This past fall, I injured my ankle on my last long run while training for a half marathon. I was at mile 5 (out of 12) and stepped on an oversized acorn.
Okay, it wasn't actually an acorn but I think that makes the story funnier and a bit more pathetic because it's exactly how I felt after doing so.
Anyways, after stepping on this mystery tree falling, my foot pronated inward and I rolled my ankle. I heard a pop and knew I had been injured. Never in my mind did I think this injury would be something that would require an MRI and rehab, but here we are 2 months later and I am finally able to jump.
I rolled my ankle and decided that I could keep going. I tried to "shake it out" as I was running. When I let my arch cave in, it felt okay! But any pivots or twists did not feel good. I made it another mile before deciding to call my husband, in tears and have him pick me up.
I wasted no time getting to a foot and ankle specialist. Luckily, they got me in within a few hours and confirmed that I had probably torn a ligament. The doctor was specific that the particular ligament was probably just a tear because my ankle was swollen, but not black or blue. She took a x-ray and saw a hairline fracture but was pretty convinced I had done this perviously because it was so so faint. I told her possibly, but I didn't have any recollection of ever injuring my ankle before. None the less, the next step was to decide if I proceed with the half marathon I was training for. It was in two weeks and I had the best training season yet to date. I really did not want to give up yet, especially if I could heal in a week. The doctor said give it a week, stay off the foot and stick to biking (if no pain). She urged me to keep it wrapped for as long as I could and not to load my ankle with squats or deadlifts. "That's fine", I thought, "I am in taper week anyways".
This story drags on and on. I went back a week later and she said the swelling has gone down and if I feel comfortable running on a wrapped ankle, I could try. I slowly worked up to 7 miles and decided to give the half marathon a go.
Two weeks after my injury, I ran the Detroit Free Press Half Marathon and I had a blast. The injury allowed me to take all pressure off in terms of performance and just run for the gratitude of the sport. After the race, I wouldn't say I was in pain.. but I was limping around a bit. But as the days followed, my ankle got worse and worse. Going down steps was painful, getting out of the car wasn't fun, I wasn't able to run comfortably and so forth. I went back to the doctor and she suggested an MRI to see if I had possibly ruptured the injured ligament. Rupturing the ligament would require surgery, in which she insured me that the outcomes were positive.
I got the MRI done and another week later, had my answers.
I had fractured my fibula, torn (not ruptured) two ligaments and a brown spot on my bone (due to bruising). This was a lot of information that unfortunately meant no quick fixes. The most major concern was the fracture. I needed to heal my bone before strengthening the torn ligaments. The doctor gave me a removable boot, told me to wear it religiously for two weeks, and to start physical therapy right away.
As much as it pains me to not move as much, I want to heal. So I did as the doctor prescribed and have been recovering smoothly! I am now able to workout without a brace, jump up and down, pivot without pain and do more cardio outside of biking (stair master, elliptical). I have yet to run, but I feel a bright future is ahead.
I have been working with a physical therapist for a month because I have never dealt with an ankle injury before. I have learned so many fabulous rehab exercises that can help anyone with weak ankles, tight calves, or a full blown injury such as myself. I have listed my favorite exercises, frequently asked questions, common ankle injuries, and more.
Common Ankle Injuries
Achilles Tendinitis
Runners sprain their Achilles more often than we really pay attention to. Anytime you "push off" from the ground, the Achilles is stretched. As we age, this ligament becomes weaker. Both of these stressors lead to tendonitis. The type of tendonitis depends on where the pain is located. There are three main injuries including: insertional tendonitis (inflammation near the heal), paratenonitis (inflammation around the outer edge of the tendon) and non-insertional tendonitis (caused by overuse).
Insertional Achilles Tendinitis: common in runners with high arches, bursas, and inflexible ankles. Pain is caused by lack of stress in the forward section of the tendon. To treat, one most strengthen this area. Things like weighted calf raises or toe walks can help strengthen the front portion of the tendon. Others suggest to get inserts for high-arched runners; however this approach does not tackle the root cause. It is better to strengthen the weak areas so this pain doesn't occur.
Paratenonitis: Overuse of the achilles causing inflammation. Overpronators tend to get inflammation on their outers health of the tendon. A bursa, or a fluid sack may grow and cause pain. To treat, you must first take care of the swelling and limit movement that causes pain. This may mean time off from running. If you leave this untreated, non-insertional tendonitis may occur.
Non-Insertional Tendonitis: degenerative, non-inflammatory tendonitis. This occurs after over-use, repetitive injuries creates fibroblasts; cells that invade damaged muscles and tissues to rebuild. Many people with weak calves and little strength tend to be at more risk. Strengthening your calves with calf raises are a great way to reduce tendonitis and elevate pain.
Tibialis Posterior Tendonitis
This muscle is the most deep muscle in the posterior leg. This typically gets inflamed by repetitive stress from running. Many people with weak ankles or low arches have problems with this muscle. If you notice you're having a hard time with simple heel raises; you may have developing tibias posterior tendonitis. The damaged tendon begins to cave in which makes raising the heel very challenging. Treatment includes strengthening your ankle and calves with exercises such as Airex pad balancing (see below).
Ankle Sprains
The most common ankle sprain is when the heel inverts. This is exactly what happened to me when I fractured my ankle. Ankle sprains are very challenging; many are susceptible to re-injury. The most important thing one can do after having an ankle sprain is take time off, heal, restore balance, gain strength, and improve mobility. These practices will help decrease the chances of re=sprianing your ankle.
The first step is to seek medical help. Determine if you need an MRI. In my experience, MRI was necessary to see if I had ruptured a ligament. You will gain a lot of information getting one of these done.
Follow your doctors advice but you will most likely be sent to a physical therapist and be encouraged to wear a brace. As much as it sucks, the brace will immobilize your joint and allow it to heal. I was able to bike through my injury while wearing a brace so determine your activity level with your doctor before attempting.
Ankle Strengthening Exercises
After determining what ankle injury you have, come up with a game plan with a medical professional on recovery. The following exercises will differ in degree of complexity. If you are practicing these exercises -weather it is to gain ankle strength or to get better balance- do so slowly and with intention.
Calf Raises with Lacrosse Ball
The first exercise to master is the calf raise, or heel raise. This not only involves range of motion in the ankle joint, but works to strengthen the calf muscles and all the surrounding ligaments. To make this exercise more complex, try adding a lacrosse ball and squeezing it between your heels. This will engage the inner foot muscles and make you work to stabilize the ball.
Single Leg Airrex Pad Balance
Shift your weight into one foot and hold on the airrex pad. This will create instability and test your balance.
Single Leg AIREX Pad Balance with Distraction
This exercise involves standing on one leg on an uneven surface. Like the exercise prior, but this one will keep your mind focused on something other than balancing. Tossing a ball on a wall or moving your arms overhead and behind your back will cause distraction. Many times while running, we are not 100% focused on each step we take. This exercise mimics that distraction.
Lateral Band Walks with band around feet
Placing the band around your feet require your ankles to stabilize as you take big steps laterally. I love this version of this great hip exercise. Try to keep both feet pointed forward.
Reverse Lunge Kettlebell Pass Through
This exercise will test your ankle mobility involving lunges. While lunging back, pass the kettlebell under the front leg. Weight will be shifted from one side to the other, similar to how running is a single leg exercise (technically). You must maintain a strong core to keep upright.
Reverse Lunge Chop
Cable Side Step Chop
This cable chop is the most complex ankle rehab exercises in the list. You will use force and pivoting to twist, driving the weight to the sky. By twisting and pivoting, you'll be testing the strength in many ligaments attaching from your fibula to your tibia.
Exercise Prescription
Start with the first exercise and master it by practicing. In the absence of pain, you can practice these every single day. Notice I said, the absence of pain. Never pursue an exercise with pain present.
Once you master the first exercise, move on to the second, then the third, fourth.... these will progress in complexity and strength. Do not jump to the last exercise and expect to be good at it if you have not practiced and mastered the ones prior.
Practice these exercises even after healing! These are meant to strengthen your ankles, calves, improve range of motion and test your balance. All vital components to being a strong and healthy runner!
If this was helpful to you please reach out and tell me! Email amanda@fitandfearlessamanda.com to let me know how these exercises have helped your recover or improve your ankle strength.
Resources
Michaud, T. C. (2021). Injury-free running: Your illustrated guide to biomechanics, gait analysis, and injury prevention. Lotus Publishing.