ANKLE FOOT PAIN

ANKLE SPRAINS / ANKLE INSTABILITY

Ankle sprains are a common injury. They usually occur when the foot is forcefully inverted or turned inward.

GRADING

§  Grade I (minor tear),

§  Grade II (partial tear),

§  Grade III (complete tear into two pieces) damage of the outer ligament complex (the anterior talofibular ligament and less often the calcaneofibular ligaments) is the result.

Injuries to the inner aspect of the ankle are rare and often result in a fracture before ligamentous damage occurs.

SIGNS AND SYMPTOMS

§  Lateral ankle pain,

§  Swelling and a sense of instability.

DIAGNOSIS: Stress X-rays may be helpful in ruling out fractures.

TREATMENT:

§  Rest,

§  Ice,

§  Compression,

§  Elevation, and

§  Bracing of the injured ankle.

Early rehabilitation assists in a rapid recovery.

Surgery (reconstruction of the ligaments) is only necessary when the ankle is repeatedly sprained.

POSSIBLE TREATMENTS

• Aerobic/Endurance Exercise 

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Gait or Walking Training 

• Isometrics 

• Mobilization 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Proprioception Exercises 

• Plyometrics 

• Physical Agents

• Soft Tissue Mobilization 

• Stretching/Flexibility Exercise 

POSSIBLE TREATMENT GOALS

• Improve Balance

• Improve ability to bear weight/stand on the leg(s)

• Decrease Risk of Reoccurrence

• Improve Fitness

• Improve Function

• Optimize Joint Alignment

• Improve Muscle Strength and Power

• Increase Oxygen to Tissues

• Improve Proprioception

• Improve Range of Motion

• Self-care of Symptoms

• Improve Safety

• Improve Tolerance for Prolonged Activities 

FRACTURES (BROKEN BONES)

        Fractures may involve the outside or inside of the leg.

SIGNS AND SYMPTOMS: Pain, swelling and bony deformities.

DIAGNOSIS: X-rays

TREATMENT: Essential and rapid “reduction” (setting the bones close together for healing) is necessary. In extreme cases, open surgery is necessary to reduce the fracture. Often pins, plates and screws are used to maintain the reduction.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Isometrics 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

POSSIBLE TREATMENT GOALS

• Improve Balance

• Improve Function

• Improve Muscle Strength and Power

• Decrease Postoperative Complications

• Improve Range of Motion

• Self-care of Symptoms

• Improve Safety

• Improve Wound Healing 

ACHILLES TENDONITIS

The Achilles tendon attaches the calf muscle (called the gastrocnemius and soleus muscles) to the heel.

ACHILLES TENDONITIS: Excessive stress or a tight or fatigued calf muscle can result in microtrauma, degeneration, and even inflammation of the tendon- a condition called Achilles Tendonitis/Tendinosis.

CAUSES: Prolonged walking, overtraining (excessive running or jumping, or walking hills can cause this condition.

Recent research suggests that a gradual onset of pain and prolonged recovery might be due to a similar condition called Achilles Tendinosis.

Tendinosis is chronic degenerative condition and it differs from tendonitis in that there is no inflammation present. It is probably more common than tendinitis because often times tendon pain is not accompanied by the classic inflammatory signs of swelling, redness, and warmth.

TREATMENT: Treatment usually consists of rest, non-steroidal anti-inflammatory drugs (NSAIDs), ice, stretching, strengthening and progressive return to function or sport. 

ACHILLES TENDON RUPTURE

Forceful contraction of the calf muscle may rupture (completely tear) the Achilles tendon. It occurs during jumping, running, and cutting and is often seen in basketball and baseball players.  

The patient often reports the sensation of having been hit or violently kicked in the lower calf. There is pain and a “divot” in the tendon above the heel.

TREATMENT: Non-surgical rehabilitation and surgical repair are viable treatment options. Active people may experience more benefit from surgical repair.

Rehabilitation may require six to twelve months of progressive care.

POSSIBLE TREATMENTS

• Aerobic/Endurance Exercise 

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Gait or Walking Training 

• Heat 

• Isometrics 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Proprioception Exercises 

• Plyometrics 

• Physical Agents

• Soft Tissue Mobilization 

• Stretching/Flexibility Exercise 

POSSIBLE TREATMENT GOALS

• Improve Balance

• Improve ability to bear weight/stand on the leg(s)

• Decrease Risk of Reoccurrence

• Improve Fitness

• Improve Function

• Improve Muscle Strength and Power

• Increase Oxygen to Tissues

• Improve Proprioception

• Decrease Postoperative Complications

• Improve Range of Motion

• Self-care of Symptoms

• Improve Wound Healing

PLANTAR FASCIITIS

Inflammation of the fascia on the bottom of the foot is the most common cause of heel pain.

CAUSES: There are many documented causes of plantar fasciitis.

Poor flexibility of the calf muscles, no arch support, a sudden increase in one's level of activity, poor footwear, being overweight, excessive pronation, or repetitive stress conditions (long distance running).

Common causes of a bruised heel bone are poor cushioning of the heel due to fat pad atrophy (shrinkage in the size of the fat pad) poor footwear, excessive walking on hard surfaces, and being overweight.

SYMPTOMS: Depending on which medical study you read, anywhere form 8-21% of the population suffers from plantar fasciitis. The pain is typically located at the front of the base of the calcaneus. Less often, the pain extends along the arch of the foot.

The result is micro-tearing of the plantar fascia where it attaches to the base of the calcaneus. An ensuing inflammatory response occurs producing pain, swelling, warmth, loss of function (difficulty with any standing or walking), and less often, redness.

Plantar fasciitis is often worst in the morning when one takes his /her first steps out of bed. Theories propose that when we are sleeping, the inflamed fascia is shortening and perhaps attempting to heal.

DIAGNOSIS: If the problem is chronic, a bone spur may be seen on x-ray.

Currently, we believe that a bone spur is not the cause of the pain but the result of the body's attempt to heal the damaged plantar fascia.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Gait or Walking Training 

• Isometrics 

• Iontophoresis

• Mobilization 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Proprioception Exercises 

• Physical Agents

• Soft Tissue Mobilization 

• Stretching/Flexibility Exercise 

POSSIBLE TREATMENT GOALS

• Improve Balance

• Decrease Risk of Reoccurrence

• Improve Fitness

• Improve Function

• Improve Muscle Strength and Power

• Increase Oxygen to Tissues

• Improve Proprioception

• Improve Range of Motion

• Self-care of Symptoms

• Improve Tolerance for Prolonged Activities 

STRESS FRACTURES

These fractures result from repetitive sub maximal loads applied to the foot, ankle, leg; they are usually the result of overuse (in athletes, over-training).

They are common in long distance runners and female athletes.

SITES: Common stress fracture sites include the lower leg (in runners), calcaneus, talus, metatarsals in distance runners, and the big toe.

SYMPTOMS: Pain and point tenderness.

DIAGNOSIS: X-rays do not always show the fracture. Bone scans and MRI may be useful.

TREATMENT: Most heal with rest, immobilization and cross training.             

Avoid high-impact workouts, and wear good shoes.

POSSIBLE TREATMENTS

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Isometrics 

• Progressive Resistive Exercises (PRE)   

• Physical Agents

POSSIBLE TREATMENT GOALS

• Decrease Risk of Reoccurrence

• Improve Function

• Improve Muscle Strength and Power

• Increase Oxygen to Tissues

• Self-care of Symptoms

• Improve Safety

• Improve Tolerance for Prolonged Activities 

TIBIALIS POSTERIOR TENDINITIS

This often occurs in overweight, middle aged women and men as a result of degenerative changes in the tendon. The rupture may be partial or complete with pain below or behind the inside ankle bone (medial malleolus). A flattened arch is common.

TREATMENT: Anti-inflammatory treatment (physical therapy modalities), orthoses, and surgical debridement are common treatments.

POSSIBLE TREATMENTS

• Aerobic/Endurance Exercise 

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Gait or Walking Training 

• Isometrics 

• Mobilization 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Proprioception Exercises 

• Physical Agents

• Soft Tissue Mobilization 

• Stretching/Flexibility Exercise 

POSSIBLE TREATMENT GOALS

• Improve Balance

• Improve ability to bear weight/stand on the leg(s)

• Decrease Risk of Reoccurrence

• Improve Fitness

• Improve Function

• Improve Muscle Strength and Power

• Increase Oxygen to Tissues

• Improve Proprioception

• Improve Range of Motion

• Self-care of Symptoms

• Improve Tolerance for Prolonged Activities