Preventive Strategies for Soft Tissue Injuries of the Ankle

Yanfu Li

College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 350122, Fuzhou, Fujian, China

Keywords: Ankle Soft Tissue Injuries, Prevention Strategies, Chronic Ankle Instability.

Abstract: Soft tissue injury of the ankle joint is a condition that has an acute onset and is prone to recurrence. According

to relevant statistical data, chronic instability of the ankle joint is the most common complication, severely

affecting quality of life and reducing life experience. This article summarizes previous research evidence,

synthesizes relevant guidelines, and analyzes expert consensus to extract effective measures to reduce the

incidence of soft tissue injuries of the ankle joint and decrease recurrences. Based on existing data, it is found

that the treatment involves multiple stages and various treatment methods. Therefore, this article integrates

and summarizes different treatment strategies for different populations and stages of ankle joint soft tissue

injuries, presenting them in the form of a three-level prevention strategy, aiming to provide procedural

references for the treatment and prognosis of ankle joint soft tissue injuries and further promote the

standardization of prevention and treatment.

1 INTRODUCTION

Soft tissue injuries of the ankle, particularly lateral

ankle ligament injuries, are among the most common

musculoskeletal injuries. They account for

approximately 10% of all emergency department

visits and 30% of all sports-related injuries

(Swiontkowski, M.F.,2004). Individuals engaged in

activities such as jumping, running, and rapid

direction changes face a higher risk. Among 200

high-level competitive aerobics athletes from China,

ankle injuries accounted for about 45% of all risks

(Ma,X. ,2024).Additionally, a gender difference has

been observed, with female athletes being

approximately 25% more likely to sustain soft tissue

injuries to the ankle compared to male athletes (Marín

Fermín, T., 2023).The increasing popularity of ball

sports has further contributed to the rise in the

incidence of these injuries, significantly impacting

patients' daily lives and imposing substantial medical

costs for initial and follow-up treatments.

Although soft tissue injuries of the ankle joint

have a high incidence in various populations, the

treatment methods following such injuries are still

under discussion. While rehabilitation is the

cornerstone of conservative treatment, the extent and

severity of the injury are often not clearly defined at

the time of diagnosis, leading to poor timeliness in the

formulation and implementation of rehabilitation

strategies. This may result in adverse outcomes,

including high recurrence rates, persistent symptoms,

reduced levels of physical activity, functional

impairment, and decreased quality of life. Research

indicates that approximately 70% of patients with

initial ankle sprains will experience recurrence or

progress to chronic ankle instability and osteoarthritis

(Marín Fermín, T., 2023). However, the

epidemiology of chronic ankle instability remains

unknown, and the long-term outcomes of post-

traumatic osteoarthritis are poor; therefore,

preventing soft tissue injuries to the ankle is crucial.

By adopting a three-tiered prevention approach to

prevent the occurrence, progression, and recurrence

of ankle injuries, primary prevention targets

individuals whose ankles have not yet been injured;

secondary prevention focuses on patients in the acute

phase of injury; and tertiary prevention primarily

aims to prevent the recurrence and adverse sequelae

of ankle injuries. Tertiary prevention plays an

important role in improving the cure rate of soft tissue

injuries in the ankle, reducing incidence and

recurrence rates. At the same time, it effectively

optimizes resource utilization, ultimately lowering

the risk of re-injury and improving long-term

prognosis.

398

Li, Y.

Preventive Strategies for Soft Tissue Injuries of the Ankle.

DOI: 10.5220/0014494000004933

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Biomedical Engineering and Food Science (BEFS 2025), pages 398-402

ISBN: 978-989-758-789-4

2 PRIMARY PREVENTION

The causative factors for soft tissue injuries of the

ankle are varied, and a large body of literature points

to the development of injuries in relation to self-

associated internal risk factors as well as many

potential external risk factors. The aim of primary

prevention is to modify the external environment and

internal risks in order to effectively avoid them and to

improve one's own fitness, thereby reducing the risk

of first-time injuries in the healthy population.

2.1 Risk Factors in the External

Environment and the Prevention

In addition to occurring during exercise, soft tissue

injuries to the ankle are also prone to occur on

slippery or uneven surfaces and can even be

dangerous due to oversized shoes or insufficient

upper support. For older adults, the risk is also higher

in dimly lit scenes and when walking up and down

stairs. In private environments, environmental

modifications can be made with the knowledge of a

rehabilitation professional, such as increasing the

brightness of the environment, reducing floor clutter,

and preventing slippery floors. In public places, the

risk rate can be reduced by wearing non-slip shoes

with hard uppers, paying attention to uneven slippery

surfaces underfoot, and carrying crutches for the

elderly.

2.2 Internal Risk Factors and Their

Prevention

2.2.1 Body Mass Index (BMI)

Research has indicated a substantial correlation

between ankle soft tissue injuries and body mass

index. Ankle soft tissue injuries are generally more

likely to occur in those with a higher body mass

index. Ankle and foot soft tissue injuries had a

significant association with higher BMI, according to

the results of Mendelian randomized analysis

investigating the causal relationship between BMI

and joint injuries (Bi, W., 2023). Therefore, it may be

possible to lower the risk of ankle soft tissue injuries

by keeping body mass index within the population

mean range of 26.5-31.2 kg/m².

2.2.2 Muscle Strength

The difference in eccentric isometric strength of the

ankle flexors between sides is a risk factor for ankle

sprains.Specifically, soccer players with

asymmetrical centrifugal ankle strength had an 9-fold

increased risk of sprains due to ankle sprains. It has

been shown that increasing muscle strength in the

pyriformis muscle is effective in avoiding lateral

ankle ligament injuries, and training in all four

directions using elastic bands may also increase

muscle strength around the ankle joint, thereby

decreasing the risk of ankle soft tissue injuries (Ge,

Q., 2025).

2.2.3 Exercise Habits

Proper warm-up before exercise is usually effective

in avoiding the risk of soft tissue injuries in the ankle

joint. A study showed that among young athletes,

participants in balance training programs had

significantly fewer ankle injuries compared to the

control group (p < 0.05) ( Nováková, T.,

2021) .Therefore, by maintaining the muscles at an

appropriate temperature, enhancing muscle elasticity

and extensibility to levels suitable for exercise, and

promoting proprioceptive neuromuscular training and

control of body awareness and kinesthesia, In

addition to sufficient basic warm-up activities,

incorporating high-intensity exercises, such as sprints

and other explosive training, during the warm-up

period effectively prevents the occurrence of soft

tissue injuries in the ankle joint ( Pieters, D.,2022).

3 SECONDARY PREVENTION

Ankle soft tissue injury tends to occur suddenly and

to varying degrees, and the treatment methods used

vary with the different periods following the injury.

Attention should be paid to the treatment methods

used in the acute phase, which tend to have a greater

impact on the prognosis and the patient's satisfaction

with the treatment, as well as on the prognosis of the

short-term treatment and the recovery period.

3.1 Cold Therapy

Reports have shown that the use of ice in the acute

phase of ankle sprains provides better pain relief than

the use of analgesics. But cryotherapy is less effective

during the recovery phase after injury; therefore,

cryotherapy should only be used in the acute phase of

injury to alleviate pain and reduce swelling at the

injury site.

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399

3.2 External or Functional Support

Many studies have shown that after pain relief from

acute ankle soft tissue injuries, it is crucial to

immobilize the affected area using external or

functional support devices. This not only prevents

secondary injuries through the immobilization of the

relevant area but also protects it from further external

harm. Currently, commonly used bandages or

pressure fixation devices are employed for

emergency immobilization, and patients use

wheelchairs or crutches to prevent weight-bearing on

the injured area, which can reduce pain and promote

recovery.

3.3 Non-Viral Anti-Inflammatory

Drugs (NSAIDs)

NSAIDs have anti-inflammatory and analgesic

effects, and their use during the acute phase of soft

tissue injury in the ankle can effectively alleviate

patient discomfort, making them a recommended

treatment option. However, long-term use can

significantly increase the likelihood of complications

such as renal dysfunction and nonunion of bones.

Therefore, it is advised to use NSAIDs only for a

short term during the acute postoperative phase.

3.4 Manual Therapy

The application of physical therapy can effectively

improve treatment outcomes in the acute phase. It can

flexibly adjust techniques and intervention levels

based on different injury conditions, demonstrating

strong adaptability. Furthermore, based on scientific

analysis and relevant treatment methods, it can reduce

patients' rehabilitation time and enhance

rehabilitation efficiency. In addition, improvements

in various assessment scales now enable physical

therapists to provide timely treatment after patients'

soft tissue injuries to the ankle joint.

4 TERTIARY PREVENTION

Tertiary prevention can play an important role in

reducing recurrence rates and complications by

aggressively treating common symptoms after ankle

soft tissue injuries. Studies have pointed out that the

most common complication after initial ankle soft

tissue injury is chronic ankle joint instability (CAJ),

which is why most people are prone to re-injury after

initial ankle injury. Therefore, systematic

rehabilitation and prognostic protection play an

important role in preventing re-injury to the soft

tissues of the ankle.

4.1 Systematic Rehabilitation Training

4.1.1 Strengthening of Muscle

Improvement of muscle strength is recognized as an

important means of enhancing joint stability and

preventing re-injury to the soft tissues of the ankle.

Muscle strength building has been used in a variety of

rehabilitation methods for ankle injuries and is

considered a primary measure in the early stages of

injury. In an analysis of 200 aerobic athletes, it was

found that the incidence of ankle injuries was

inversely related to the level of exercise, and that for

professional athletes, the differences in physical

fitness were greater than the differences in skill, with

which muscular strength is usually associated. After

the control group was treated with acoustic waves

while the experimental group was treated by

strengthening the muscles around the ankle joint, it

was found that the total effective rate of treatment in

the experimental group was higher than that of the

control group (p < 0.05) (Li, X.,2022).And it was not

easy to recur, so it can be concluded that the

strengthening of the muscles in the relevant areas can

effectively prevent the occurrence of soft tissue

injuries of the ankle joint.

4.1.2 Enhanced Proprioception

The control of proprioception is closely related to

neuromuscular, for the enhancement of

proprioception training is often not the only way,

mainly through the enhancement of neuromuscular

regulation of integration, so that the individual for

their own postural judgment, the perception of

movement and the activation of motor units more

agile. The cause of recurrent sprains is also related to

impaired proprioceptors after the first injury to the

ankle ligaments. Therefore, strengthening

proprioception, primarily through balance training, is

also effective in reducing the risk of ankle soft tissue

injuries.

4.1.3 Conventional Intervention Plan

In a study involving 43 patients with CAI, a 4-week

intervention with resistance bands and a

biomechanical ankle platform system was conducted

three times a week. Using the foot lift test, balance

test, and 8-shaped jump test, it was found that each

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intervention group showed improvement compared to

the control group that did not engage in related

exercises (p < 0.05)(Cain, M. S., 2020).This was

primarily achieved through a set of 10 repetitions,

repeated 3 times, of ankle eversion, inversion,

dorsiflexion, and plantarflexion exercises using

resistance bands, and exercises on the biomechanical

ankle platform system that involved changing the

rotation direction clockwise or counterclockwise

every 10 seconds during a 40-second activity, which

can effectively improve CAI.

4.2 Sports Protection

Following an ankle injury, exercise is often

recommended to facilitate recovery and adaptation to

normal life. To prevent re-injury during exercise, a

systematic evaluation incorporating rue therapy has

shown that the use of a kinesio tape application to

assess kinesio tape (KT) is effective in improving

functional gait stability and ankle stability during

exercise. This effectively reduces the risk of ankle re-

injury (Liu, Q., 2024).

5 CONCLUSION

Primary prevention involves improving and

controlling external environmental risks, as well as

managing one's BMI, muscle strength, and exercise

habits to prevent soft tissue injuries of the ankle joint,

providing preventive measures for individuals with

uninjured ankles. In secondary prevention, cold

therapy or short-term use of NSAIDs is applied to

patients with acute ankle soft tissue injuries to

alleviate initial discomfort, while external functional

support and manual therapy are used to enhance

short-term treatment and provide support for

prognosis and recovery. For patients with

rehabilitated ankle soft tissue injuries, tertiary

prevention involves systematic rehabilitation training

and protective measures in physical activities to avoid

recurrence, while enhancing proprioception and

muscle strength through traditional interventions can

also improve ankle stability and effectively prevent

the occurrence of related complications.

In addition, long-term patient education and

adherence to maintenance plans play a crucial role in

maintaining ankle joint health. As research continues

to advance, the integration of innovative

rehabilitation techniques and personalized treatment

approaches will further improve tertiary prevention

strategies. The correlation between different risk

factors and incidence will also be analyzed more

accurately through scale analysis. With the

development of artificial intelligence, prevention

measures at all levels will also incorporate individual

differences for more detailed analysis and provide

prioritized treatment methods, offering guidance for

clinical and public treatment.

By prioritizing comprehensive rehabilitation,

external support measures, and long-term injury

management, clinicians and patients can work

together to reduce the burden of soft tissue injuries in

the ankle and improve overall functional outcomes.

At the same time, the current literature generally

suffers from issues such as small sample sizes,

significant age differences among samples, limited

discussion of gender differences, and non-

standardized rehabilitation methods at various levels.

Through technological breakthroughs and the

integration of multidimensional strategies, it is

possible to significantly reduce the incidence of

injuries, improve prognosis, and enhance the quality

of life for patients. Furthermore, progress in this field

relies not only on technological innovation but also

on the integration of social resources and the

enhancement of public health awareness. It is hoped

that more research outcomes will contribute to the

supplementation and improvement of this field in the

future.

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