Foot and Ankle Pain

Foot and Ankle Pain

Foot pain and injuries are extremely common. Foot pain can be sourced from local structures such as muscles, ligaments, bones and joints, or it can be referred from other sources including your lower back and other systemic diseases.

Because foot pain can have so many causes it is very important to have foot pain assessed by a health professional with an expertise in the management of foot pain. Only then can you be confident that your foot pain treatment is managing the “right” cause of your foot pain.

Common sources of foot pain include:

  • Plantar Fasciitis.
  • Bunion, Heel Pain.
  • Heel Spur.
  • Ankle Injuries.

Achilles Tendonitis

Achilles Tendonitis is an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially for joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

What Causes Achilles Tendonitis?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

Common Causes of Achilles Tendonitis include:

  • Over-training or unaccustomed use – “too much too soon”.
  • A sudden change in training surface – e.g. grass to bitumen.
  • Flat (overpronated) feet.
  • High foot arch with tight Achilles tendon.
  • Tight hamstring (back of thigh) and calf muscles.
  • Toe walking (or constantly wearing high heels).
  • Poorly supportive footwear.
  • Hill running.
  • Poor eccentric strength.
Symptoms of Achilles Tendonitis?

Achilles Tendonitis may be felt as a burning pain at the beginning of an activity, which gets less during activity and then worsens following activity. The tendon may feel stiffness first thing in the morning or at the beginning of some exercise.

  • Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area.
  • The pain may get worse when you use your Achilles tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
  • Achilles tendons will often have a painful and prominent lump within the tendon.

Achilles Tendon Rupture

When your Achilles tendon snaps it is known as Achilles Tendon Rupture.  Often an Achilles rupture can occur spontaneously without any prodromal symptoms. Unfortunately the first “pop” or “snap” that you experience is your Achilles tendon rupture.

Achilles tendon rupture most commonly occurs in the middle-aged male athlete. Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton.

It does appear that previous history of Achilles tendonitis results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture.

Treatment of a ruptured Achilles tendon is usually conservative (non-operative) in a Controlled Motion Ankle (CAM) Boot or it may require surgery.  Achilles tendon surgery is usually considered if your Achilles has re-ruptured or there is a delay of two weeks between the rupture and the diagnosis and commencement of conservative bracing and treatment.

Post-Surgical Physiotherapy

Most surgeons will recommend that you commence physiotherapy about one-week post-op. It is important to not over-stress your Achilles tendon repair.

Plantar Fasciitis

Plantar Fasciitis is one of the most common sources of heel pain. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. Your plantar fascia acts as a passive limitation to the over flattening of your arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis.

Symptoms of Plantar Fasciitis

First, you will notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting.  Your heel pain will be worse with the first steps and improves activity as it warms up.  As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage you are in using the following guidelines:

  • No Heel Pain – Normal!
  • Heel pain after exercise.
  • Heel pain before and after exercise.
  • Heel pain before, during and after exercise.
  • Heel pain all the time. Including at rest!
  • This symptom progression is consistent with the four stages of a typical overuse injury.

If left further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone it is known as heel spurs, which have a longer rehabilitation period. Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods. They are either traction or compression injuries.  Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles.

It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.

Traction Plantar Fasciitis

Plantar fasciitis symptoms are usually exacerbated via “traction” (or stretching) forces on the plantar fascia. In simple terms, your plantar fascia is repeatedly overstretched. The most common reason for the overstretching is an elongated arch due to either poor foot biomechanics (eg overpronation) or weakness of your foot arch muscles.

Compression Plantar Fasciitis

Compression type plantar fascia injuries have a traumatic history. Landing on a sharp object that bruises your plantar fascia is your most likely trauma. The location of plantar fasciitis pain will be further under your arch than under your heel, which is more likely to be a fat pad contusion if a single trauma caused your pain. The compression type of plantar fasciitis can be confused with a fat pad contusion that is often described as a “stone bruise”.

Plantar Fasciitis Diagnosed?

Plantar fasciitis is usually diagnosed by your physiotherapist on your symptoms, history and clinical examination.  After confirming your plantar fasciitis they will investigate why you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts.

  • X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur
  • Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.
  • Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
You are more likely to develop plantar fasciitis if you are:
  • Active – Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. Running, ballet dancing and aerobics.
  • Overweight – Carrying around extra weight increases the strain and stress on your plantar fascia.
  • Pregnant – The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation.
  • On your feet – Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses.
  • Flat Feet or High Foot Arches – Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.
  • Middle-Aged or Older – With ageing the arch of your foot may begin to sag – putting extra stress on the plantar fascia.
  • Wearing shoes with poor support.
  • Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury.
  • Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
  • Diabetes. Although doctors don’t know why plantar fasciitis occurs more often in people with diabetes.

The good news is that plantar fasciitis is reversible when treated. About 90 percent of people with plantar fasciitis improve significantly within two months of initial treatment.

Poor foot biomechanics is often the primary cause of your plantar fasciitis so it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development of a heel spur.  We may recommend that you seek the advice of a podiatrist, who is an expert in the prescription on passive foot devices such as orthotics.

With accurate assessment and early treatment, most foot pain responds extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living.

Please ask Mend Physio for their professional treatment advice.

Call 01869 340690 for an appointment

Ankle Sprain

 

A sprained ankle occurs when your ankle ligaments are overstretched. Ankle sprains vary in their severity, from mild “twisted ankle” or “rolled ankle” sprain through to severe complete ligament ruptures, avulsion fractures or broken bones.

 What are the Symptoms of a Sprained Ankle?

A history of your ankle rolling is the key ingredient to suspecting a sprained ankle. At the time of the injury, you may hear a popping or cracking sound and will notice swelling, bruising and ankle pain. Lateral or medial ligament sprains are usually acutely tender over the injured ligament.

Depending on the severity of your ankle sprain, you may have trouble walking or standing on your foot.  In more severe cases, there may be sharp pain deep in the ankle joint associated with a talar dome fracture or pain between your lower shin bones, which may be a syndesmosis or high ankle sprain.

Which Ankle Ligaments are Commonly Sprained?

Your ankle joint, known as the talocrural joint, is made up of three bones: the tibia (shin bone – inside ankle bone), fibula (outer lower leg – outside ankle bone) and talus (deep ankle bone). Underneath the talocrural joint lies the subtalar joint, which is the articulation between the talus and the calcaneus (heel bone). Your ankle ligaments attach from bone to bone and passively limit the motion available at each joint.

On the outside of the ankle lie the lateral ligaments, which are the most frequently injured in an ankle sprain.

These include the:

  • Anterior talofibular ligament (ATFL)
  • Calcaneofibular ligament (CFL)
  • Posterior talofibular ligament (PTFL)

The main medial (inside of ankle) ligament is the much stronger deltoid ligament.  High ankle sprains involve the inferior tibiofibular ligament and syndesmosis. These are more disabling ankle injuries and are often misdiagnosed as the more simple sprained ankle.

Treatment for Sprained Ankle

A sprained ankle can increase your risk of re-injury as much as 40-70%, but the correct post-injury rehabilitation exercises significantly decrease the risk.

Physiotherapy Treatment Aims
  • Injury Protection, Pain Relief & Control Inflammation
  • Regain Full Range of Motion
  • Strengthen your Ankle and Calf Muscles
  • Restore Joint Proprioception & Balance
  • Restore Normal Function

Call 01869 340690 for an appointment

Injuries by body region