Ankle & Foot Pain

The plantar-fascia is a thick band of tissue that runs from the heel to the big toe. It provides support to the medial arch of the foot.

Plantar-fasciitis is a common condition in which the plantar-fascia becomes irritated and sensitive at its attachment to the heel bone. This often presents as pain in the sole of the foot, particularly at the inner aspect of the heel. People with plantar-fasciitis can experience this pain when walking & running. It is often more severe first thing in the morning and on moving from static.

Risk factors for developing plantar-fasciitis include age, raised BMI, distance running, diabetes and sudden changes in activity levels.

The management of plantar-fasciitis include relative rest from the aggravating activities, a specific programme to stretch and progressively load the fascia and a graded return to activity. Adjunctive physiotherapy treatments including soft tissue treatment, acupuncture, taping & orthosis and shock wave therapy may also help.

Many cases of plantar-fasciitis resolve within six months of conservative treatment as described above. In more severe cases, where the pain is not improving as expected you may require a referral to a consultant to consider further treatment options.

A sprained ankle is a soft-tissue injury to the ligaments surrounding the ankle joint. It most commonly involves the ligaments on the outside of the ankle and occurs when you roll the ankle inwards. Ankle sprains are often graded out of 3 depending on how much soft-tissue is thought to be damaged.

Symptoms of a sprained ankle include pain, swelling, bruising, difficulty weight-bearing and ankle stiffness (most commonly pointing the toes or turning the foot inwards is restricted by pain). Also, as your ankle joint and ligaments provide your brain with a lot of feedback about where your ankle is in space, following an ankle sprain it is common to feel a bit unbalanced or as if your ankle may give way.

Most ankle sprains can be managed conservatively. Depending on the severity it may be appropriate to immobilise the ankle for a short period in a boot or brace to help it settle down and make weight-bearing easier. There is good evidence to suggest that early mobilisation and functional treatment produces better outcomes than immobilising the ankle for an extended period.

Most people who suffer from an ankle sprain make a complete recovery. Dependent on the grade of sprain the recovery may vary from 2 weeks to 6 months. In some more severe cases where the ankle is unstable, surgery may be appropriate although this is rare.

Physiotherapy following an ankle sprain may involve hands on treatment to restore range of movement, strengthening and balance exercises, taping or strapping, ultrasound and sports-specific rehabilitation in the later stages.

The Achilles tendon connects the muscles of the calf to the heel bone. Tendinopathy is the term used to describe an injury to the tendon and often occurs as a result of over-loading the tissues. Current research suggests that pain develops when the tendon regeneration process cannot keep up with the load being applied to the tendon. This often occurs due to sudden increases in activity levels, over-training and training error. Other factors including age, weight and smoking may also contribute to the development of Achilles tendon pain.

Symptoms of Achilles tendinopathy include pain and stiffness in the lower calf, the tendon and the heel. Pain and stiffness are often felt in the mornings and on moving from static positions. This usually settles with gentle movement. Walking and running can exacerbate the symptoms.

Achilles tendinopathy responds well to Physiotherapy. Pain and function generally improves with twelve weeks of rehabilitation and activity modification. A physiotherapist will be able to assess your symptoms and make recommendations regarding specific exercises to improve the load tolerance of the tendon. It may be necessary to reduce running or high impact activities in the initial phase your rehab; your physiotherapist will be able to advise you on alternate activities and a graded return to your sport.

Tibialis posterior (tib-post) tendinopathy is a common foot and ankle problem. It is an overuse injury to the tendon on the inner side of the ankle joint, just behind the ankle bone. It usually occurs as a result of repetitive activity or load, especially from high intensity activity such as running and jumping sports. Sometimes the tendon is injured as a result of a fall which can result in a tear. Obesity, diabetes and hypertension are all risk factors, as well as it being a more common injury in females and people aged over 40 years.

Symptoms of tib-post tendinopathy include pain around the inside of the ankle or arch of the foot. The tendon can be painful at its insertion into the navicular bone (a bone on the inside of the foot), or in the tendon itself behind the ankle bone on the side.

The pain may or may not be accompanied by swelling. It is usually painful or difficult to lift the heel when standing on one leg and to turn the foot inwards when the toes are in a pointed position.

Symptoms tend to be worse with high intensity activity although can be sore day to day when walking or climbing stairs when acute. It is also possible for the foot shape to change, or arch to drop resulting in a flat-foot deformity.

Most tib-post problems can be managed conservatively with Physiotherapy. Physiotherapy may include strengthening exercises for the tendon itself, or for other muscles throughout the leg where there may be a weakness (e.g. gluteal muscles). It may also include calf stretching, taping, ultrasound, soft-tissue work and gait re-education. Advice may be given regarding activity modification, footwear and orthotics. A referral may be made to a Podiatrist for custom-made orthotics.

In the early stage of the tendinopathy, non-steroidal anti-inflammatory medications may be helpful, or a steroid injection around the tendon to calm down any inflammation. There are also many surgical options available if conservative methods fail, some of which are very successful however the post-operative recovery time can be extensive.