Foot and ankle pain

The main function of the foot and ankle is to provide stability as we move around, whether it is during spots or everyday activities. Our feet and ankles play an important role in keeping the rest of our body stable and mobile, as they absorb the impact of walking, running and jumping, and ensure that we can stand without putting unnecessary pressure on other muscles or joints.

Alignment of the feet and ankles have significant importance, not only for their own health but also to reduce the risk of knee, hip, and spinal complications. In saying that, a malalignment can result in injury to not only the foot and ankle, but to the knee, hip, and lower back as well. Besides causing pain in the food and ankle, it can also affect your posture and functional movements like walking and running. This is why ankle pain treatment is so important.

There are different factors that can cause ankle or foot pain.
Common causes of pain in the ankle include:

• • • Ligament injury, commonly a sprain or tear – It can occur at any age group due to:

1. 1. 1. 1. 1. Awkwardly planting or landing on your foot when running.
            2. Landing unbalanced from a jump or hop.
            3. Stepping unto an irregular surface.
            4. Sports that involve swift direction changes, like soccer or rugby

• • • Achilles tendon injury.
    • Dislocation
    • Fracture
    • Retrocalcaneal bursitis
    • Anterior ankle impingement
    • Posterior ankle impingement

Common causes of pain in the feet include:

1. 1. 1. 1. Plantar fasciitis – inflammation of the tissue that connects the toes to the heel bone
         2. Navicular stress fracture – overuse injury resulting in cracking of the navicular’s (bone in the foot) outside layer
         3. Lisfranc injury – injury to the bones or ligaments of the midfoot
         4. Hallux limitus/rigidus – limited movement in the big toe
         5. Hallux valgus – deformation of the foot, often causing a bump on the side of the foot
         6. Osteoarthritis
         7. Gout
         8. Sever’s disease – inflammation of the growth plate located at lower back of heel where Achilles tendon attaches
         9. Heel spur – bony outgrowth at the bottom of the heel
         10. Peroneal tendonitis – structural changes to a tendon that provides stability to the ankle
         11. Cuboid syndrome – injury of joints/ligaments near cuboid bone in the foot including movement of the bone
         12. Tibialis posterior tendinopathy
         13. Metatarsalgia
         14. Pes planus / flat feet
         15. Morton’s neuroma
         16. Plantar plate injury
         17. Tarsal tunnel syndrome
         18. Muscle/tendon strain

You can often find swollen legs, feet, or ankles in older people. This can be an indicator for an injury, especially if reported in conjunction with pain. However, there are other reasons for swollen ankles in elderly. Swelling (‘edema’) is generally caused by excess fluid, that sits in the body tissue and is being pulled down by gravity. Some possible causes are vein blockage, injuries, arthritis, but also just sitting or standing for a longer period of time as this can make it hard for the body to pump fluids back up. It is best to see a doctor to get a diagnosis before threating swollen ankles in elderly.

You may experience the following symptoms at the time of injury:

• • • A ‘popping’ sound at time of injury
    • swelling
    • bruising
    • pain
    • inability to put weight on the affected foot
    • general stiffness

If you experience any of the above symptoms you should see a doctor for an official diagnosis.

Treatment after any acute ankle injury (such as a sprain) should always consist of the RICED principles (rest, ice, compress, elevate, do no harm and avoid HARM factors in the first 48 – 72 hours).

After the injury has healed enough (the period of time depends on the severity of the injury), regaining active movements of the ankle joint needs to occur (e.g. drawing letters of the alphabet with your ankle). This includes improving strength, balance and proprioception with the help of specific exercises as guided by your Physiotherapist.

Correction of poor biomechanics, pain management and improvement of functions are the main goals of physiotherapy as part of your foot and ankle pain treatment.

There are many potential reasons for foot and ankle pain, as mentioned above. Hence, there are many potential physiotherapy treatment options, depending on the cause of your pain. Our therapists will always thoroughly examine you to rule out any red flags. These red flags are signs and symptoms that might indicate a more serious condition. If needed, you will be referred for scans (x-rays, ultrasounds and MRIs) and any further tests required to rule out potential other reasons for your pain.

Once you have been cleared of any red flags, our therapists will perform a series of tests to assess the bones, joints, cartilage, muscles, tendons and ligaments of the foot and ankle. This will help us diagnose your condition and prepare a personalised treatment plan.

Our therapists can provide you with the following treatment:

• • • Education on early injury treatment (RICED etc.)
    • Education on how to avoid the HARM (Heat, Alcohol, Running/Exercise, Massage) Factors in the first 48 – 72 hours after injury occurred
    • Acupuncture and Dry Needling
    • Soft Tissue Injury Treatment
    • Closed Kinetic Chain Exercises
    • Active Foot Posture Correction Exercises
    • Gait Analysis
    • Biomechanical Analysis
    • Proprioception & Balance Exercises
    • Agility & Sport-Specific Exercises
    • Orthotics recommendation
    • Soft Tissue Massage
    • Brace or Support recommendation
    • Dry Needling recommendation
    • Electrotherapy & Local Modalities
    • Heat Packs
    • Joint Mobilisation Techniques
    • Kinesiology Tape

The goals of physiotherapy after a surgery include:

• • • Decrease pain
    • Decrease inflammation
    • Increase strength
    • Increase range of motion
    • Improve dynamic and static balance
    • Improve proprioception
    • Proper independent ambulation

Our therapists will follow the four rehabilitative phase management to ensure that your goals are met. These phases include:

• • • Initial rehab 0 – 4 weeks: Usually started while in hospital and continued when discharged in an outpatient setting.
    • Recovery rehab 4 weeks – 3 months
    • Intermediate rehab 12 weeks – 6 months
    • Final rehab 6 months – 1 year