The ankle

One part of the ankle joint moves like a hinge, moving up and down to allow you to stand on your toes and squat. The other part of the ankle joint allows your foot to rock side to side under your leg to enable you to move across uneven ground.

Ankle muscles

The gastrocnemius is the big muscle that sits behind your shin bone. It attaches to your heel by the Achilles Tendon, which is the cord you can feel above your heel. When this muscle contracts it points your toes. If you are standing up this means you are standing on your toes. The soleus (so-le-us) muscle below the gastrocnemius also helps with this function.

Because these muscles cover a long expanse of bone they often become very short and tight as you undergo a growth spurt, This makes them more susceptible to injury. It is important to stretch these muscles.

The peronei (pare-o-ne-eye) are two long muscles which pull your foot out to the side. They are important in maintaining the stability of your ankle and can help to prevent injury.

Aching muscles

The most common complaint associated with muscles is aching following unaccustomed exercise, particularly in the calf (gastrocnemius and soleus). The soreness may develop 24 to 48 hours after the activity and last up to a week. Prevention is better than cure! Warm up thoroughly before activities and try to build up gently to exercises you are not used to. For example, if you haven't done any skipping for a while you could start with five minutes rather than half an hour!

If your calves are sore following exercise treat them gently. After a bit of walking do some gentle stretches before undertaking anything more vigorous, such as the stairs!

Ankle ligaments

Ligaments are fairly strong, non-elastic structures which hold the bones of the ankle joint in place.

Ankle ligament injuries

The most common ankle injury is the 'sprained ankle' and this is usually an injury to the lateral ligament. The lateral ligament is made up of three sections which are stretched when the foot is turned in. This is a common mechanism of injury. 'Going over on your ankle' by slipping off the footpath, stepping into a hole, landing from a jump, or unexpectedly landing on someone else's foot are all common ways to 'sprain your ankle'. The ligament may be torn (all or just some fibres) or just stretched. You will have an idea of how bad the damage is by how it looks and feels.

Stretching or tearing more fibres of the ligament results in more swelling and changes in skin colour related to bruising. Swelling may be just on the outside of the ankle or your whole ankle joint may be swollen. It will be more painful and difficult to take weight through your ankle. It is important you seek help as you may need crutches to help you rest your ankle.

A severe ankle sprain may damage structures other than the lateral ligament. Because of the differences in the adolescent skeleton it is possible that the growthplate at the base of the fibula may be damaged rather than the ligament itself.

Treatment of sprained ankles

Ankle sprains should be treated according to the R.I.C.E.R. regime.

Try to keep a swollen ankle elevated even if you are sitting in lessons at school. Keep your toes moving and move your ankle joint as much as you are able to. It is very important not to hold your foot completely rigid as it will become more congested, painful, and difficult to move rather than better.

Follow the advice of your physiotherapist or doctor carefully. Every injury is different and it is important to get specific advice to help YOU!

Ankle bones

The tibia and fibula are the two long bones which reach from your knee to your ankle.

The tibia is the biggest bone, it sits to the inside of the fibula and takes most of the weight. The fibula is the skinny bone on the outside of your leg. These two bones make a solid 'arch' in which the talus sits. This provides the hinge-like up and down movement of the joint.

The talus sits on another bone called the calcaneus, which you can feel at your heel. The joint between these bones allows your foot to roll and enables you to walk over uneven ground.

Ankle bone injuries

Heel pain is a common cause of discomfort in adolescents. It often occurs gradually, being an overuse rather than an acute injury. It may become more painful over time, initially hurting only after vigorous activity.

This condition is known as severs apophysitis. It affects the growthplate where the achilles tendon attaches to the heel bone (calcaneus).

Pain generally gets worse with activities such as running, jumping, and walking. It also tends to feel worse on hard surfaces or with thin soled shoes. It is more common in males than females and typically occurs somewhere between the ages of seven and fifteen years.

Several things may contribute to this disorder:

• tight calf muscles. This often occurs during growth
• a heavy heel strike when walking - can people always hear you coming?
• footwear - Poorly fitting shoes with poor heel support may make things worse. Shoes with cleats or spikes can put strain on your heel if used on hard ground
• 'Too much - Too soon' activity.

Treatment for severs apophysitis

The bad news is that because severs apophysitis involves a growthplate, it may take many months to settle. The good news is that it will get better when the growthplate fuses.

There are things you can do to help.

Firstly you need to rest from the activity that makes things worse. This may just mean cutting down and substituting a few activities that put less strain on your heel, such as cycling or swimming.

In the acute stage, a heel lift ( a small pad that fits in your shoe) and massage with ice may help.

Flexible cushioned footwear may feel more comfortable than thin, less supportive shoes.

Exercises and stretching can be used to improve the flexibility of your calf muscles and help to balance the strength of the muscles that move your ankle joint.

Specific advice from a physiotherapist will help to decide which exercises you need, identify things which may be making your problems worse and help you get back to pain free activity as soon as possible.

Prevention of severs apophysitis

As a teenager participating in any activity, there are some important points to remember.

• EMPHASISE FLEXIBILITY! Gently stretch muscles to prevent them becoming too tight. This should help to reduce your risk of injury.
• Whatever activity you are doing, start gently and build up slowly over a few weeks. Give your body time to adapt to new activities and time to adapt to any changes in size. You may have grown considerably since last season and this will affect how you play!

• Warm-up and cool down. An adequate general warm-up will increase coordination and balance skills. A specific ankle warm-up can be added if you have problems in this area or your activity is particularly tough on ankles.

• Appropriate footwear is important. Shoes should not rub and cause blisters, or be used for the wrong sport.
• Avoid activities on uneven surfaces, particularly in poor lighting conditions.