On the programme ‘Gyvensenos paraštėse’, researcher and presenter Edita Kondrotienė spoke to Gintautas Pocius, an orthopaedic and trauma surgeon at Gijos Klinikos, about sports injuries affecting the ankle and foot, their prevention and diagnosis, and modern treatment options.

The specialist emphasises that modern trauma care is changing not only in terms of diagnosis and treatment, but also in its approach to what should happen immediately after an injury. The long-established principles of rest, ice and immobilisation are not considered the best solution in every case. For isolated ligament injuries, increasing emphasis is being placed on early, safe movement, targeted exercises and individually tailored rehabilitation.

Professional athletes are not the only ones at risk

According to Dr Pocius, ankle and foot injuries are more likely in sports involving frequent jumping, sudden stops and changes of direction.

‘When we talk about basketball, our national pride, or volleyball, these injuries can occur in any sport involving a lot of jumping, where you might land awkwardly on an opponent’s foot. The risk is also higher in football, where you need to change direction suddenly. Padel is now very popular among businesspeople and others, as are tennis and badminton. All these sports carry a higher risk of ankle and foot injuries,’ says the orthopaedic surgeon.

However, the choice of sport alone does not determine whether someone will sustain an injury. Individual anatomy and biomechanics also play a part.

A flattening arch or, conversely, a particularly high arch, as well as certain abnormalities in the mechanics of foot and ankle movement, can increase instability. In some cases, the foot can give way even when walking on a level surface. Another important risk factor is the inherited nature of a person’s connective tissue and what is known as hyperlaxity, or excessive joint mobility. People with these characteristics may experience ankle injuries more frequently.

Running shoes on a tennis court may be riskier than you think

The doctor points out that footwear designed for different sports differs for reasons beyond appearance. Sports footwear manufacturers take account of the movements involved in each sport, the playing surface, foot biomechanics and the grip between the shoe and the ground. Running shoes are therefore not necessarily suitable for tennis, basketball or other activities involving sudden sideways movements.

‘If you turn up to play tennis in running shoes, you will have a very different level of grip on the court,’ explains Dr Pocius. Basketball likewise has its own specialist footwear. According to the specialist, in some cases, excessive ankle support within a shoe may actually reduce natural muscle activity and responsiveness. A high-top shoe alone is therefore no guarantee against an ankle injury.

Warming up is one of the most important steps before exercise

Another very common mistake among recreational sports participants is failing to prepare adequately for physical activity.

In professional sport, preparing for competition is taken for granted, but the doctor would like to see the same culture adopted in recreational sport. ‘You cannot go straight from the office onto the court and expect everything to be fine. More often than not, that ends in either an Achilles injury or a twisted ankle,’ warns Dr Pocius.

Ankle ligament tears are the most common injury

Ankle ligament injuries are among the most common injuries not only of the foot and ankle, but of the musculoskeletal system as a whole.

Typically, the foot suddenly rolls inwards, damaging the ligaments on the outside of the ankle. One, two or even three ligaments may tear, either partially or completely.

The peroneal tendons may also be damaged and can slip out of position. Achilles tendon ruptures are a particular concern among middle-aged men. Metatarsal fractures, whether caused by repetitive stress or an acute injury, also occur during sport.

However, there is another problem which, the doctor says, needs to be identified promptly: damage to the cartilage in the ankle joint that occurs alongside a ligament injury.

This is precisely why an X-ray alone is not always enough. ‘We often see associated cartilage damage alongside a ligament injury, and this should not be overlooked. That is why we frequently arrange an MRI scan for these patients, as it can reveal cartilage damage,’ explains the orthopaedic surgeon from Gijos Klinikos.

‘I’ve stretched a ligament’ is not quite medically accurate

In everyday language, people often describe an injury by saying they have ‘stretched their ligaments’. However, the doctor points out that a ligament does not, in essence, ‘stretch’ in this way.

If an injury causes pronounced bruising and pain specifically over the ligaments, a ligament is likely to have been damaged, with either a partial or a complete tear.

‘If someone is in severe pain, has extensive bruising and finds even the slightest turn of the foot painful, the ligament may well be completely torn. By the following morning, the pain may make it difficult to put weight on the foot,’ says the doctor.

Four steps after an injury can provide important information

The Ottawa Ankle Rules are used in the initial clinical assessment of ankle injuries. They were developed to help identify patients who need urgent investigation for a possible fracture following an injury.

One of the simplest indicators is whether a person can put weight on the injured foot and take at least four steps. ‘If you can put weight on your foot and take at least four steps, there is probably no fracture,’ explains Dr Pocius.

Pain over specific bony areas is also assessed: the inner and outer ankle bones, as well as the fifth metatarsal and the navicular bone.

If the pain is localised to the soft tissues and ligaments rather than the bone, a fracture is less likely.

Care after an injury involves more than rest and ice

For many years, the RICE approach — rest, ice, compression and elevation — was widely used following soft tissue injuries.

However, according to Dr Pocius, the modern approach is changing, with increasing attention being paid to the MEAT method.

The principle is to avoid protecting the injured limb from all movement for too long. Instead, once a fracture or another condition requiring immobilisation has been ruled out, movement should be reintroduced gradually and safely.

M — motion. The injured limb should not be kept completely immobilised for longer than necessary.

E — exercise. Specific exercises are introduced gradually to strengthen the muscles, with movement kept within safe pain limits.

A — analgesia. The doctor points out that inflammation is a natural part of the healing process, so the modern approach seeks to avoid suppressing it excessively without good reason.

T — treatment. This includes exercise-based rehabilitation, physical therapy modalities, massage and other individually selected measures.

There is, however, a crucial condition: the nature of the injury must be established before more active treatment begins. ‘It is very important to know that we will not harm the patient by using this approach — that there are no fractures and that we are dealing only with an isolated ligament injury,’ the doctor stresses.

An X-ray alone may not be enough

According to the specialist, accurate diagnosis makes it possible to choose the most appropriate treatment for each patient rather than relying on guesswork.

In some cases, even after an initial examination and an X-ray, it is not straightforward to identify the full extent of the damage. At Gijos Klinikos, more detailed diagnostic methods are therefore used when clinically indicated.

One of these is ultrasound. Its advantage is that ligaments and other structures can be assessed dynamically: during movement, it is possible to observe changes in a ligament’s length, whether it is still functioning and whether it is torn.

Another highly informative method is magnetic resonance imaging. ‘MRI is invaluable in these cases because it shows several things: the soft tissues and whether they are torn, changes in bony structures, bone marrow oedema and, most importantly, cartilage damage,’ explains Dr Pocius.

Not every torn ligament needs surgery

A torn ligament does not necessarily mean surgery. In fact, first-time ankle ligament injuries are usually treated non-surgically in the first instance. Dr Pocius explains that acutely injured tissues are not always suitable for immediate surgery and suturing. In addition, many ligament injuries heal on their own with appropriate treatment.

Surgery is more often considered when chronic ankle instability develops and a person experiences recurrent episodes of the joint partially slipping out of place — for example, more than twice a year. In such cases, stabilisation surgery may be performed. These procedures not only repair or reinforce the damaged ligament but, where necessary, also use additional structures or specialised implants to restore the required ankle stability.

Professional athletes are treated too

The team at Gijos Klinikos also works with professional athletes from a range of sports. Its doctors therefore encounter injuries where the goal is not just recovery, but a return to a very high level of physical performance.

‘We are involved at every stage of treatment, both non-surgical and, where necessary, surgical. There are many cases in which patients return to their previous level of professional sporting activity,’ says Dr Pocius.

For the doctor, one of the greatest professional rewards is seeing a patient competing at the highest level again after complex treatment.

‘It is always rewarding to sit in a packed arena and see a patient who has undergone ankle stabilisation surgery return not just to participation, but to the very highest professional level in their sport. That gives you a great deal of motivation to keep working,’ he says.

It is important to understand that a successful recovery depends on an accurate diagnosis, appropriate treatment and a suitable rehabilitation programme. An incorrect diagnosis, inappropriate treatment or poorly chosen rehabilitation can restrict mobility and compromise a person’s ability to return to sport or everyday life.

 

This article was originally published on Lrytas.lt on 6 October 2026. Read the original version here.