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Ankle and Foot Conditions

Ankle Sprain

What is it?

Ankle sprains are a common form of injury commonly referred to as ‘rolling the ankle’. It involves a tearing of some of the structures supporting the ankle and can be graded for severity. Grade I is minor tearing of the ligaments, grade II is moderate ligament injury and often associated with injury of tendon’s and grade III is classified as a complete rupture of 1 or more of the ligaments and can sometimes involve a fracture.

What are the Signs & Symptoms?

  • Pain at rest and especially with weight bearing
  • Local or diffuse swelling
  • Heat
  • Bruising

How can Physiotherapy Help?

Firstly, the Physiotherapist will be able to accurately diagnose the specific structures injured in the ankle sprain. Whilst these are normally ligament injuries it is important to clear more significant injuries to the tendons, talar dome, fractures and complete ligament ruptures where further medical intervention may be required. Physiotherapy can assist in the reduction of inflammation and swelling in the early stages after an ankle sprain by limiting the damage post injury. The correct early management can decrease ongoing symptoms of stiffness or instability. Rehabilitation has been shown to reduce the recurrence of ankle sprains be restoring optimal movement, restrengthening and improving balance and proprioception.

Achilles Tendinopathy

What is it?

Tendinopathy is a newer term to what has traditionally been referred to as ‘tendinitis’. The role of the tendon is to transfer load from the muscle to it’s attachment on the bone. Tendinopathy occurs when there is an inability for the tendon to cope with the load placed upon it. It is characterised by microtearing of the tendon and a failed healing response. The common teninopathies of the ankle are Achilles tendinopathy, tibialis posterior tendinopathy and fibularis tendinopathy. These are located at the back, inside and outside of the ankle respectively.

What Causes Tendinopathy?

Tendinopathies occur when the tendon is not able to cope with the load placed upon it. This may be due to overload, return to activity after a period of inactivity, seronegative disorders such as HLA-B27 and with age related degeneration. It is often associated with an underlying biomechanical fault which would need to be identified.

What are the Signs & Symptoms?

  • Pain and or stiffness with activity which improves and then worsens at the end of the day  or after activity
  • Pain and or stiffness in the morning, especially the day after activity
  • Tenderness with touching the tendon
  • Symptoms that do not improve with rest

How can Physiotherapy Help?

The Physiotherapist will be able to identify the cause(s) of the reasons behind the tissue overload. This can be to muscle weakness, muscle tightness, poor foot structure, issues with training load (volume, type, intensity), inappropriate footwear to name a few. Treatment and home exercises to correct the causes of the tendinopathy will be administered and advice regarding training loads will be given. It is important that adequate load is provided in the management of tendinopathies as rest will more often than not only provide a temporary relief and will not provide a long term solution.

Plantar Fasciitis

What is it?

The plantar fascia is a connective tissue on the sole of the foot that spreads from the heel to the toes. It has an important role in helping to support for arches of the foot. Irritation of the plantar fascia results in overstretching of the structure. This can occur as an acute injury or slowly over time. Pain is generally localised on the undersurface of the heel and can spread down the foot towards the toes.

What Causes Plantar Fasciitis?

Plantar fasciitis is generally due to poor foot biomechanics and is often associated with excessively high arches or ‘flat feet’. The faulty biomechanics of the foot results in a repetitive strain of the fascia due to overstretching. The fibres of the fascia become inflamed and painful. It can also occur as a result of an acute injury where the fascia is overstretched and suffers tearing of the fibres.

What are the Signs & Symptoms?

  • Pain with weight bearing, particularly in the morning
  • Pain on touch of the undersurface of the heel or up the arch of the foot

How can Physiotherapy Help?

Physiotherapy can assist by reducing the body’s inflammatory response and in stretching the fascia. An assessment of the biomechanical disorder would be used to identify the cause of the issue and can be treated with manual therapy and taping. Advice regarding footwear and activity can be provided to ensure that the condition improves and does not reoccur. Home exercises will be provided to stretch and/or strengthen structure to improve the load through the plantar fascia, hence eliminating the pain.

Fat Pad Contusion (Bruised Heel)

What Causes Fad Pad Contusions?

  • Landing onto heels after jumping or falling
  • Poor heel cushioning/arch support
  • Repetitive stop- starts and changing directions
  • Excessive/repetitive use of heel

What are the Signs & Symptoms?

  • Heel pain especially with weight bearing
  • Pain in heel and along outer edge of heel

Navicular Stress Fracture (Stress Fracture of Midfoot Bone)

What Causes Them?

  • Excessive and repetitive forces from weight bearing activity e.g. running, dancing, jumping) beyond the bone’s capacity to withstand

What are the Signs & Symptoms?

  • Subtle onset of pain which is difficult to localize in the midfoot
  • Pain that increases with impact activity and subsides rapidly with rest

Extensor Tendinopathy (inflammation of the tendons that run along the top of the foot)

What causes it?

  • Muscle weakness
  • Poorly fitted shoes, shoes that are too tight
  • Overuse
  • Increase in training

What are the Signs & Symptoms?

  • Pain on top of the foot
  • Sometimes there is associated swelling on top of the foot

Tibialis Posterior Tendinpathy

What causes it?

  • Overuse
  • Low arches/flat feet

What are the Signs & Symptoms?

  • Pain on inside of foot that may radiate along tendon (along inside of lower leg)
  • Tight calf muscles

Mortons Neuroma (swollen inflamed nerve between bones at ball of foot)

What causes it?

  • Poorly fitted shoes, shoes that are too tight
  • Excessive pronation (rolling inwards in ankle/foot)

What are the Signs and Symptoms?

  • Burning pain in forefoot
  • Pain radiating into toes
  • Sometimes pins and needles and numbness in toes and foot

Stress Fracture of the Fifth Metatarsal (stress fracture of bone on the outside edge in midfoot)

What causes them?

  • Overuse
  • Excessive supination (rolling inward of ankle/foot)

What are the Signs and Symptoms?

  • Vague pain on outside of foot

1st Metatarsophalangeal Joint Sprain (aka Turf Toe damage to ligaments and joint capsule in big toe)

What causes it?

  • Hyperextension (excessive bending backward) of big toe
What are the Signs & Symptoms?
  • Pain and swelling at big toe
  • Pain with extension(bending backward) of toe
  • Difficulty walking/pain especially during toe off in walking