Q) I injured my ankle playing football about 3 and half months ago. It was near the end of the season so I carried on playing on it and it took a long time for the swelling to settle down. At first the pain was over the outside of the ankle and this seems to have mostly settled down. Although my ankle is still a bit stiff. Since the football season started again I have noticed a sharp pain at the back of my ankle. It’s not there all the time but it is really bad when I try to strike the ball hard.

What’s causing this?

A) Hello. I think that the initial injury you sustained to your ankle sounds like the most common type of ankle sprain. This tends to occur when we turn the foot in (underneath us). This mechanism of injury will damage the ligaments on the outside of the ankle (the lateral ligament). This ligament is made up of three distinct bands and depending on the severity of the sprain you can tear part or all of one or all three bands.
We grade soft tissue injuries (ligament sprains and muscle strains) using a system of I, II and III. I is an overstretch, II is a partial tear and III is a complete rupture. Given the fact that you were able to play on despite the pain tells me that it was almost certainly not a total rupture. I would suggest, given the length of time that it took for the swelling to settle down that it was a grade II lateral ligament sprain.

The symptoms that you now describe sound like a posterior impingement. This can happen when people do not allow enough time for their ankles to recover and return to sports while there is still a lot of inflammation. It can not only prolong how long it takes for the swelling/inflammation to settle down but it can also make the inflammatory process a little more vigorous. This can lead to thickening of some of the soft tissues that line the ankle joint (the capsule and the synovium). This type of problem will be noticed when you forcibly flex the foot and ankle ie: kneeling with your toes pointing behind you, kicking a ball with your laces, rising onto tip toes.

I am sure that in your case this problem can be completely resolved.

I would suggest seeing a chartered physiotherapist who can guide you on the correct type of stretches to do alongside some manual therapy to restore full flexibility to your ankle joint and the lateral ligament.

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