Foot And Ankle Problems
Ankle sprains are one of the most common sports injuries. A sudden jolt or twist can overstretch and tear the supporting ligaments of the joint, causing pain and swelling. Initial treatment should include RICED regime. Diagnosis is most important so the injury can be managed appropriately. Your Prime Physiotherapist can ensure that the treatment is appropriate and timely.
The Ankle joint
The ankle joint has three bones that are precisely shaped to interlock and give stability. Strong bands of connective tissue called ligaments reinforce the joint and help hold the bones together. These ligaments prevent too much movement of the joint.
A sudden movement or twist, often when the foot rolls in, can overstretch the supporting ligaments, causing tears and bleeding around the joint. The lateral ligaments are most commonly injured.
Avoid HARM; Heat, Alcohol, Running and Massage in the first 48 hours, as these can all exacerbate swelling and cause further injury.
Recurring Ankle Sprains
Some people get recurring ankle sprains. This can be caused by a number of factors including:
- Ligament scarring and excess looseness, as a result of previous ankle sprains
- Insufficient rehabilitation from previous sprains. This can lead to weak muscles surrounding the ankle joint. It can also cause decreased capacity to judge where your foot is in relation to your leg; this is called a proprioceptive deficit.
If you are unable to take any weight on the foot or able to take 4 steps, seek medical attention immediately. An x-ray may be needed to see whether a bone is broken.
Any ankle sprain no matter how minor could benefit from physiotherapy. Prime Physiotherapy can provide you with an accurate diagnosis, education and treatment ensuring that your injury is treated properly, minimising the risk of re injury.
Recurring ankle sprains need thorough investigation and rehabilitation. Physiotherapy treatments may include:
Exercise programs to improve mobility of the joint
Exercises to strengthen the muscles surrounding the ankle (peroneal muscles)
Advice on taping and ankle braces for use during activity
The use of a wobble board or trampoline to encourage balance and improve the proprioceptive deficit.
There is strong evidence from research that starting this sort of exercise program in the first week after ankle sprain improves ankle function and early return to weight bearing activity such as walking. If persistent instability does not respond to comprehensive physiotherapy, an orthopaedic opinion could be considered.
Preventing Ankle Sprains
Suggestions to prevent ankle sprains include:
- Warm up prior to exercise, including movements that are specific to the sport you are about to play.
- Correctly fitting, sport appropriate supportive shoes.
- Consider ankle braces or tape, as directed by your physiotherapist.
- Take care when exercising on uneven or wet ground, especially in the first few weeks after a sprain.
Hyper Pronation (Flat Feet):
This condition can predispose you to further injury, including shin splints, plantar fasciitis and foot pain. Treatment may include muscle stretches, intrinsic strengthening exercises and the provision of orthotics. Prime Physiotherapy provides these services. “Too many toes”. When looking at the heel from the back of the patient, usually only the fifth toe and half of the fourth toe are seen. In a flatfoot deformity, more toes can be seen. Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot.
Too Many Toes, Even The Big Toe Can Be Seen
Hyper Pronation And Correction With Orthotics
Loss Of Transverse Arch, Moreton’s Neuroma:
When the forefoot/transverse arch of the foot is lost due to biomechanics or poorly fitting shoes (high heels) the metatarsal heads (foot bones) can rub together, irritating the small nerves between the toes resulting in pain. The provision of exercises, corrective footwear and the inclusion of a metatarsal dome can provide relief of pain.
Heel Spur (Plantar Fasciitis)
Hyper Pronation and correction with orthotics Loss of transverse arch, Moreton’s neuroma: When the forefoot/transverse arch of the foot is lost due to biomechanics or poorly fitting shoes (high heels) the metatarsal heads (foot bones) can rub together, irritating the small nerves between the toes resulting in pain. The provision of exercises, corrective footwear and the inclusion of a metatarsal dome can provide relief of pain. Heel spur (plantar fasciitis) The tissue running from the base of the toes to the heel bone can become inflamed and painful for a number of reasons. Pain is most commonly occurring after periods of rest, in particular first thing in the morning after a sleep. The first few steps can be extremely painful for the person with plantar fasciitis. It can be caused by a direct blow, but most commonly associated with pronated feet. The plantar fascia acts like a bow string under the foot, and as the arch collapses, the string is pulled tighter. This can result in a spur of bone growing from the base of the calcaneus (heel bone) the pain is associated more with the inflamed tissue, rather than the spur. Physiotherapy treatment can include electrotherapy, stretches, taping, orthotics and the use of a special sock (Strasberg sock) for use at night.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a condition that occurs from abnormal pressure on a nerve in the foot. The condition is similar to carpal tunnel syndrome in the wrist. The condition is somewhat uncommon and can be difficult to diagnose. Tarsal tunnel syndrome usually causes a vague pain in the sole of the foot. Most patients describe this pain as a burning or tingling sensation. The symptoms are typically made worse by activity, especially standing and walking for long periods. Symptoms are generally reduced by rest. You may feel pain if you touch your foot along the course of the nerve. If the condition becomes worse, your foot may feel numb and weak. While this condition can require surgery to correct, provision of orthotics, ice, anti inflammatories and exercises can help.
The achilles tendon is a large tendon at the back of the ankle. The tendon is an extension of the gastrocnemius and soleus (calf muscles), running down the back of the lower leg attaching to the heel bone (calcaneus). The achilles tendon connects the leg muscles to the foot and gives the ability to push off during walking and running. Until recently achilles tendinopathy was referred to as achilles tendinitis, however, research has found that this type of injury does not involve inflammation (itis), and is most likely due to a series of microtears (tendinosis) that weaken the tendon. The condition is usually a chronic one and occurs as a result of overuse in combilation with biomechanical factors.
- A sudden increase in the intensity, frequency and duration of activity.
- A decrease in recovery time between activities.
- Wearing inadequate or incorrect footwear.
- Excessive pronation (force on achilles tendon increases).
- Running on hard or uneven surfaces.
- Change of surface (seasonal).
- Tight calf muscles, weak calf muscles.
- Decreased joint range of motion (e.g. stiff ankle joint).
- Inadequate warm up, stretching and cool down.
Initial treatment should include RICED and avoiding HARM. Rehabilitation will vary depending on the stage of tendinopathy and will include a program of stretching and strengthening exercises, correction of poor biomechanics and changes to the above risk factors to ensure that treatment results in long lasting recovery.
As with the Achilles tendon, the peroneal (evertor) tendons can become affected by tendinopathy. This injury can be associated with a lateral ligament sprain, and involves the tendons behind the lateral ankle bone (lateral maleolus).
Fractured distal fibular (lateral maleolus)
Fractured fifth metatarsal (foot)
Talar dome fracture:
This fracture can occur following a major ankle sprain, the early X ray may not show the fracture, but a repeat X ray or a CT scan or Bone scan may be required to diagnose this injury.
Calcaneal Fracture (heel)
This fracture occurs after a fall, landing on the heel. It can be as simple as missing a rung of a ladder. It often requires surgery to fix this type of fracture.