Foot & Ankle Pain

Ankle sprains are a common injury. They usually occur when the foot is forcefully inverted or turned inward. Grade I (minor tear), Grade II (partial tear), or a 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 of an ankle sprain include lateral ankle pain, swelling and a sense of instability. Stress X-rays may be helpful in ruling out fractures.

Treatment of an acute injury requires 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.

The Achilles tendon attaches the calf muscle (called the gastrocnemius and soleus muscles) to the heel. 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. 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 usually consists of rest, non-steroidal anti-inflammatory drugs (NSAIDs), ice, stretching, strengthening and progressive return to function or sport.

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

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.

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. 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.

This is a very common question we are asked by patients complaining of foot or ankle pain and the answer depends on several factors. In many cases, over the counter pre-fabricated inserts can effectively provide the support needed to help in minimizing symptoms associated with a host of foot and ankle conditions, however, having a professional evaluation by one of our skilled clinicians is critical to determining if they are necessary and what type is best. Custom made orthotics can be a good option for those that have exhausted other options without resolution of their condition, however, this again would require a thorough evaluation to determine if a custom orthotic would be appropriate. If you are wondering if an orthotic (over the counter or custom) would be right for you, call us and schedule an evaluation with one of our expert clinicians!

One of the most important factors regarding footwear is actually ensuring that they are properly sized, something that can change as we age. Most shoe stores can provide accurate sizing and this should be done periodically. There are as many different foot types as there are types of shoes so answering this question does not a have a “one size fits all” answer. That is where a thorough physical therapy evaluation can help to determine different factors that may be contributing to your foot pain and make specific recommendations for you to find a shoe with the support that will address your individual needs.

Our first goal for many patients is to help alleviate their pain. This is achieved by starting with a thorough evaluation to determine the underlying cause of symptoms and then implementing a combination of therapeutic modalities, manual treatments, and therapeutic exercises to reduce inflammation, muscle spasms, and overall pain. As symptoms improve your physical therapist will help you to restore your normal mobility by implementing a stretching and strengthening program to provide better support to the structures of your foot, ankle, and lower extremities as well as extensive education on posture and body mechanics to help avoid future injury.