Church Lane Physiotherapy Clinic Ltd

Church Lane Physiotherapy Clinic Ltd Services include isokinetic testing, shockwave therapy and fitting of pessariess.

Church Lane is well established offering expert treatment for MSK and women's health conditions, 4 private treatment rooms and a fully equipped rehabilitation gymnasium.

Gangaa is getting ready to start her yoga classes at Church Lane Physiotherapy Clinic. You can book by calling 01782 71...
20/07/2025

Gangaa is getting ready to start her yoga classes at Church Lane Physiotherapy Clinic. You can book by calling 01782 719232

Baxter’s Nerve Entrapment Also known as Baxter’s neuropathy, Baxter’s nerve entrapment is a condition in which one of th...
09/07/2025

Baxter’s Nerve Entrapment

Also known as Baxter’s neuropathy, Baxter’s nerve entrapment is a condition in which one of the nerve’s traveling through the foot (the inferior calcaneal nerve) gets compressed between the surrounding structures, and subsequently inflamed, causing pain on the inner aspect of the heel. The nerve involved is the medial plantar nerve, which provides sensation to the skin of the arch of the foot and the inside of the heel.

It is a condition that develops over time, sometimes in the absence of any trauma or injury. Baxter’s nerve entrapment can be caused by a variety of factors, such as wearing shoes that are too tight or poorly fitting, standing or walking for extended periods of time, and direct trauma to the foot.

Anatomy
The tibial nerve, which is a major nerve of the lower leg, is one of the two terminal branches of the sciatic nerve. When it enters the foot through the tarsal tunnel it splints into several
branches.

Distal to this tunnel, the nerve gives off its terminal branches, the lateral and medial plantar nerves, which are responsible for sensory and motor functions of the foot.

Just after the splitting of these branches, the inferior calcaneal nerve arises, making it the first branch of the lateral plantar nerve.
Baxter’s nerve runs down between the abductor hallucis and the quadratus plantae muscles of the foot, and along the medial border of the long plantar ligament.

Being a mixed nerve, it also gives out sensory branches to the calcaneal periosteum, long plantar ligament, and the nearby vessels.

Symptoms of Baxter’s Neuropathy
Baxter’s nerve entrapment is estimated to be responsible for approximately 20 percent of chronic heel pain (Coles et al., 2021). It is a condition that is frequently overlooked, and the
symptoms usually include:


o Pain in the heel or arch of the foot, which may be sharp or burning in nature.

o Tingling or numbness in the heel or arch of the foot.

o Swelling or tenderness around the affected area.

o Difficulty walking or standing for extended periods of time.

o Pain that worsens with activity, and improves with rest.

o A sensation of electric shock in the heel or arch of the foot.
Is my heel pain due to Baxter’s Neuropathy or Plantar Fasciitis?
Baxter’s nerve entrapment is often misdiagnosed as most of the cases of heel pain, especially in young adults, are attributed to plantar fasciitis.

Plantar fasciitis has symptoms similar to Baxter’s neuropathy and is the most common cause of heel pain, which is why clinicians may sometimes misdiagnose Baxter’s nerve entrapment as Plantar Fasciitis. However, there are a few differentiating points. Pain directly beneath the heel is more common in Plantar Fasciitis
Also pain and stiffness that gets worse after periods of rest including after waking up in the morning, often occurs in plantar fasciitis.

In Baxter’s nerve entrapment, pain may be felt more on the medial arch of the foot and a sensation of numbness or pins and needles is also more likely as this involves compression of a nerve. It is always worth scanning the medial arch of the foot to ensure there isn’t a
thickening or tendinosis of the medial component of the plantar fascia which may potentially have a secondary effect on the Baxter’s nerve. In addition, palpation and scanning the abductor hallucis muscle on the medial arch of the foot is also important as this may swell or enlarge causing entrapment of the Baxter’s nerve.
Although Plantar fasciitis is distinct from Baxter’s neuropathy it can lead to the development of this condition.

What causes Baxter’s Nerve Entrapment?
There are quite a few reasons for the development of this condition. The nerve can get compressed between the inner muscles of the foot very easily due to its anatomical
placement.

Common causes of Baxter’s neuropathy include:

o Poor posture leading to poor foot mechanics, including
excess pronation.

o Having flat feet.

o Engaging in sports like running, which can cause compression
due to overuse.

o Atrophy of the heel pad muscles.

o Development of bony spurs on the calcaneus impinging the
nerve.

o Entrapment due to wearing poorly fitting shoes.

o Trauma or injury to the heel which causes swelling.

o Obesity.

o Plantar fasciitis.

o Hypertrophy of the Abductor Hallucis muscle of the foot.

Diagnosis
A careful medical history and a detailed physical exam pave way for a correct diagnosis (Along with that, a few diagnostic tests may be necessary, including:

o Xray – to rule out spurs, fractures, or other bony deformities.

MRI – great for imaging the soft tissues, it can show signs of compression in the inferior calcaneal nerve including atrophy of abductor digiti quinti muscle,
plantar fasciitis (if present), and edema around the calcaneum

o Ultrasound: usually to exclude Plantar Fasciitis as the cause of the
pain.

o Ultrasound guided nerve block – a local anesthetic agent such as
co***ne, is injected at the origin of Baxter’s nerve under the
guidance of an ultrasound. If the pain stops, it is diagnostic for
this condition.

Treatment and Management
Baxter’s nerve entrapment causes a lot of discomfort, and the pain is usually managed by rest, icing, and giving over the counter NSAIDs like ibuprofen or naproxen. Patients are advised to take a break from strenuous physical activity, and in cases of severe pain stronger analgesics are prescribed. Steroid injections or nerve hydro dissection can help minimise the inflammation around the nerve, reducing pain and promoting healing.

Soft tissue massage and mobilisation techniques can help alleviate the pressure on the nerve.

Orthotics (inner soles for the shoes) can be utilized. Physical therapy is an important part of the management of this condition, and certain stretching exercises can be incorporated to help
with the recovery process.

Injections for Baxter’s nerve entrapment
Nerve hydro dissection is an effective treatment for Baxter’s nerve entrapment, in which an anesthetic, saline, or 5% dextrose solution is used to separate the nerve from its surrounding
tissues, like fascia, muscles, or ligaments, under the guidance of an ultrasound. In the case of Baxter’s neuropathy, the inferior calcaneal nerve is blocked in this manner, and this technique provides rapid, effective, and long-lasting resolution of pain.

Ultrasound guided radiofrequency ablation is a procedure that involves using sound waves to heat the Baxter’s nerve to 90 degrees, causing a semi-permanent numbing of the nerve.
It prevents the nerve from transmitting pain signals, and leads to the formation of new blood vessels, thereby accelerating healing. The ablation needle is guided by ultrasound, and after
administering a local anesthetic.

In a few cases, surgery may be performed to decompress the nerve. However, that is generally done as a last resort in cases which have failed to respond to other treatments.

Conclusion
Baxter’s nerve entrapment can become a chronic condition if timely intervention is not done.
However, following an accurate treatment plan can not only manage pain, but help improve
the overall quality of life and allow the patient to resume physical activity

25/06/2025

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The transformation HC had struggled with pelvic floor issues for years, made worse by menopause. But through dedicated practice with specialised techniques and myofascial work, she reclaimed her confidence and freedom.
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✨ Professional guidance
🎯 Please get in touch so we can have a chat and discuss options..
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World Continence Week runs June 23-29, 2025. It's never too late to prioritise your pelvic health.

Uncommon injuries: medial knee pain from the pes anserinus Knee injuries are prevalent in athletes due to the loads tra...
13/06/2025

Uncommon injuries: medial knee pain from the pes anserinus
Knee injuries are prevalent in athletes due to the loads transmitted through the knee joint during sport. When medial knee pain presents, there are several possible causes, including an injury to the medial ligament, medial cartilage/meniscus, or medial tibial stress fracture. However, in athletes with vigorous and repetitive hamstring use, there is another possibility – pes anserinus injury. Because these injuries are comparatively rare, missed diagnosis is common and can result in unnecessary knee surgery.
The pes anserinus – also known as pes anserine or the ‘goose’s foot’ – refers to a conjoined insertion of the sartorius, gracilis and semitendinosus muscles along the proximal medial aspect of the tibia. Each of these three muscles is innervated by a different nerve: the femoral, obturator and tibial nerves respectively. Visually, these conjoined tendons form a structure reminiscent of a goose’s webbed foot and were named from the Latin roots, pes for foot and anserinus for goose. Under the conjoined tendons lies the pes anserine bursa, a sac which provides smooth movement of the conjoined hamstring tendons over the medial collateral ligament. The pes anserinus aids knee stability by helping the medial ligament resist valgus forces.
Although not especially relevant in a clinical context, it is worth appreciating that the structure of the pes anserinus differs among individuals. For example, a recent study examined pes anserinus structure in 102 cadaveric limbs. The researchers found that in all cases, the pes anserinus consisted of the sartorius, gracilis, and semitendinosus tendons. However, six distinct types of pes anserinus were distinguished based on the presence of accessory bands. Additionally, three types of insertion were noted (short, band-shaped, and fan-shaped).
Pes anserine pathology and risk factors
Pain as a result of pes anserinus pathology can arise as a result of
1) tenosynovitis of the pes anserinus tendon,
2) inflammation of the pes anserinus bursa, or
3) a combination of the above.
Clinically, it is difficult to distinguish these two pathologies. Fortunately, the treatment is the same for both conditions. Having said that, evidence suggests that a pes anserinus bursitis occurs more frequently and responds more quickly to treatment than tenosynovitis
The underlying factors increasing the risk of pes anserinus injury are often multifactorial, but typically involve high hamstring loading combined with sub-optimal biomechanics. Movements that can precipitate a pes anserinus injury are those involving valgus (eg as a result of excessive pronation in running gait ) or rotatory stresses at the knee. Because gait patterns most significantly tax the medial knee, it is unsurprising that PA tendonitis and bursitis affect long-distance runners more than other athletes. Mexican researchers evaluated 22 patients with pes anserinus bursitis and found valgus knee deformity, alone or in association with medial collateral instability, to be a risk factor for pes anserinus injury.
Some researchers have proposed that pes anserinus tendon pathology is much more likely in those who are older and with osteoarthritic co-morbidities. A Turkish study performed an ultrasonographic assessment of the pes anserinus tendon and bursa in patients with knee osteoarthritis. They found that the mean thickness of pes anserinus in knees with osteoarthritis was significantly greater than the controls and that higher pes anserinus thicknesses were associated with higher osteoarthritis scores on a visual analogue scale (VAS). However, the researchers in the Mexican study did not find such an association. Indeed, they concluded there was no association between pes anserinus injury and previously reported predisposing factors such as diabetes, knee osteoarthritis, and obesity. On the face of it, these findings seem conflicting. However, one interpretation is that in older patients with pre-existing osteoarthritis, some pathology affecting the pes anserinus is to be expected – but is distinct from a pes anserinus injury caused by repetitive overload involving the hamstring muscles.
Patients with pes anserine bursitis typically present with tenderness and swelling along the proximal medial tibia. However, symptoms may also include vague medial knee pain, which may mimic medial meniscal or tibial collateral ligament injury. Indeed, some research suggests that a significant proportion of patients may not present with proximal tibial swelling, but instead present with either posteromedial joint pain or medial joint line pain, raising a (false) suspicion of a medial meniscal tear. Other pain characteristics and functional symptoms include:
Pain experienced approximately 2-3 inches beneath the medial aspect of the anterior knee joint (which may also extend to the front of the knee and down the lower leg).
Gradual onset of pain over a prolonged period.
Exacerbation of pain on ascending or descending stairs, walking steep gradients, or sitting down/rising from chairs.
A lack of pain when walking on level surfaces.
Pain experienced when contracting the hamstrings against resistance.
Pain upon stretching the hamstring muscles.
In more severe cases, pain at night, waking the patient when he/she bends the knees resulting in sleep disturbance.
A successful diagnosis of pes anserinus requires a thorough physical examination of the patient, along with a detailed history of the symptoms and characteristics of the pain presentation (see above). In particular, the exact site of pain should be identified by both superficial and deep palpation. The pain-producing movement(s) should be performed during a physical examination in order to support the diagnosis.
Due to the proximity of pes anserinus to the skin surface, ultrasound imaging is an effective method for detecting the morphology of pes anserinus and its peripheral structures; and as such, a useful tool to help diagnose pes anserinus bursitis, cysts, tendonitis. However, the gold standard for pes anserinus imaging is magnetic resonance imaging (MRI). In particular, MRI is more sensitive to the appearance of fluid beneath the pes anserine tendon near the joint line than ultrasonography. Regardless of imaging modality, however, the patient’s history, examination, and pain presentation characteristics remain the cornerstone of diagnosis. Imaging studies are perhaps more critical for the exclusion of other pathologies that may present with similar symptoms. These include:
Tibial stress fracture
Osteoarthritis
Popliteal cysts
Bursal Infection
Malignant tumour (rare)
As mentioned earlier, a pes anserinus injury in athletes typically involves bursitis or tenosynovitis. However, other (rarer) pes anserinus pathologies are possible. In children, a type of pes anserinus syndrome may occur as a result of proximal tibial exostoses. These can take the form of an osteochondroma, producing a painful lump, or a rose-thorn shaped bone spur, which leads to a snapping/locking sensation of the PA tendons. In the former, removal resolves the issue. In the latter, symptoms may resolve without surgery, although some cases require excision.
Another (very rare) pathology is a rupture of the pes anserinus bursa. Ruptures are more likely to occur in older patients with underlying medical/metabolic conditions such as diabetes, obesity, and osteoarthritis. If the anserine bursa retains synovial fluid due to chronic inflammation from knee osteoarthritis, mechanical stress from walking or other loading activities may cause a rupture. Evidence of a rupture includes sudden and isolated swelling of the associated calf muscles. In patients at risk, weight reduction and quadriceps strengthening are recommended as preventative strategies.
Another rare pes anserinus pathology is ‘snapping pes anserinus syndrome,’ which causes medial knee snapping. This snapping sensation results from a translation of the pes anserinus tendons (usually gracilis or semitendinosus) across the posteromedial aspect of the medial femoral condyle and tibia during knee movement. Unlike the other rare conditions above, snapping pes anserinus syndrome has been reported in athletes as a result of overuse and trauma. Ultrasonography is often the diagnostic imaging test of choice in cases of mechanical snapping. However, while static imaging forms part of a diagnosis, dynamic imaging (ie during the snapping movement) is also essential to confirm a diagnosis.

Acute Wry Neck Have you ever woken up one morning and your neck is sore and feels like it’s stuck in one position? There...
26/05/2025

Acute Wry Neck
Have you ever woken up one morning and your neck is sore and feels like it’s stuck in one position? There is a chance you might be suffering from acute wry neck.

Wry neck, also referred to as torticollis, is a very common condition which can be quite debilitating as it can cause severe pain with the smallest neck movements. Approximately 70% of the population experiences an episode of neck pain at some point in their lives. Anyone can get a wry neck, but it typically occurs in young people between 12 and 30 years of age. It can be very worrisome for patients as they quickly realise it is difficult to carry out their daily routine/activities when they have a lack of range of motion within their neck. The good news is that acute wry neck can be successfully treated in a short period of time.

Pain from acute wry neck typically happens all of a sudden / the onset comes out of the blue, hence the reason it is often termed “acute” wry neck. It is associated with neck pain and stiffness, which is often accompanied by muscle spasms of the surrounding neck muscles. This causes restriction of the neck to turn through its full range of motion.
Signs and Symptoms
Pain: Onset of pain is sudden. Pain is commonly located in the middle or side of the neck that is affected. The pain is localised to the neck area and does not extend past the shoulder joint.
Location: Usually symptoms are felt on one side of the neck, as this is a protective reaction of the body to safeguard the neck.
Loss of Range of Movement: The neck is often fixed in an abnormal position (most frequently in a flexed forward and rotated position). The side that the patient’s head is rotated towards will often be away from the side of pain.

Muscle Spasms: The surrounding neck muscles, for example sternocleidomastoid, scalenes and levator scapula, have tightened or spasmed in response to the facet joint irritation. This in turn limits the patient’s neck range of motion.

Causes of Wry Neck
The exact cause of wry neck is not fully understood, but it is thought to be caused by the result of a minor injury to the neck or simply caused by sleeping with the neck in an awkward position, uncomfortable pillows or waking up suddenly in the middle of the night. Our necks are made up of several vertebrae, intervertebral discs and joints. The small swivel joints that allow for smooth gliding movements and turning are called facet joints. Through diagnostic imaging the cause of wry neck seems to be due to an injury or irritation of one or more of the facet joints. The first theory is that the facet joints become ‘locked’ or jammed, like a door jamming on its hinge. Therefore, a locked facet joint is the most common cause of acute wry neck, causing pain and the protective muscle spasms throughout the neck.

The second theory of wry neck is due to discogenic irritation. Between our vertebrae we have spinal discs which help absorb shock and stress to the spine. These intervertebral discs can sometimes bulge or tear under stress almost like a small sprain, therefore causing inflammation and swelling, putting pressure on the surrounding structures and nerves within the neck. Since there are many nerve endings around the spine, this can explain why movement can be very painful. Movement is more limited by pain, not mechanically blocked as in the facet theory. This type of wry neck usually comes on over a period of time (more gradual onset) and is not as sudden. Symptoms of discogenic wry neck can radiate into the arm and occasionally people may experience pins and needles or numbness.
Treatment & Prognosis
Common treatment methods used for acute wry neck include:
massage
dry needling
gentle passive mobilisations
heat
stretches/ light movement
NSAIDs

alongside reassuring the patient that wry neck is a common and short-lived condition.

Most cases of acute wry neck resolve quickly over a period of 2-3 days, with some residual symptoms lasting up to a week. Neck issues can sometimes return however, so it is important to strengthen the neck muscles and normalise range of motion to help prevent it in the future.

Ligamentous Ankle Injuries: Acute assessment When a patient with an ankle injury ho...
07/03/2025

Ligamentous Ankle Injuries:

Acute assessment

When a patient with an ankle injury hops or hobbles into the rooms, the first clinical decision to make is whether to send them for an x-ray. The severity of the swelling and bruising rarely corresponds to the severity of the injury. The Ottawa Ankle Rules are reliable to help make this decision.

As per the Ottawa Ankle Rules, patients only require ankle and foot X-rays if they have one of the following criteria:

Bony tenderness along distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus,

Bony tenderness along distal 6 cm of the posterior edge of tibia/tip of medial malleolus,

Bony tenderness at the base of the fifth metatarsal,

Bony tenderness at the navicular,

If they could not bear weight immediately after injury and for four steps during the initial evaluation.

Clinicians can use antero-posterior and lateral views to exclude lateral malleolus or distal fibula fractures, the most common ankle fracture.

Fractures of the base of the fifth metatarsal are commonly associated with severe ankle sprains. Avulsion fractures account for 93% of these, with Jones fractures less common but important not to miss because they take longer to heal due to poor circulation (see figure 1).

The other fracture associated with severe ankle sprains is a Maisonneuve fracture of the proximal fibula, especially if there is a rotational component in the mechanism of injury. This is a spiral fracture often associated with a syndesmosis injury. If this fracture is present, clinicians must assess for an associated fracture of the medial malleolus and possible complete rupture of the deltoid ligament complex.

Ankle Ligament Injuries

Lateral ligament complex

The most common ankle injury is a lateral ligament sprain. The mechanism of injury is typically combined plantar flexion and inversion, which places an excessive load on the lateral ligament complex. The anterior talofibular ligament resists torsion and inversion stress in plantar-flexion and is the weakest and most commonly injured. The calcaneo-fibular ligament is extra-articular and resists torsion and inversion in dorsiflexion. Finally, the posterior talofibular ligament resists posterior movement of the talus, is the strongest ligament, and is hurt the least. Injuries to the posterior talo-fibular ligament usually only occur in severe ankle sprains, which also involve the anterior talofibular ligament and calcaneo-fibular ligament.

Lateral ankle sprains are graded in two ways: by the number of ligaments involved and by the severity of the injury. A grade three lateral ligament complex sprain involves all three lateral ligaments, but an athlete could sustain a grade three ligament sprain (complete rupture) to only the anterior talofibular ligament.


Clinical Assessment
The anterior drawer tests the anterior talofibular ligament and has a specificity of 80% five days post-injury. This test glides the calcaneus anteriorly while applying posterior counter-pressure on the distal fibula and tibia in neutral plantar-flexion. Pain and excessive gliding is a positive test with an increased glide of 4-5mm, indicating an anterior talofibular ligament tear.

The talar tilt/inversion stress test has a sensitivity of 52% and tests the calcaneo-fibular ligament. With the ankle in neutral, the clinician inverts the heel, with the talus and calcaneus moving as one unit to avoid sub-talar inversion. Pain over the calcaneo-fibular ligament or a clunk is a positive test. An outward translation of >5o with a spongy or empty end feel indicates a complete rupture (see figure 2).

Medial/deltoid ligament complex

The deltoid ligament complex is stronger than the lateral ligaments and is only sprained in a severe injury. The deltoid ligament stabilises the talo-tibial joint and transfers forces between the tibia and tarsus. It fixates the tibia above the talus and restricts the talus from shifting into a valgus position, translating antero-laterally, or rotating externally.

Clinical Assessment
The eversion stress test/eversion talar tilt test has a 96% sensitivity and 84% specificity five days post-injury for the deltoid ligament complex. Clinicians evert and abduct the heel while stabilizing the lower leg. The test is positive if there is pain and laxity on the medial side of the ankle. A spongy or empty end feel indicates a complete rupture.

Syndesmosis Injury)
A syndesmotic, or ‘high’ ankle sprain involves the ligaments binding the distal tibia and fibula at the distal tibio-fibular joint and may lead to ankle instability. Injuries can occur with any ankle motion, but the most common motions are extreme external rotation or dorsiflexion of the talus. The talar dome is broader anteriorly than posteriorly, and these movements force the ankle mortise apart, separating the medial and lateral malleoli. The sufficient distraction can cause strain or rupture to the anterior inferior tibio-fibular ligament, superficial posterior inferior tibio-fibular ligament, transverse tibio-fibular ligament, and inter-osseous membrane (see figure 4). Injuries are also commonly present with fractures of either malleolus or a proximal fibular spiral fracture (Maisonneuve fracture).


Clinical Assessment
Kleiger’s test/external rotation test has a sensitivity of 75% and assesses the anterior tibio-fibular ligament and syndesmosis. The test is positive if there is pain over the inferior tibio-fibular syndesmosis with foot external rotation while stabilising the leg. Athletes may experience pain over the deltoid ligament, or it may radiate upwards into the syndesmosis.

The squeeze test/fibular compression test assesses the anterior tibio-fibular ligament and syndesmosis. Clinicians compress the tibia and fibula around the calf midpoint, which will reproduce pain in the distal syndesmosis area if it is positive.

To immobilise with bracing or taping?

The effects of ankle taping and bracing on proprioceptive input to the central nervous system, peroneal muscle activity, and deceleration of ankle motion may be as important as restricting ankle ROM following injury. Initially, clinicians can recommend bracing or taping to protect and provide an optimum environment for healing. As athletes progress through rehabilitation, they can use bracing or taping to prevent another ankle injury.


Bracing vs. taping

Cost: A brace is a once-off cost, whereas tape costs are ongoing.

Skin condition: Repeated taping may negatively affect skin condition.

Sport-specific legislation and equipment limitations, e.g., wearing taping with tight footwear may be easier.

Access to professionals to apply the tape effectively.

Clinical Management

Clinicians must guide their clinical management according to a thorough assessment. Although pain and swelling may be the acute signs following injury, a wide range of neuromuscular skeletal deficits will impact rehabilitation and return to sport. Clinicians must continue to assess and re-evaluate these deficits and adjust rehabilitation to meet the demands of the sport for the injured athlete. Below are critical areas of concern and their respective assessment tools to reassess adequate recovery.

The knee-to-wall/standing lunge test assesses the passive ankle dorsiflexion range. Assessing and monitoring ankle dorsiflexion range of motion is essential, aiding in evaluating functional recovery and preventing long-term mobility limitations. It is important to compare the affected and unaffected limbs.

Assessing soleus and gastrocnemius muscle length after an ankle injury is crucial to identify and address potential muscle tightness and imbalances that impact ankle stability, joint function, and the risk of future injuries.

Maintaining balance through the single-leg stance test is essential. While age-specific norms typically range between 45 to 60 seconds, it’s important to remember that superior balance control significantly enhances sports performance, making it a critical factor for overall athletic success.

Proprioception plays a crucial role in balance control. Distal proprioception tests and contralateral joint matching tasks assess proprioception. Ankle proprioception correlates strongly with competitive sport level and is the most significant predictor of sports performance. Ankle proprioception provides essential information to adjust ankle positions and upper body movements to successfully perform the complex motor tasks required in elite sports.

Calf muscle strength and endurance are essential for good performance in sports. Clinicians can use the heel rise test to assess calf capacity. The median in healthy adults is 24 for males and 21 for females. However, clinicians must note the pre-injury physical condition of the athlete as some may need to surpass population norms due to participating in high-demand sports, e.g., long-distance runners.

Foot posture, function, and biomechanics ensure a strong medial arch to create a robust springboard for jumping, running, and acceleration. The ability to absorb and transfer force through the foot and ankle is critical for performance and resilience against injury.

Researchers in the Netherlands reviewed the preventive effectiveness of neuromuscular training in reducing ankle sprains. The analysis of 30 studies, including various types of interventions, found that neuromuscular training, particularly balance training, significantly reduces the occurrence of ankle sprains in both athletes with previous ankle injuries and those without. While the evidence for preventing first-time ankle sprains is inconclusive, both single-component and multi-component neuromuscular training interventions appear effective, emphasising the importance of selecting appropriate interventions based on the context.

Conclusion

Ankle ligament injuries are commonly seen in the physiotherapy clinic. The diagnosis and management are based on clear and thorough assessment and the many clinical clues provided by the patient. This will lead to sound clinical decision-making and a successful return to sport for the athlete.

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