Ankle and Foot Pain
Our feet and ankles are incredibly complex structures. In fact, did you know the human foot has 26 bones - a quarter of all the bones in our body! It is also made up of 33 joints, and more than 100 muscles, tendons and ligaments, not to mention a sophisticated network of blood vessels and nerves(1).
Every day our feet are put under significant load during activities of daily living such as walking and running. During walking alone, the ankle and foot are exposed to reaction forces of approximately three to six times our body weight (2). The ankle and foot play an essential role in stability, load transfer and balance during locomotion (3). It is not surprising that at times things go wrong and injuries occur.
Foot and ankle problems cause significant pain and dysfunction for the individual. Some very common foot and ankle injuries are:
· Ankle Sprains
· Achilles Tendinopathy
· Plantar Fasciitis
An ankle sprain or ‘rolled ankle’ is a very common and painful condition involving micro to frank tearing to the ligaments in the ankle. Approximately ninety percent of ankle sprains involve ligaments on the lateral side of the ankle, in particular the anterior talo-fibular ligament (ATFL)(4). Initial treatment for an acute ankle sprain involves the RICE principle (Rest, Ice, Compression and Elevation). Further management depends on the grade of the ankle sprain. It may include strengthening, balance retraining, footwear prescription, manual therapy and sports specific drills(5).
The plantar fascia is an important structure on the inside of the foot that acts as a ‘sling’ to support the arch and to provide shock absorption. Plantar Fasciitis is an overuse condition, and those affected often have pain of the heel and mid foot that becomes exacerbated by prolonged standing and walking. It is often worse with taking the first few steps in the morning. Those with low or overly high arches are more prone to developing Plantar Fasciitis. Being overweight also increases the risk. Treatment including stretches, ankle mobilisations, massage, taping and acupuncture are effective in providing pain relief. Non-steriodal anti-inflammatory drugs and cortisone injections can provide short term relief but need to be combined with more long term solutions such as correct foot wear and improved control of the lower limb to address the underlying problem (5,6).
The Achilles tendon attaches your calf muscle to your heel. It is the strongest tendon in the body and is placed under a great deal of stress with activities that involve running, jumping or prolonged walking. Those suffering from Achilles tendinopathy usually report pain at the back of the heel and distal calf area. It often occurs following an increase in training volume or intensity, although sometimes can occur in those who are relatively inactive. Treatment includes a very specific form of eccentric (lengthening) strength exercises depending on whether the mid-portion or insertion of the Achilles tendon is most implicated(5).
The symptoms of an ankle fracture can be similar to those of ankle sprains but are often more severe. The ankle will usually be painful and swollen with an inability to weight bear on the foot. Pain due to a fracture is usually well localized. Stress fractures occur in the weight bearing bones of the ankle and foot due to repeated load over time. In athletes it is often as result of overtraining and inadequate footwear (5). Please contact your health professional if you are concerned you may have a fracture. A simple Xray is the first line of investigation if a fracture is suspected, but a CT scan or MRI may be required. Immobilization in the form of a cast or boot and cessation of activity on that limb is required. Rehabilitation can then resume post immobilization to restore range of movement, strength and flexibility.
Many foot and ankle injuries are preventable, particularly overuse injuries. Some management principles can be applied to both prevent injuries and relieve your condition if you already have an injury.
APMA would like to thank the Fortus Health for permission to reprint this information.
1. Gray's Anatomy: The Anatomical Basis of Medicine and Surgery (British Edition. 40th Ed) (2008).
2. Hills A P, Hennig E M, McDonald M and Bar-Or O. Plantar pressure differences between obese and non-obese adults: a biomechanical analysis. International Journal of Obesity (2001) 25, 1674-1679
3. Marieb E N, Hoehn K. Human Anatomy & Physiology. (2007). Pearson Education.
4. Aronen JG, Garrick JG. Acute Ankle Injuries, Part 2: Treatment of Uncomplicated Lateral Ankle Sprains. Consultant. 2009; 49:734-740.
5. Brukner P, and Khan K. Clinical Sports Medicine. Revised Second Edition. (2008). McGraw-Hill Australia Pty Ltd.
6. Kangas J, Dankaerts W, Staes F. New approach to the diagnosis and classification of chronic foot and ankle disorders: Identifying motor control and movement impairments. Manual Therapy (2011), 16:6, 522-530.
This sheet contains general information only and should in no way be considered as a substitute for the advice and information provided by your health care professional about your particular condition. Please seek advice from your health professional if you have any concerns about symptoms.