About the Ankle and Foot
The ankle joint is where the two lower leg bones (the tibia on the inside and the fibula on the outside) meet the upper foot bone (the talus). This joint allows the ankle to flex and extend. There is a second joint in the ankle between the talus and the heel bone (the calcaneus). This joint allows the foot to invert (i.e. the sole of the foot turns inwards) or evert (i.e. the sole of the foot turns outwards).
The inner side of the ankle is supported by the deltoid ligament. The outer side of the ankle is supported by the anterior and posterior talofibular ligaments and the calcaneofibular ligament.
Many muscles start in the lower leg, cross the ankle, and end in the foot. The calf muscle (gastrocnemius) attaches to the heel bone via the Achilles tendon, and is the muscle used when you stand on your toes. The plantar fascia is a fibrous tissue that connects the heel bone to the toes and creates the arch of the foot. It acts to transmit the forces of walking/running/ jumping from the ankle/heel through the foot to the toes and vice versa.
What causes ankle and foot pain?
There are many possible causes of ankle and foot pain including:
Achilles Tendonitis occurs when there is pain and swelling in the area at the back of the heel, caused by inflammation of the Achilles tendon. The pain can be experienced during activities such as running (while pushing off) or jumping, and after periods of rest (e.g. when first walking in the morning).
This injury is caused by overuse of the affected leg. It is common in recreational athletes because of training of the affected limb under poor conditions, especially after a sudden increase in the training schedule or a change of footwear. It is related to lack of flexibility of the calf muscle and over-pronation of the foot (i.e. when the arch of the foot flattens).
Because the Achilles tendon has poor blood supply, this injury can be slow to heal.
Achilles Tendon Rupture
Achilles Tendon Rupture is when there is a full thickness tear of the Achilles tendon connecting the calf muscle to the heel bone.
This injury causes sudden pain in the back the ankle, which may be accompanied by an audible “pop” or a “snap”. Some individuals report that it feels as though they have been suddenly kicked in the back of the ankle, even though they have not.
Achilles tendon rupture results in difficulty in pointing the toes downward, or raising up on the toes in standing. It is most common in middle-aged, male athletes, especially “weekend warriors”.
Treatment may be surgical or non-surgical.
Plantar Fasciitis is caused by inflammation of the plantar fascia that develops when it is overstretched or overused. It can cause pain and make walking difficult, especially first thing in the morning.
It develops when there is excessive strain because the arch of the foot flattens when walking, or the arch of the foot is too high/rigid and does not cushion forces through the foot while walking. It can also be caused by obesity or sudden weight gain; long distance running, especially downhill or on uneven surfaces; wearing shoes with poor arch support or soft soles; or when the calf muscle/Achilles tendon is too tight.
A Stress Fracture is a hairline fracture, or a very small crack, that occurs in the bones of the foot, usually the fifth metatarsals on the outer side of the foot or the tibia in the lower leg.
It is very common in long distance runners or when there is repeated weight bearing through the bone. Usually this injury involves generalized pain in the foot with weight bearing. A stress fracture will often cause severe pain at the beginning and towards the end of a run, as well as after the run with moderate pain in between the start and the end of the run.
Groups of muscles, nerves and blood vessels in the lower leg are separated into compartments by thick, in-flexible tissue called fascia. Compartment Syndrome develops when there is swelling inside the compartment which leads to increased pressure and pain.
Compartment syndrome can be caused gradually by long-term activity or exercise and become a chronic problem, or it can occur very suddenly; the latter of which can be dangerous. Very intense pain that develops quickly may be indicative of acute compartment syndrome, which would require immediate attention. This may happen because of a severe trauma, a broken bone, a large burn or after excessive overuse. Because it can lead to permanent muscle and nerve damage and problems with blood flow after just 8-12 hours, it is important to notify a doctor immediately if you think you may have acute compartment syndrome.
Ankle Sprains result when the ligaments of the ankle are stretched, partially torn or completely torn during an injury.
The most common way that an ankle sprain occurs is in the ligaments on the outer side of the ankle when the foot twists inwards. However, it can also occur when the foot twists outwards, damaging the ligaments on the inner side of the ankle.
There are three grades of ankle sprains. Grades I and II are when the ligaments are stretched or just partially torn causing mild to moderate pain, swelling, and tenderness over the inner or outer side of the ankle. Grade III is when the ligaments are completely torn, causing the ankle to become unstable. With Grade III sprains there is severe pain and disability.
A Syndesmosis Sprain, also called a high ankle sprain, is a sprain of the ligaments that connect the two lower leg bones, the tibia and the fibula.
This sprain happens when the lower leg and foot twists outward. This injury can happen to anyone, but is most common in sports such as football, ice hockey, basketball and soccer. It usually involves a sharp or dull pain in the area above the ankle on the outside-front of lower leg, which is made worse by twisting.
Because it often involves little swelling compared to common ankle sprains, a syndesmosis sprain is harder to diagnose. In many cases, individuals are treated for common ankle sprains, and are later diagnosed with a high ankle sprain when the injury does not heal within the expected time frame.
Tarsal Tunnel Syndrome
Tarsal Tunnel Syndrome is a nerve injury that occurs when the tibial nerve becomes compressed in an area called the tarsal tunnel of the ankle, which is just behind the inner ankle bone (tibia).
Tarsal tunnel syndrome involves medial or plantar foot pain and numbness. Often there is also increased pain at night.
Morton’s Neuroma is caused by an injury to the nerves of the toes causing them to thicken.
It involves burning and/or shooting pain between the bones in the foot (metatarsal). The pain often radiates from the middle of the foot into the toes, and happens more often between the third and fourth toes. Cramping or tingling in the toes is also common.
Several factors can cause this injury:
Abnormal positioning of toes
Flat feet or high arches
Forefoot problems such as bunions or hammer toes
Tight shoes or high heels
What can you do if you have ankle or foot pain?
At Saanichton Physiotherapy and Sports Clinic, your therapist will perform a detailed assessment to determine the exact cause of your symptoms and prescribe the best course of treatment for your injury. This treatment may include one or more of the following:
- Specific instruction to care for your injury, which may include the use of crutches to decrease weight bearing on your ankle/foot
- Taping to support or stabilize your ankle joint
- Modalities for pain relief including electrical currents, acupuncture, heat and ice
- Massage to promote soft tissue healing and break up scar tissue
- Manual therapy to improve movement in your ankle joints
- An exercise program including strengthening and stretching
- A specific plan to help you to avoid ankle injuries in the future