Ankle Pain Education

Ankle Pain

All of our lives begin from the ground up! When speaking in terms of the human body, this means that we have a functional dependency on the ankle, it is what connects the rest of our body to the earth. The ankle is one of the most commonly used/abused and underappreciated joints of the body; we don’t appreciate its true value until it begins to pain us. We walk and run on it day in and day out and often pay it very little attention minus a bit of washing and trimming. It is very common to hear of people complaining of ankle soreness that slowly begins to impinge on their lifestyle. The result of a mild limp because of ankle pain can begin to turn into knee, hip or back pain. By quickly addressing issues at the ankle, not only can you prevent things from becoming more severe, but you can help deter some other aches/pains.

Plantar Fasciitis:

Problem

The plantarfascia is a band of connective tissue that supports the underside of the foot (it runs from the heel and fans out to the toes). This band of tissue can become inflamed and painful from running, jumping, etc. This often stems from excessive tightness in the tissue as well as tightness in the calf muscles. The pain can be “point specific” or is more severe cases the whole bottom of the foot can be painful.

Symptoms

Pain on the underside of the foot which is often worse when getting out of bed in the morning and/or after prolonged periods of sitting.

How Peak Physical Therapy can Help

A Peak Physical Therapist can immediately help control the pain and inflammation through the use of ultrasound, massage, electric stimulation, etc. In addition, the therapist will specifically identify the true reason for your pain and functionally begin to correct it giving you long-term relief.

Ankle Sprain

Problem

An “overstretching” of the ligaments that surround the ankle. (Ligaments connect bone-to-bone). This is commonly referred to as “rolling your ankle”. When you “roll your ankle”, your ankle rolls to one side in such a manner that the muscles can no longer support it at which time the ligaments provide the last source of stability. When your ankle rolls further, the ligament become “over stretched” or sprained the more severe the overstretching, the more severe the sprain; ankle sprains most commonly occur on the outside of the ankle.

Symptoms:

  • Pain over the ankle.
  • Swelling (the more severe the sprain, the more swelling).
  • Possible brusing of the ankle, which may settle in the bottom of the foot.
  • Limited range of motion.

How Peak Physical Therapy can Help

The best time to handle an ankle sprain, is IMMEDIATELY. The faster you control the inflammation, and begin restoring motion the faster you will heal. Peak Physical Therapy will initially focus on controlling the pain/inflammation with the introduction of gentle motion exercises. They will give you home instructions on how to care for your ankle and through the course of rehabilitation progress you with functional exercises to help you return to full activity.

Ankle Tendonitis

Problem

The lower leg muscles (gastrocnemius and the soleus) join together at the back of the ankle to form the Achilles tendon. “Tendonitis” is when the Achilles Tendon becomes inflamed and painful. Tightness and weakness of the tendon can place undue stress on the tendon aggravating it, in addition poor footwear or specific activities (if not adequately prepared for) can irritate the tendon.

Symptoms

  • Pain at the back of the ankle/heel
  • Symptoms increase when getting out of bed/after prolonged sitting, with fast walking, walking up hills, walking up stairs, running.

How Peak Physical Therapy can Help

A peak physical therapist will identify the underlying cause of your tendonitis and begin to correct the reasons for it to persist. Through the use of modalaties (ultrasound, soft tissue techniques, electric stimulation), they will help control your pain/inflammation. Additional arch supports or modifying your footwear may be necessary to decrease the stress to the tendon. Based on your daily activities, work, recreation you will be set up on specific exercise to get you back into all those activites without pain and the risk of reinjury.

Ankle Bursitis

Problem

Irritation of the “bursa” that lies either on top/or underneath the Achilles tendon. A bursa is a fluid filled sac whose purpose is to act as a cushion between 2 surfaces, preventing friction and irritation. There is a bursa that lies underneath the Achilles tendon (between the tendon and the bone) in addition to a bursa on top of the Achilles tendon (between the tendon and the skin). The bursa can become irritated from tight calf muscles, poorly fitted shoes, from being struck or hit by something, or certain activities that have placed too much stress on the bursa.

Symptoms

  • Pain at the back of the heel (this may be at the Achilles tendon or at the sides of the tendon)
  • Symptoms increase when getting out of bed/after prolonged sitting, with fast walking, walking up hills, walking up stairs, running.

How Peak Physical Therapy can Help

Bursitis will be handled much like Achilles tendonitis. A peak physical therapist will identify the underlying cause of your tendonitis and begin to correct the reasons for it to persist. Through the use of modalaties (ultrasound, soft tissue techniques, electric stimulation), they will help control your pain/inflammation. Additional arch supports or modifying your footwear may be necessary to decrease the stress to the tendon. Based on your daily activities, work, recreation you will be set up on specific exercise to get you back into all those activites without pain and the risk of reinjury.

Achilles Tendonitis

Achilles tendonitis more common in middle-aged runners (not that I qualify) and “weekend warriors” and accounts for 5-18% of running injuries. The Achilles tendon is more vulnerable to injury as it is covered by a peritendon sheath making it more susceptible to inflammation, has a poor blood supply 2-6 cm above where it attaches to the calcaneus (heel), and twists 90 degrees 12-15 cm above its insertion.

Symptoms of Achilles tendonitis include:

  • Sharp, achy pain located in the back of the lower leg or the Achilles tendon.
  • Thickening of the tendon.
  • Pain worsens with activity.
  • Morning stiffness.
  • Tightness in the calf and Achilles tendon.
  • Decreased ankle flexibility especially with pulling the foot up (dorsiflexion).
  • Swelling over the Achilles tendon.

The following are possible causes of Achilles tendonitis:

  • Faulty running form such as a “heel whip” during swing phase, excessive pronation in stance phase, or overstriding.
  • Running on cambered roads or uneven surfaces.
  • “Eccentric” weakness in the calf muscles.
  • Hamstring weakness/tightness.
  • Pelvic rotational abnormalities.
  • Lack of stretching the calf muscles before and after running.
  • High mileage.
  • Higher training intensity.

Sound familiar? What can be done to abolish the symptoms of Achilles tendonitis and get you back to running? I’m glad you asked. If you already have symptoms, try to decrease running mileage or try alternative cross-training activities like biking, swimming, or aqua jogging. Use ice to aid in inflammation. Perform gentle calf stretching. Make sure to stretch hamstrings too. Consulting a licensed physical therapist may be beneficial to get an accurate diagnosis and professional instruction to strengthen weak muscles (such as calf muscles, hamstrings, and hip muscles) and increase flexibility in tight muscles. Often weakness in the hip stabilizing muscles can alter running form and cause pain in structures further down the leg such as the knee or ankle. Peak Physical therapists can also provide modalities to decrease inflammation such as ultrasound, electrical stimulation, and iontophoresis. Peak Physical therapists can also address pelvic rotational abnormalities & leg length issues by performing manual therapy techniques or address the needs for a heel lift or orthotics. Balance exercises can also be instructed to help stabilize the ankle.

If you trail run like I do an ankle sprain is always a likely possibility. Commonly, ankle sprains occur when the foot turns inward (inversion sprain) and usually affect the anterior talofibular ligament and occasionally the calcaneofibular ligament. Aside from pain, ankle sprains can result in swelling/inflammation and bruising in the foot and ankle. When treating a fresh ankle sprain, first think “RICE.”

R – REST. Take some time off from activity. Prevents further injury and avoids stress on already inflamed tissue.
I – ICE. If applied soon after injury, ice prevents much inflammation from developing and can reduce swelling, redness, and warmth.
C – COMPRESSION. Using an ACE wrap can provide support, limit motion of the ankle, and limit inflammation.
E – ELEVATION. Try to prop the ankle up so it is above the level of the heart. This will help the body absorb inflammation.

If you are able to get into a swimming pool soon after spraining your ankle this can greatly aid in decreasing inflammation due to the hydrostatic pressure of the water increasing venous return. Aquatic activity is also a great form of cross training. If you don’t have access to a pool, a contrast bath may provide the same benefit. Soak your ankle for 2 min in cold water, followed by 1 min in hot water, then back in the cold water for 2 min. You can repeat this cycle but always end with the cold water.

Peak Physical therapy can also aid in ankle sprains by applying modalities to decrease inflammation (ultrasound, electrical stimulation, ice), instruct in appropriate range of motion and strengthening exercises, and initiate appropriate balance/proprioception exercises to help strengthen ankle stabilizers to prevent re-injury.

To prevent Achilles tendonitis or ankle sprains avoid increasing your mileage or intensity too fast and watch where you step. Incorporate regular stretching before and after your run for the calf muscles and hamstrings. Perform appropriate strengthening for the calf muscles and the entire leg. Integrate balance exercises into your regular exercise routine. To learn exercises that are specifically appropriate for you, consult a licensed physical therapist. Peak Physical Therapy offers free consultations that could help guide you in appropriate interventions if you have one of these injuries or prevent you from sustaining these and other types of injuries.


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