Ankle and Foot Overview

ankle foot.jpg

Don’t Let Ankle or Foot Pain Keep You Down.

Depending on your job and your lifestyle, you can spend a lot of time using your feet every day. When you are suffering from ankle or foot pain, your life can be hugely impacted. It can cause dread and pain when taking the first few steps, or going up and down stairs, walking, standing or even driving your car. Pain in your ankle or foot can arise from a number of different causes, but Freedom Physical Therapy can help get you back on your feet. Request a consultation today with one of our licensed physical therapists and begin your journey to recovery, because moving freely shouldn’t hurt.

 

Why does my ankle or foot hurt?

Your feet and your ankles are complex mechanical structures that must work together in harmony in order to function at their optimal level. The foot and ankle form a complex system which consists of 28 bones, 33 joints, 112 ligaments, controlled by 13 extrinsic and 21 intrinsic muscles. The foot is subdivided into the rearfoot, midfoot, and forefoot.

 

It functions as a rigid structure for weight bearing and it can also function as a  flexible structure to conform to uneven terrain. The foot and ankle provide various important functions which includes:

 Supporting body weight.

 Providing balance.

 Shock absorption.

 Transferring ground reaction forces.

 Compensating for poor alignment further up the leg or trunk.

 Substituting hand function in individuals with upper extremity

amputation/paralysis.

 

Because there are many complicated structures that make up your ankles and feet, pain in those areas is a very common problem. An injury to your ankle or foot can result in pain so severe that you avoid putting weight down on your foot correctly, if at all. This leaves you with limping or using crutches risking injury to other areas and can cause changes and limitations to your daily life.

 

What could be causing my ankle or foot pain?

According to the Mayo Clinic, there are several common causes of foot pain and, ankle pain including:

Achilles Tendinitis. The achilles tendon attaches the calf muscle to the heel bone and can become irritated, painful, and swollen.

Achilles Rupture. The achilles tendon attaches the calf muscle to the heel bone and can become irritated, painful, and swollen, or can rupture with overuse or sudden excessive forces.

Arthritis. Arthritis is a common inflammatory condition that affects the joints and results in pain; the most common types including osteoarthritis and rheumatoid arthritis. Both types of arthritis can greatly impact the foot and ankle joints.

Bunions. It’s a bony bump that forms on the joint where your big toe meets your foot -- called the metatarsophalangeal (MTP) joint. It happens slowly over time, and eventually gets bigger and sticks out. It can make your big toe turn in, sometimes so far that it moves on top of the toe next to it. This can cause redness, pain and decreased toe mobility which is important for balance and gait.

Bursitis. Bursitis occurs when the tendons rub against the “bursae” or anti-friction sacs, causing them to become irritated and swollen.

Fallen arches. Your foot contains several tendons that work together to form your arch. When the tendons pull together properly, your foot will form a proper arch. However, when the tendons do not pull together properly, your foot will form a very small arch, or no arch at all. This is referred to as “fallen arch” or “flat foot” and can cause pain or discomfort with time.

Fractures. A fracture occurs from excessive force or trauma to the bone, causing it to crack or break entirely. A fracture to the foot or ankle could result in weeks of downtime to ensure proper healing.

Plantar fasciitis. Plantar fasciitis is an inflammation in the connective tissue on the bottom of your foot. This can occur from aggravated overuse, such as constant standing, improper posture, or footwear that lacks proper arch support.

Strains and sprains. A strain occurs when a muscle or tendon is stretched, while a sprain occurs when a ligament is stretched too far or

torn.

Tarsal tunnel syndrome. Tarsal tunnel syndrome occurs when the posterior tibialis nerve becomes pinched and inflamed. This nerve runs

from the ankle to the foot.

Tendinitis. Tendinitis occurs from excessive overuse of the tendons, causing them to become inflamed.

 

How can Freedom Physical Therapy help you?

Our experienced physiotherapists will take a thorough history from you and then conduct a full assessment to identify the underlying cause of your ankle or foot pain. The results will be discussed with you along with a plan of care. You can expect to receive manual therapy which is a hands-on approach to mobilize any tight joints. This increases joint mobility and increases circulation. Strengthening of extrinsic and

intrinsic muscles will be taught along with any stretching that might be required. For pain and swelling a variety of modalities, taping or bracing may be used. Balance work is also important for good foot and ankle stability. A home exercise program will accompany you home.

 

To begin your healing journey, call us today at 587-758-1716. Remember: moving freely shouldn’t hurt!

Sources:

https://www.mayoclinic.org

https://www.physio-pedia.com/Foot_and_Ankle_Structure_and_Function

Achilles Tendinitis/Tendinopathy

 

The Achilles tendon is the largest tendon in the body and attaches the calf muscles to the back of the heel bone. When the calf muscles contract, the Achilles tendon is tightened, pulling the heel up. This allows you to point your foot and stand on tiptoe. It is critical for the activities of walking, running and jumping.

 

Tendinitis or tendinopathy as it is now generally referred to, is inflammation and irritation of the tendon that occurs either at the site of insertion on the back of the heel or 4-6 cms above in the tendon belly.

 

Symptoms:

  • Tenderness in lower region of tendon (may feel a bump or thickened area in the tendon)

  • Redness and/or swelling 

  • Mild burning sensation aggravated by activity

  • Pain with activity

 

Causes:

  • The biggest cause is the excessive overburdening of the tendon which is seen in weekend athletes, sports requiring sudden changes in direction and speed

  • Tight hamstrings and calf muscles

  • Poor mobility in the ankle and foot joints

  • Flat feet

  • Being overweight or sudden weight gain

Treatment:

The physical therapists at Freedom Physical Therapy will take a full history from you. This will be followed by an objective examination looking at your gait, your foot and ankle mechanics, the flexibility and strength of your leg, ankle and foot muscles to determine the underlying cause of your pain. Your physical therapist will discuss the findings with you and create an individualized treatment plan to help you reach a full recovery and to allow you to return to doing what you love.

Sources:

https://www.physio-pedia.com/Achilles_Tendinopathy

https://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/symptoms-causes/syc-20369020

 

Achilles Rupture

The Achilles tendon is the largest tendon in the body and attaches the calf muscles to the back of the heel bone. When the calf muscles contract, the Achilles tendon is tightened, pulling the heel up. This allows you to point your foot and stand on tiptoes. It is critical for the activities of pushing off your forefoot with walking, running, and jumping.

 

If you overstretch your Achilles tendon, it can tear partially or (rupture) completely. This usually occurs at the lower aspect of the tendon, a few inches (~6 cms) above the heel bone.

 

Symptoms:

  • A popping or snapping sound when the injury occurs

  • The feeling of having been kicked in the calf

  • Pain, possibly severe, and swelling near the heel

  • An inability to bend the foot downward or "push off" the injured leg when walking

  • An inability to stand on the toes on the injured leg


Causes:

Rupture usually occurs in the section of the tendon situated within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. The lower portion of the tendon might be prone to rupture because blood flow is poor, which can also impair its ability to heal.

 

Ruptures often are caused by a sudden increase in the stress on your Achilles tendon. Common examples include:

  • Increasing the intensity of sports participation, especially in sports that involve jumping or sudden changes in direction, and sudden stop/starts.

  • Falling from a height

  • Stepping into a hole

 

Treatment:

If you felt a sharp pain or popping sensation followed by the inability to point your foot down or do a heel raise, you should go to the emergency department of your nearest hospital.  A ruptured Achilles needs either a surgical repair or needs to be treated conservatively with progressive casting.

In either case, physical therapy will begin at 6 weeks after the injury occurred and will include a thorough history, objective examination which includes ankle range of motion and a progressive treatment plan that will include range of motion, strengthening eccentrically, isometrically and finally concentrically with a functional return to normal activities.  This usually takes 6-9 months to heal properly.

Arthritis

 

Arthritis is a general term for a group of more than 100 diseases. It can involve inflammation and swelling in and around your joints and the nearby soft tissue.

Hyaline Cartilage is a low-friction, wear-resistant tissue that coats joints and is designed to bear and distribute weight. It is strong, rubbery and flexible but has poor blood flow leading to poor healing.1

With many kinds of arthritis, your cartilage and joints wear down over time. You slowly lose the smooth "cushioning" cartilage inside them. As a result, your bones rub and wear against each other. Soft tissues in your joints also may begin to wear down. After some time, the joint might not work or move the way it should.

 

Symptoms:

Symptoms of foot and ankle arthritis often include:

  • Tenderness when you touch the joint

  • Pain when you move it

  • Trouble moving, walking, or putting weight on it

  • Joint stiffness, warmth, or swelling

  • More pain and swelling after you rest, such as sitting or sleeping

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Causes:

  • Osteoarthritis, or "wear-and-tear" arthritis, is the most common type. It is a degenerative joint disease and is often age-related. Osteoarthritis usually causes changes over many years. The foot and ankle joints where it’s most common are:

    • The three joints involving your heel bone, your inner mid-foot bone, and your outer mid-foot bone (talocalcaneal, talonavicular and calcaneocuboid joints).

    • The joint of your big toe and foot bone (1st metatarsophalangeal joint).

    • The joint where your ankle and shinbone meet (talocrural joint).

  • Rheumatoid arthritis is one of the most serious forms. It’s an autoimmune disease in which your immune system attacks the joint. It usually happens in the same joint on both sides of your body, which helps to differentiate it from other forms of arthritis.

  • Gout happens when you have a buildup of uric acid in your blood from your diet. It forms sharp crystals in one or more of your joints. It’s most common in your big toe because it’s the farthest body part from your heart. Attacks are sudden and cause serious pain, often with redness and swelling around the joint. They usually last 3 to 10 days, but the first 36 hours are typically the most painful. 

  • Psoriatic arthritis can happen in one or more joints, including your ankles and the ends of your toes. It may also cause toe swelling called dactylitis and psoriasis which causes an itchy and painful skin condition. Most people are diagnosed between 30 and 50, but you can get it at any age. 

  • Post-traumatic arthritis happens after an injury, especially a dislocation or bone fracture. You might not notice problems for years.

Treatment:

The primary goal is to return the patient to their desired level of activity with pain relief, restoration of foot and ankle mechanics which includes proper foot and ankle alignment, range of motion and proper load distribution. This may include the following:

  • A thorough foot and ankle assessment and gait analysis

  • Modalities such as heat or ice, ultrasound, interferential current which help to reduce swelling and pain while increasing blood flow.

  • Taping, bracing or orthotics to assist in foot and ankle alignment.

  • Proper foot wear that supports the arch, has a wide enough toe box and occasionally a rocker bottom sole to reduce stress on arthritic joints.

  • Strengthening exercises of the foot intrinsic and extrinsic muscles to help support the joints in the foot and ankle.

  • Manual mobilizations to assist in joint mobility and circulation.

Sources:

https://www.webmd.com/arthritis/psoriatic-arthritis/psoriatic-arthritis-symptoms

https://www.news-med

https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-foot-and-ankle/

https://www.physio-pedia.com/Ankle_and_Foot_Arthropathies

 Bunions

 

A bunion is a deformity of the big toe that results in the big toe rotating and moving sideways towards the second toe.  It is often characterized by a large red bump on the inside of the first toe where it attaches to the foot.

Symptoms:

  • Pain is usually what causes people to seek help

  • Inflammation/redness

  • Other foot/ankle problems

 

Causes:

  • Bunions are a result of complex biomechanical changes that occur in your feet.

  • The type of footwear that you wear does cause bunions. We know that foot bunions occur in about 30% of the population of most Western countries but only 3% in Eastern countries. They are seen most commonly in women and become more common as people get older.

  • High heels, cowboy boots or foot wear that have tight toe boxes. The slope causes the front of the foot to bear your weight, which encourages your forefoot to widen. Also, the angle pushes your toes into the narrow toe box, causing the toes to become angled and squeezed together.

  • Flat feet

  • Family history

bunions.jpg

Treatment:

  • Begin your own treatment by changing your foot wear to include a wider toe box and good arch support.

  • If your bunions are severe, you may require surgery.

  • Pain and swelling relief modalities (ice, ultrasound, k-tape)

  • Manual mobilizations to restore joint mobility and circulation

  • Foot muscle strengthening/stretching

  • Taping or orthotics

 

The physical therapists at Freedom Physical Therapy will take a full history from you. This will be followed by an objective examination looking at your gait, your ankle, foot and toe mechanics, and the flexibility and strength of your leg, ankle and foot muscles to determine the underlying cause of your pain. Your physical therapist will discuss the findings with you and create an individualized treatment plan to help get you back on track.

 

 

Sources:

https://physioworks.com.au/pain-injury/foot-pain/foot-bunion/

Bursitis

 

Bursae are small fluid filled sacs that cushion bones, tendons and muscles near your joints.  It helps to create shock absorption and reduce friction. The most common locations in your foot are at the heel and the base of the big toe.

Bursitis occurs when the bursae become irritated and inflamed and generally occurs near joints that perform repetitive motion.

Symptoms:

  • An achy, stiff joint

  • Tender to palpation

  • Red and swollen area at the back of the heel.

  • Pain with weight bearing that loads the calf muscles, stretching, pushing off the front of the foot especially running uphill, doing heel raises or pressure of shoes on the back of the heel.

Causes:

  • A sudden impact contusion to the back of the heel.

  • A gradual onset due to overtraining or excessive loading.

  • Tight or poorly fitting shoes that put too much pressure on the back of the heel.

  • A tight joint

  • Haglund deformity (an excessively prominent heel bone)

Treatment:

  • Ice and anti-inflammatory modalities such as ultrasound or interferential current in the acute phase

  • Rest or reduce activity that aggravates the foot and ankle in the acute phase

  • Gradual progressive stretching of the Achilles tendon

  • Joint mobilizations if there is joint stiffness.

  • Foot intrinsics to strengthen the muscles in the foot to help with stability, flexibility and alignment

 

Sources:

https://www.healthline.com/health/bursitis-ankle#symptoms

https://www.physio-pedia.com/Retrocalcaneal_Bursitis

Fallen Arches