscle that allows the ankle to invert and sprain. For more information on Chiropractic ankle sprain treatment , click here: ANKLE SPRAIN TREATMENT ...

  • REHABILITATION of the ankle is essential. For more about ankle exercises , click here: ANKLE EXERCISES ...

Hip arthritis

A chronically fixated ankle mortise or subtalar joint after a sprain that was not adequately managed, prevents normal pronation whilst walking and running.

This changes the whole gait cycle producing strain on all the joints above. Hip arthritis is but one consequence. This Kellgren Lawrence grading system is a useful measure of the severity of the degenerative change. 

Hip arthritis starts insidiously with discomfort and stiffness in the groin, side of the pelvis or buttock, often around fifty years of age. Initially it's intermittent, coming and going, eventually after about a year becoming a constant nagging ache with some sharp stabs.

Because it changes the biomechanics of walking, it begins to affect the sacroiliac joint and buttock pain is not uncommon.

Eventually raising the leg to put a sock on becomes painful and restricted. The key, as with all disease, is an early diagnosis and the correct treatment. In the case of hip arthritis that might just be a simple set of exercises done faithfully and some dietary changes to include rich sources of omega 3.

Fatty fish like salmon and freshly ground flax seeds are the best sources.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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