Foot & Ankle Pain

The foot and ankle, 26 bones and 33 joints that are so often overlooked and only focused on when someone says they have pain there. The fact is the feet are the only parts of our body that interact with the ground when we walk or run. How they move, or in a lot of cases how they don't move, will directly impact on every joint above it.

When the feet are unable to move correctly, then movement is lost. Something somewhere else in our system will then either; not be able to move as well or may have to move a little more to make up for this loss. That in turn could create the same scenario for another joint, and then another joint and so on. 

So with that in mind, we pay close attention to the feet and how they influence every other joint in the body.

Ankle sprains

Ankles sprains most commonly occur as either as a result of a direct trauma in sport, landing awkwardly from a jump or slipping off a pavement curb or step. The severity of the sprain will often determine how much bruising and swelling there may be. In some cases there may be very little swelling and still a lot of pain. In some cases it may be the opposite.

There are a strong set of ligaments on both the inside and outside of the ankle joint. They are there to provide stability and prevent excessive end range movement. When these ligaments are sprained, pain is usually felt either on the inside or outside of the ankle joint (depending on which set of ligaments have been damaged) but can spread over the whole foot and sometimes up into the Achilles tendon and calf muscle area.

In a lot of cases, the advice following an ankle sprain is to simply rest and ice it. Then, when the swelling has gone down, the advice is to try and stand on it to regain balance. Although this is good advice, there is so much more that should be done. The joints and ligaments need to re-learn how to move properly again in order to fully regain optimal function. This requires careful mobilisations and exercise therapy. In some cases massage and ultrasound can be extremely beneficial. Remember, there are 26 bones in the foot and ankle, and any number of them could have been affected by just one ligament sprain. 

It is important to note that ankles sprains are one of the most re-occurring injuries. It is therefore vital that the appropriate treatment is started early to help re-educate the whole musculoskeletal system. As already stated, the whole body is reliant on how our feet interact with the ground so we need to make sure that they are back moving to their full potential following an injury. 

Achilles tendinopathy / tendinitis

The Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscles to the heel bone and helps to both absorb pressure as well as help propel the body forward during walking and running. The term "tendinopathy" is the term used to describe "damage" to a tendon. In previous years, it was much more common for the term "tendinitis" to be used. The phrasing of "itis" is used to describe inflammation. In more recent years, due to further understanding of tendon pathology, the term "opathy" is the now the more preferred term. This is because upon inspection of injured tendons, very few inflammatory cells were present. Understanding the exact pathology of tendon injuries has led to a more detailed rehabilitation approach over the last 10-15 years.

Achilles tendinopathy symptoms will often include:

Achilles tendinopathy is classified as an "overuse" condition, meaning that there has been repeated micro-trauma to the tendon. Despite it being common in runners, it can affect anyone regardless if they participate in sport or not.

You might be thinking, how can a non-sporty person suffer with an "overuse" injury if they don't overuse the tendon. More often than not, Achilles tendon problems occur due to either the foot and ankle not moving enough, or the foot and ankle moving too much. This movement issue will often lead to a slight increase in stress onto the tendon. If this increase in stress happens only a few times, then the tendon can easily cope and repairs that is what our bodies are designed to do. If it happens every time we take a step (remember the recommend number of steps a day is 10,000), then eventually the tissue can break down and fail to recover. As a result, pain is then very often felt.

So, just a small increase or small decrease in movement at the ankle joint, can very often lead to a slight increase in Achilles tendon load. This repeated many times a day, can eventually lead to pain.

Why does it occur so often in runners?

Well as already stated, either too much or not enough movement at the ankle joint can result in increased Achilles tendon load from just walking. When we run we place 3-4 times more force through the body and subsequently the Achilles tendon. Therefore, running may just be highlighting a problem you didn't know existed.

Our assessment of Achilles tendon problems will always include a biomechanics assessment of the whole leg.  Once we work out why the foot is doing what it is doing, we can start to correct it with movement therapy, soft tissue massage, strengthening, ultrasound and taping.   

Plantar fasciitis

Underneath the foot is a large flat band of elastic tissue connecting the heel bone to the toes. This is known as the plantar fascia. It's job is to absorb pressure by lengthening as the foot flattens and propels the body forward during motion as it shortens. When this tissue is subjected to repeated excessive stress, damage and inflammation can occur. This is known as Plantar fasciitis.

This can be a very complex condition to treat as trying to rest this area is very difficult as it is repeatedly subjected to stress every time the foot hits the floor. In order for tissue to heal, we have to give it a chance to heal. Treatment will focus on "why" the plantar fascia is being excessively stressed. The plantar fascia doesn't just inflame without reason. We need to find this reason, correct it and let the body heal.

The reason for the inflammation maybe because of a lack of movement available in the foot and ankle joints, or maybe because of too much movement happening. It may even be because of a problem higher up the body, for example, in the knee or hip. Once we find the reason then treatment is often extremely quick.

To help lower the pain in the early stages of healing we can use therapies such as Ultrasound as well as taping techniques. Patients often respond extremely well to this and often report very quickly how much easier it is to place the foot on the floor. 

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