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Ankle/Foot pain

Achilles Tendonitis

Achilles tendonitis is a condition whereby there is acute inflammation in the large tendon at the back of the ankle. The pain can either originate where the tendon attaches to the heel (insertional tendonitis) or a few centimetres above the heel (non-insertional tendonitis). Achilles tendonitis tends to occur in people who engage in recreational physical activity such as running, high impact exercise and sports that involve jumping.

One of the most common causes for Achilles Tendonitis is excessively tight calf muscles. Initially treatment is aimed at reducing inflammation in the acute stage. Treatments such as taping the tendon, provision of heel lifts and ultrasound can quickly stem the inflammatory process and reduce pain. Soft tissue techniques are then employed to improve flexibility in the calf musculature and stretches and strengthening exercises are provided to aid the healing process at home.

As with any condition, we will always strive to understand the cause your condition. Often tightness in the calf muscles can be caused by poor supportive footware, progressive weight gain, overuse, training errors and weakness in the powerful hip muscles (the gluteals).

Achilles Tendinosis

This condition is different to an Achilles Tendonitis in that there is no inflammation present. It is a much more chronic problem and people may have been complaining of pain in the Achilles for many months. It is a condition which develops gradually and is associated with a thickening and degeneration of the tendon.

The pain is caused by abnormal blood flow due to a process called neo-vascularisation which develops within the tendon. It is thought that the blood vessels which form in the tendon have sympathetic nerve endings which give rise to the pain felt.

As with Achilles Tendonitis, it is important to understand why the tendon has become degenerative in this way so that these factors can be addressed. Treatment for this condition can be successful with manual therapy such as friction massage to the tendon, soft tissue mobilisation and massage. Evidence based exercises called eccentric strengthening are prescribed to rehabilitate the tendon and stretches are used to improve flexibility. It is important for the patient to realise that the Achilles tendon can take a long time to heal due to its inherent poor blood supply. In some cases, it can take up to three months of performing the exercises diligently before any significant improvements are realised.

Ankle sprain

Ankle pain � Ankle sprain

Ankle sprains are a direct result of a traumatic event to the ankle. The most common way of spraining the ankle is to invert the ankle. Inverted ankle injuries or inversion sprains occur when the foot rolls underneath you. This places all the weight of the body through the outer edge of the foot and ankle. Inversion sprains frequently occur in sports like football or can happen by simply miss placing the foot when stepping off a curb. It is common for there to be swelling present after an ankle sprain and for bruising to appear. This is because there is soft tissue damage to the ligaments and muscles resulting in bleeding and swelling due to an inflammatory response by the body.

Ankle sprains can vary in severity from a mild trauma to the soft tissues to complete rupture of muscles, ligaments and bone fracture. It is very important that if you are unable to place any weight through the ankle following a sprain that you attend your local minor injuries unit so an X-Ray can be taken to ensure you haven�t fractured (broken) a bone.

It is advisable to follow the acronym P.R.I.C.E after sustaining an ankle sprain injury.

P stands for Protection

Protect the soft tissues in the ankle by reducing stress placed on the ankle. If the sprain is bad enough you may need to keep your weight off your foot for a few days by using a pair of elbow crutches.

R stands for Rest

Give your body a chance to heal and rest your ankle for the first 48-72 hours after the injury. The pain and swelling in the ankle will inhibit the action of the muscles supporting your ankle so trying to push through the pain will only prolong the recovery period.

I stands for Ice

It has been long established that cryotherapy (ice therapy) is the best form of therapy for an acute soft tissue injury. There are ice packs which are available on the market but a good old fashioned bag of frozen peas will suffice. It is very important that you wrap your ice pack up in a damp cloth or tea towel before applying it to your ankle. Direct contact with ice to the skin can result in an ice burn in addition to your already painful ankle. You should apply an ice pack to your ankle for the first 2-3 days after your injury.

The application of cold to the ankle will help constrict the blood vessels thereby stemming any bleeding and help divert the swelling away from the injured tissues. The coldness from the ice will also act as a really good pain killer by gently numbing the area. It is advisable to only apply the cold pack for 10-15 minutes. After this time you should remove the ice pack. Once the tissues have returned to normal body temperature the ice pack can be re-applied if desired.

C stands for compression

The application of a good support bandage like tubigrip can be really helpful to squeeze the swelling out and away from the damaged area. The bandage will also help prevent the damage tissues from being over stretched thereby allowing the tissues to �knit� together quicker and hasten the healing time. The bandage should only be worn during the day and removed at night for sleeping in case the bandage were to be too tight and restrict circulation.

E stands for elevation

Try and elevate your foot above the level of your hip whilst resting your ankle. The nearest lymph nodes (like drains in your body) to your ankle are located in the groin. Elevating your ankle will encourage any swelling to drain away towards the lymph nodes in your groin.

Physiotherapy is recommended following an ankle sprain injury to help restore joint range of movement, strengthen the ankle muscles and improve balance and reaction time in the ankle. This is essential to prevent the ankle from becoming weak and �giving way� when walking on uneven surfaces.

Plantar Fasciitis

The plantar fascia is a tough fibrous band of tissue which acts like a ligament to support the arch of the foot. It attaches to the heel of the foot and extends and fans out to attach into the toes. Its role is to support the arch of the foot and act like a spring to aid propulsion when walking.

The plantar fascia is subjected to large forces during every day movement and is perfectly designed to cope with this. As with other structures in the body, the plantar fascia can become overloaded and strained. Overload to the plantar fascia can arise from poor supportive shoes, increased weight gain and training errors such as increasing training volume/increasing running distance too quickly. Having excessively tight calf muscles is also a very common cause for getting plantar fasciitis as the tightness in the calf causes an excess pulling effect on the plantar fascia during walking. Excessive tightness in the calf muscles can be due to wearing high heeled shoes, excessive exercise or due to weakness in the hip muscles thereby placing more strain and load on the calf.

When the plantar fascia is overloaded, micro tears appear which then scar over. This process can gradually build which causes the plantar fascia to tighten and become weakened. Patients will normally feel pain underneath the heel and can feel pain along the arch of the foot. The pain is normally worse on getting out of bed first thing in the morning, after walking long distances or after a long period of sitting and then standing to walk.

Physiotherapy can be very effective in improving this painful foot condition. Treatment is aimed at improving the flexibility to the foot and giving the arch of the foot more support. This can be achieved with taping/strapping or orthotic insoles. Stretches are also given as well as exercises to strengthen the arch and intrinsic muscles in the foot.


For more information or to book an appointment please call 01322 275 402 or email info@westhillphysio.co.uk. Alternatively please feel free to complete the form below.
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