The Impact of Chiropractic Care on Foot and Ankle Performance in Footballers
Research indicates that football accounts for one-fourth to one-half of all sports-related injuries in Europe, given its high-risk, injury prevention is essential for player safety and performance.
Ankle injuries are common in football, with sprains being the most prevalent. Among football players, ankle injuries account for 11 %–25 % of acute injuries
A common type of injury is posterior ankle impingement (PAI) often seen in athletes performing repetitive plantarflexion movements, such as running, jumping, and kicking.
Posterior ankle impingement is characterised by deep pain at the back of ankle typically caused by compression of soft tissue structures between the talus, tibia and posterior aspect of calcaneum during plantar flexion.
This condition can become chronic, especially with repeated strain from football activities
Because this condition affects plantar flexion, there is often compensation in football players.
To compensate for the plantarflexion loss, athletes with Posterior ankle impingement may inwardly rotate their feet, risking ankle sprains, calf sprains, contractures, and plantar foot pain.
Posterior ankle impingement may also result from an os trigonum or Stieda's process at the back of the ankle , and is associated with other issues like fractures in the lateral tubercle of the posterior talar process, compression of the posterior soft tissues, tension on the posterior talofibular ligament (PTFL) and posterior capsule, as well as inflammation of the flexor hallucis longus (FHL) tendon or tenosynovitis.
How do we test for Posterior ankle impingement?
We perform the heel thrust test - The doctor places the ankle in maximal plantar flexion with the patient prone, applying overpressure with an inversion/eversion bias for less irritable patients
What can Chiropractors do?
Nonsurgical management of PAI typically combines rest, ice, compression, and elevation (REST), along with physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation management
Research shows that non surgical management has a success rate of 81% and another showed a 60% success rate
More success is noted after following the 8-week plan compared to the 4-week plan
Rehab Plan:
Week | Goal | Exercise Type | Exercises | Sets | Duration |
Phase 1(0–2 weeks) | • Improvement of static ankle stability • Improvement of dynamic ankle stability • Partial ankle plantar flexion was begun (5°) | Closed Kinetic Chain Exercises | Single leg isometric hold | 10 | 5–10 s of hold |
Alternate single and double leg squat/stable surface up to 60 degrees of knee flexion | 4 | 5–15 s of hold | |||
Balancing over dynadisc with injured ankle with alternate eyes open/eyes closed | 3 | 1 min hold | |||
Progression- ROM pain free for all ankle movements except passive plantarflexion (NPRS: maximum 4/10) | |||||
Phase 2(3–4 weeks) | Static and Dynamic ankle stability enhancement | Closed kinetic chain exercises majorly focusing on Lunges and squats | Lunges in multiple directions | 2 (in front, back & side) | 4 reps in each direction |
Bilateral Lunge (eyes open/eyes closed) | 2 | 4 | |||
Bipedal squats on Dynadisc-for dynamic ankle stability |
| Progression from (2x 10 eyes opened and 1x10 eyes closed) to (3x10 eyes closed) | |||
Progression-Pain with passive plantar flexion at end range only (NPRS score maximum, 4/10). Subjective improvement in ankle stability (unipedal stance). Ability to do all exercises without discomfort and pain | |||||
Phase 35–6 weeks) | • Increasing ankle load tolerance. • Progression to 10° of ankle plantar flexion. • Introduction to plyometrics for improving power and dynamic stabilization of ankle | Closed kinetic chain exercises focusing on dynamic stabilization, lower limb plyometrics | 2 legged front jump Landing on one leg | 2 | 1 min |
2 legged jump 90° turn in the air Landing on 1 leg (both sides) | 2 | 1 min | |||
Front Jump on 1 leg | 2 | 10 reps | |||
Side jump on 1 leg | 2 | 10 reps | |||
Rope jumping (Alternate day) | 5 | 1 min | |||
Walk/run intervals on treadmill (Alternate Day) | 10 min | 3 days/week | |||
Side step up and down | 3 | 1 min | |||
Unipedal stance with other leg Theraband swings (multiple destabilizations with Theraband swings) | 4 | 1 min | |||
Lunge with isometric abduction (Theraband) | 3 | 8 each leg | |||
Progression-No pain with CKC/plyometrics and landing exercises | |||||
Phase 4(7–8 weeks) | Return-to-play without pain | Sports specific exercises focusing on running | Running patterns with acceleration/deceleration | 2 | minimum 10 min |
Cut and turns | 2 | 5 each direction | |||
Forward and backward running | 2 | 5 each direction | |||
Rope jumping program continued between running exercises every other day |
| 20 min |
For more information about how we can help. Please call Health Wise Chiropractic 03 9467 7889 or book online to see one of our Chiropractors in Sunbury or Melton/Strathtulloh Today!
We are also really proud to offer our patients an APP for their Mobile- iPad. With access to your rehab exercises and our health tip blogs with over 500 articles.
Chiropractic has moved online. We offer our online program -STAND CORRECTED- To help you through the day.
We have over 30 programs on different health conditions
Each program contains
- Information about the conditions
- things to do and things to avoid
- nutrition advice
- all the stretches that are needed to help
Gupta J, Rizvi MR, Sharma A, Sami W, Fahad A Al-Kuwari N, Hegazy F, Hasan S. Beyond the needle: How nonsurgical management transforms foot and ankle ability in male footballers with posterior ankle impingement- a longitudinal study. Heliyon. 2024 Nov 16;10(23):e40484. doi: 10.1016/j.heliyon.2024.e40484. PMID: 39654717; PMCID: PMC11626724.
Comments