“It’s My Ankle”
The foot and ankle contain 26 bones, 33 joints and over 100 muscles, tendons and ligaments which provide the supportive base of our movement. Foot pain or loss of proper function can make daily life a challenge.
The most common sporting injury in netball, basketball and all of the football codes is a sprain of the ligaments on the outside of the ankle. It can happen in daily life if you quickly change direction, miss a step on a flight of stairs or trip on an uneven surface such as when stepping off a kerb. You may want to keep off your feet for a day or two after the injury, elevate the injured ankle where possible, and apply ice and compression. Starting gentle soft tissue therapy and mobilisation after this time helps to further reduce pain and swelling. This minimises muscle inhibition around the joint, permitting you to begin range of motion exercises. Physio treatment aims to prevent joint stiffness and progressively load and retrain the injured structures.
Ankle joint stiffness, if left unaddressed, can change your walking or running pattern and your foot’s ability to adapt to different surfaces and slopes, increasing your risk of further ankle, knee or lower body injury. Ankle instability may also be an ongoing issue if the ligaments are inadequately rehabilitated, as they are full of proprioceptors, or balance receptors, that provide your joint position sense and postural corrections to keep you upright.
If you roll your ankle badly, it should be examined to exclude any fractures. Generally speaking, ability to weight-bear immediately after the injury, followed by an increase in pain and swelling as you continue to play sport or walk about, indicates a ligament sprain rather than fracture.
It’s also possible to tear the peroneal tendons that cross behind the ankle joint, which will cause greater weakness and loss of balance and function. This may be accompanied by tenderness up the side of the leg as high as the knee. The muscles and tendons generally heal well with appropriate rehab exercises. If your recovery isn’t coming along as it should be in the normal timeframe, we will investigate for bone bruising or other less common factors which can accompany a sprain.
After an ankle sprain, your risk of doing it again is greater – without rehabilitation recurrence is as high as 75%. With a full rehabilitation this risk drops to 30%. You may wish to tape your ankle or wear a brace when returning to sport. Specific exercises for balance and joint awareness also aim to minimise the risk of another injury, and unlike the external supports, they address the underlying cause of your ankle instability. Both methods have a proven benefit in reducing injury recurrence, but the exercise program takes about 8 weeks for full effect. In the meantime, tape or a brace can give you an immediate improvement in stability.
Less common ankle injuries include a syndesmosis or high ankle sprain and ankle impingement, which may require longer periods of rehabilitation.
“It’s my heel”
Achilles tendon pain
The heel is not only a load-bearing structure, but also the attachment point for commonly injured ligaments and tendons. The Achilles is the strongest and thickest tendon in the body, but is still susceptible to overload, especially in runners and in jumping sports. Achilles tendon pain can affect members of the general population, on the other hand, if they have not kept their muscles and tendons strong enough. The term Achilles tendonitis is no longer used as structural changes, rather than inflammation, are present. Healthy tendons need movement and the right amount of load, so often a period of rest is not enough to fully restore function. Muscle tightness should be addressed and followed by controlled exercises, which we often recommend continuing to prevent recurrence.
Plantar heel pain
The layers of tissue in the sole of the foot often become tight or weak due to footwear and disuse. This can lead to plantar heel pain (previously known as plantar fasciitis) in runners or those with active occupations. A treatment plan takes into consideration your footwear, the surface on which you are standing or running, and the amount of time you are on your feet. Manual therapy can reduce muscle tightness and there are great exercises you can do to retrain the intrinsic foot muscles. Occasionally walking barefoot on the beach is a great way to maintain the flexibility and strength of your foot arches and muscles.
Other causes of heel pain include bruising of the bone or fat pad, stress fractures, nerve entrapments or referred pain from the lower back.
“It’s my foot”
The numerous structures in the foot, as well as the potential for referred pain, make a thorough examination necessary. After palpation of the painful area, we may refer you for imaging, or we may need to assess the mobility, strength and function of your entire lower body. The onset and pattern of pain give us the best indication of what may be affected. Treatment of the foot may include manual therapy and joint mobilisation, dry needling, taping, orthotics or padding, and exercise.
We also have crutches and braces to lend you.
Whenever foot pain is accompanied by symptoms of pins and needles, numbness, temperature change or burning or lancinating pain, we need to consider the involvement of the nerves that supply the foot or that can refer pain to the foot. Tarsal tunnel syndrome is a condition that may at first feel like plantar heel pain but involves a compression or a sensitisation of one of these nerves. Treatment may include techniques to mobilise the nerve along its path, relax surrounding soft tissue, desensitise the nerve and address any aggravating postures or movements.
If you work a standing occupation or do a lot of walking, and are suffering from foot pain, we can assess your foot posture, including how well the natural arches are supporting you when weightbearing, and recommend the appropriate orthotics if needed.
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