Ankle & Foot Pain
Acute or chronic ankle and foot pathologies are often debilitating and impact the ability of patients to play sport, go for a run or even walk the dog. The ankle and foot are made up of 26 bones and over 100 muscles, tendons and ligaments that must work toegether to produce efficient movement and force transmission.
Common ankle and foot pathologies treated successfully by physiotherapy include;
Shin splints and compartment syndromes.
Tibilais posterior, flexor hallucis longus and peroneal tendinopathies.
The ankle is made up of three joints; the talocrural joint, the inferior tibiofibular joint and the subtalar joint.
The talocrural joint is made us of the tibia
and fibula superiorly, and the talus inferiorly. The talocrural joint allows plantarflexion and dorsiflexion. This joint is least stable in plantarflexion and therefore injuries usually occur in this position due to the ligaments providing the majority of stability. The subtalar joint is made up of the talus and the calcaneus and provides inversion & eversion of the foot to accomodate for uneven surfaces and shock absorption during gait. The inferior tibiofibular joint is made up of the tibia and fibular, joined together by fibrous connective tissue called a syndesmosis. This joint provides a small amount of rotation that is important to running.
There are three ligaments that make up the lateral ankle ligament complex, the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). These ligaments are injured on landing in a plantar flexed and inverted position, with the toes pointed and foot rolled in, putting excessive load through these ligaments, with the ATFL most commonly injured compared to the CFL and PTFL.
The medial or deltoid ligaments look like a fan sprouting from the medial malleolus and is made up of a deep and superficial layer. Inversion
injuries are 4 x more common that eversion injuries due to the usual mechanism of injury and the lateral ligaments are significantly weaker than the medial ligaments.
Another less common type of ankle sprain is that of the syndesmosis. This injury is caused by dorsiflexion and internal rotation with the foot fixed to the ground. Here at Game Time Physiotherapy, it is becoming a more frequent presentation in clinic, as our therapists are currently working with rugby league teams in which syndesmosis or high ankle sprains are more common.
Ankle pain may not be linked to an acute injury but more of an overload of soft tissues or bone, with patients often reporting an increase in training load. Common overuse injuries of the ankle include; tibialis posterior tendinopathy, with medial ankle pain with excessive running or walking; flexor hallucis longs tendinopathy due to excessive toe flexion in ballet dancers or high jumpers, and peroneal tendinopathies; which are most common in people with flat feet and dancers, basketballs and volleyballers, where the peroneals can be overworked.
'Shin splints' is a frequent complaint in athletes in running sports and can effect two areas of the shin, anterior or posterior. Shin splints are most commonly due to;
Increased training volume in a short period of time.
Poor glute and core control through gait.
Running on hard surfaces.
Excessively pronated or supinated feet.
Tight hamstrings and calves.
Weak foot musculature or quadriceps.
Shin spints is generally a combination of muscle, tenoperiosteum and shin bone dysfunction, due to the above causes. Overuse of the lower leg muscles leads to tenderness, inflammation and muscular tightness, with the tibilais anterior (anterior shin splints) and the tibialis posterior (posterior shin splints) most commonly effected. All bones are covered by a layer periosteum, that provides an attachment site for tendons. The area where the tendon meets the periosteum is known as the tenoperiosteum and is almost always inflammed in patients with shin splints, due to the excessive pull on the connective tissue. Bone damage to the shin may also play a part in patients with shin splints. With any bony overload, a stress reaction occurs to accomodate for the increase pull on the bone, or in severe cases, a stress fracture may be present. Common shin splint symptoms include tenderness on shin palpation and a dull, aching pain in the front or back of the lower leg.
Compartments syndrome is caused by the increased pressure in one or more of the compartments in the lower leg. Each compartment is covered by fascia, which helps transmit force within and in-between muscles to allow efficent muscular contraction. The pressure within one or more of these compartments can reach levels that excessively compress the muscle, nerves and blood vessels from excessive activity or training, leading to pain. Symptoms of compartments syndrome include; pressure/tightness, cramping and burning sensations that are provoked by exercise and relieved by rest. The plantar fascia is a common source of pain and runs from the heel, into the bottom of the toes. The plantar fascia provides static support of the longitudinal arch of the foot and shock absorption during gait. It also provides support to the plantar ligaments and neural structures as you push off at the end of stance pahse. Pain in this area is often gradual, and is initially worse in the morning and relieved by walking. Periods of inactivity often provoke pain when activity resumes, with symptoms usually felt around the inside of the heel. In the sporting population, plantar fasciitis is often provoked with excessive running or dancing, whereas the older population report excessive walking in un-supportive shoes.
Archilles tendinopathy is another overuse injury that we see in the clinic every day here at Game Time Physiotherapy. Several muscles attach into this tendon, that then inserts into the calcaneus or heel bone, so when these muscles contract, the archilles tendon transmits force into the heel, pointing the toes as a result. With all other overuse injuries, the patient will report some change in training volume, shoes, training environment etc to create an overload to this connective tissue.
Have a question about your ankle or foot pain?
These conditions are just a few we see and treat successfully everyday here at Game Time Physiotherapy. If any of these presentations are similar to your pain, book an appointment online now or ask a question in the box below, so as a team, we can rid you of your foot or ankle pain to allow you to take control of your health and perform at your best.
Game Time Physiotherapy
1/449Lytton Road, Morningside QLD 4170