Ankle Therapy & Treatment

As the communicating bridge between our powerful leg muscles and our springy platform feet, the ankles play an important role in keeping us successfully upright, bipedal animals. These crucial components can become compromised when relied upon to navigate unstable surfaces, and one can be left with a painful and debilitating nuisance. The good news is that, unlike the brain, we have a good understanding of ankle anatomy and function. The body has an incredible ability to heal itself, and often professionals like physical therapists can help to expedite that healing process of an ankle injury.

Ankle Anatomy

The ankle itself is comprised of several bones, notably the tibia and fibula of the lower leg and talus and calcaneus of the foot. Sprained Ankle Injury Physical TherapyThe shape of these bones form a unique joint with multiple planes of possible movement. The tibia and fibula of the lower leg come together to form a cup shaped cavity that sits on top of the talar dome, the highest bone of the foot. This “true ankle joint,” or tibiotalar joint, allows for two primary movements, dorsiflexion and plantarflexion. Pull your toes up towards your shin bone- this is dorsiflexion. Point your toes down like a ballerina- this is plantarflexion.  The talus then rests atop the calcaneus, or heel bone of the foot. This is called the subtalar joint. Together with the tibiotalar joint, these junctions allow inversion and eversion. Pull the bottoms of your feet together- this is inversion. Push the bottoms of your feet away from each other- this is eversion. Inversion and eversion are important to allow walking on unstable and uneven surfaces without falling. In addition to these multiple joints and joint surfaces, there is a network of connective tissues keeping these bones held together called ligaments.

The ligaments on the lateral aspect of the ankle are the anterior talofibular ligament (ATFL), the calcaneo-fibular ligament (CFL), and the posterior talofibular ligament (PTFL). The ATFL and CFL are the most commonly injured ligaments and are affected in an inversion ankle sprain (described in detail below). On the medial side of the ankle we have the anterior tibiotalar ligament, tibiocalcaneal ligament, posterior tibiotalar ligament and the tibionavicular ligament. These ligaments are known collectively as the deltoid ligaments, which are affected during an eversion ankle sprain.

Causes of Ankle Sprains

Ankle sprains are one of the most common sports injuries, estimated to impact thousands to tens of thousands of people on a daily basis. An ankle sprain can occur during daily activities as simple as stepping down off of a curb, but people at highest risk may be those participating in sports involving quick cutting or lateral movements requiring rapid changes in direction and speed. The most reliable predictor of injuring your ankle is having done it previously.


The type of ankle injury often has to do with what specific tissues or combination of tissues were affected. The most simple way to arrange these injuries would be into bone, ligament, or tendon as the main damage.

  1. Bone: The most common bone injury in the ankle region is a fracture. Fractures often occur as a result of a traumatic event such as stepping in a hole while running, falling from a height, or landing on a slanted surface.
  1. Ligament: When the foot or ankle is pushed beyond its normal range of motion and the bones stay intact, ligaments can be stretched beyond their tensile limit or torn.
  1. Tendon: Where the muscle attaches to the bone is called a tendon. With repetitive movements or high impact activities, tendons can become inflamed leading to injuries known as tendinitis (acute inflammation) or tendonosis (prolonged irritation or pathology of the tendon).

FRACTURE Diagnosis and Treatment

The first step in diagnosing an ankle injury is to determine whether or not radiographs (x-rays) need to be taken to look for a fracture. In order to save time and resources, a set of rules were developed with research to better indicate when a fracture is possible or likely. This set known as the Ottawa Ankle Rules are as follows.

Get imaging if:

  • you are over the age of 55
  • you are unable to bear any weight through the affected ankle and take 4 steps at the time of injury or in the emergency department
  • you experience severe point tenderness on the inside or outside tip of your ankle

Ankle treatment of a simple ankle fracture typically will involve a period of immobilization in a cast.

Depending on the severity of the fracture, you may be required to unload the tissues by using crutches while the bone heals. After an ankle fracture, it is important to see a doctor of physical therapy in order to safely return to walking. Your ankle tissues will shorten when immobilized in a case over time, so this will often require exercise and manual ankle injury therapy to improve range of motion and strength.  

LIGAMENT Diagnosis and Treatment

When the ankle is quickly moved beyond its normal range of motion, ligaments can get stretched beyond their limits, and the result can be a sprain. If swelling, pain, and even bruising result, but the rules above do not indicate a need for imaging, we are often dealing with a sprain. Low-grade sprains will often heal themselves with time and rest, but seeing a physical therapist for diagnosis, manual ankle therapy, and strengthening/balance training has been shown to significantly decrease the time before returning to your favorite activities.

TENDON Diagnosis and Treatment

Tendon injuries are diagnosed based on location of symptoms and mechanism of injury. When pain the ankle or foot is related or reproduced by pressing on the muscles further up the leg, we become suspicious of the tendinous attachments to the bones. A key predictor of tendon injuries comes from how/when the person first started experiencing the symptoms. Common mechanisms of injury include repetitive impact activities such as jumping or running.

Seeing  a skilled ankle physical therapist is crucial with nagging tendon injuries in order to determine the source of dysfunction, whether that be a weakness, muscle imbalance, joint hypomobility, joint hypermobility,  or a footwear issue. Often the most beneficial ankle sprain treatment for tendon injuries will include a training modification and specific strengthening exercises called eccentrics. These are very individualized ankle injury treatments, so it’s important to team up with a Doctor of Physical Therapy such as those at the Portland Area Stride Strong clinics who are willing to put the time into learning about you and your goals.

Ana Lucia Pinheiro
Ana Lucia Pinheiro
02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
Prashant Gupta
01:00 02 Oct 17
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
steven zollin
20:57 14 Sep 17
Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
Lindsay Nied
Lindsay Nied
23:33 18 Dec 17
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
JoAnn Hatch
JoAnn Hatch
08:20 08 Nov 17
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
Clare Perry
Clare Perry
21:58 23 Oct 17
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
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