One of the more common injuries for runners is the rolled ankle. Treatment for this issue varies according to severity. In this article, I’ll discuss what to do initially, how to strengthen the area again and how to avoid repeating the incident during the high risk months afterwards.
- How do rolled ankles happen when running?
- What injuries can occur when a runner has a rolled ankle?
- What should I do if I get a rolled ankle while running?
- How long does it take a rolled ankle to heal?
- How can runners speed up recovery after rolling an ankle?
- Rolled ankle treatment for runners – strength exercises and proprioception work
- High risk of repeat injury and how to avoid this – IMPORTANT!
How do rolled ankles happen when running?
The normal cause of rolled ankles during running is an uneven surface that the foot can’t respond to quickly enough. The runner places their foot down on something uneven, like the edge of a kerb, a tree root or loose rock / paving and the unsupported side of the foot dips away quickly resulting in injury to ligaments, tendons, muscles, nerves and even bone. The most common mode of roll is called “inversion”, where the ankle rolls to the outside and the sole of the foot ends up facing inwards towards the middle of the body. The opposite where the ankle rolls outwards, called “eversion”, is far less common and normally more serious. You can see the differences in the image below.
It’s very unlikely a strong ankle would ever roll while running on a flat surface in well fitting shoes or barefoot. In other sports, like football, where sudden changes of lateral direction are required, there is a higher risk of rolling the ankle from the foot tipping over under sideways load, but this scenario would rarely happen for a normal runner.
The other ways a rolled ankle can occur while running are when jumping over something and landing on the ball of an extended foot, or while running downhill and landing on the back of the heel.
Normally while we run, we should try to land close to a flat foot, sometimes the heel very slightly first and sometimes the forefoot very slightly first, but ultimately, with the ball of the foot / metatarsals being placed down in very close timing to the heel of the foot. This creates a stable platform underfoot with maximum proprioception – the ability to feel and respond to what is happening. The dorsiflexion of the ankle (pulling the foot up, so 90° to the leg) also makes the ankle strong and tense.
However, if we land a foot on the ground while it’s in plantar flexion (foot and toes pointed out in a straight line from the leg), this isn’t stable or strong and there’s a risk that the metatarsals can’t respond quickly enough, at which point the foot / ankle starts rolling to one side. Similarly, running down a steep slope, you’d normally try to get your foot flat against the slope as quickly as possible, but if you lean backwards out of fear perhaps, you end up landing on the heel alone, which is unstable.
What injuries can occur when a runner has a rolled ankle?
If you roll an ankle further than it should go normally, the injuries that might happen are Sprains, Strains, Nerve damage, and Bone or Cartilage damage.
A “Sprain” is where the ligaments holding your bones together get wrenched or twisted harder than they can cope with. As you can imagine, the combination of foot bones and lower leg bones means a lot of ligaments in the area. Pain from an ankle sprain would normally manifest more from within the ankle.
A “Strain” is where the tendons or muscles are pulled beyond their normal range of motion. For example one of the peroneal tendons that attach the bottom of the foot to the peroneal muscles up the sides of the leg, or even the muscle themselves might get damaged. This would normally manifest closer to the surface level near the skin of the ankle, and up the leg.
Nerves in the foot might also get damaged, either being stretched on one side of the foot, or crushed on the other. If so, your proprioception will be impaired, taking a long time to relearn exactly what the foot is going to do again.
Bone and cartilage damage is less likely to happen during a rolled ankle, but can occur in severe cases. For example, instead of a ligament or tendon tearing, they might stay strong and instead pull a chunk of bone away (this happened to me playing 5-a-side football a long time ago). Alternatively, the excessive movement of the joint can push bones towards each other and cartilage in between can be damaged during that compression, or even the bones themselves.
During a sprain or a strain, you may hear a disturbing popping sound where joints are moving to places they shouldn’t be. This doesn’t necessarily mean you have fractured a bone, but it’s worth the wait for an x-ray just in case. Sprains, strains and bone fractures can all result in black pooling of blood in the foot, so you can’t diagnose based on this.
Most of these rolled ankle injuries will result in a visually swollen ankle, normally within minutes, which will restrict movement a little for a while:
What should I do if I get a rolled ankle while running?
Regardless of which injuries occur, a rolled ankle is normally very painful. If possible, you should not try to continue your run, and even walking home if that’s an option – it will need a little recovery time during which powering through pain will only make the injury worse. Try to get a ride home, or hobble as best you can with minimal weight on the affected foot.
How long does it take a rolled ankle to heal?
The sprain and strain aspects of a rolled ankle will normally feel a lot better after 1-2 weeks and heal in around 8 weeks, depending on age. However, nerve damage can take a few months to heal, so caution is advised for at least 3 months.
How can runners speed up recovery after rolling an ankle?
Within 24-48 hours or a rolled ankle, you should be able to put a small amount of weight on your foot without too much pain. Therefore you should get both the ankle joint and yourself moving where possible. Increased blood flow in the area will help speed up healing. Don’t attempt long walks to start with because your hobble will end up injuring something else while you are off balance.
Quality of sleep is essential for healing, so avoid alcohol completely and get lots of sleep. If pain is preventing you from sleeping, you can take anti-inflammatory medication, but otherwise you might want to avoid them before bed since, again, you want increased blood flow for healing, not less.
Rolled ankle treatment for runners – strength exercises and proprioception work
Once you are able to put weight on the ankle with only minimal pain, you can move on to strength and proprioception work. Here are a few to get you started:
Blind balance:
Stand on one leg, shut your eyes. How long can you go before putting the other foot down. If you find this too hard, start on two legs with your eyes open, one in front of the other. Make it a bit harder by standing on cushions.
Ankle / heel raise and lower:
Stand on two feet and raise up on to tip-toe then lower yourself down again slowly. If this is too hard, push yourself up with your hand on desk. As the healing progresses, move on to doing this one foot at a time. However, when doing one foot at a time, still try to raise straight up, so you feel the ball of the foot and the big toe engaging, rather than rolling off on to the smaller toes. Even after healing is complete a few months later, you could always benefit from eccentric heel drops.
L-Jumps:
Once you feel able to jump and land safely, try jumping forwards, then left, then right and then backwards. You should go in an L shape and end up back roughly where you started. Start on two legs and eventually progress jumping on just one leg.
90° rotation jumps:
Stand still. Jump a quarter turn a few times. Then go back in the other direction. Once you feel able, progress to doing it on just one leg.
Fight the lean:
Stand on one leg and lean slowly to the side – see how far you can lean while keeping yourself upright with the foot muscles. Have a wall to reach out and touch so you can repeat the move quickly. Then turn around and try leaning to the other side.
High risk of repeat injury and how to avoid this – important!
This is possibly the most important part of this article. The nerves take longer to recover than the rest of the injuries, so all runners should be aware that even after a couple of months, when the swelling and pain has died down and everything seems OK to run again, there is still an increased risk of repeating the ankle roll. This is because you aren’t yet fully aware of what is going on under your foot, how your foot is moving and how to respond. If you roll the foot a second time, a couple of months after the first time, the strength isn’t there yet, so it’s likely the roll will be even worse and take you out of action a lot longer. Therefore I recommend that any runner starting out running again after an ankle roll should avoid trails completely for a few months and stick to flat roads. Remind yourself at the beginning of each run not to do anything stupid like try to jump over a puddle. Lower profile shoes rather than high stack wobbly super shoes might also be a good plan for a while.
If there are any other exercises that helped you when recovering from an ankle roll, please comment below. Meanwhile, here’s an official race photo someone posted on Facebook of the exact moment they stopped concentrating on running the terrain and rolled their ankle. So let this be a lesson – focus on what’s happening under your feet, especially if it’s uneven.
