Foot and Ankle pain

Ankle sprains

Ankle sprain is an overstretching of the ligaments more commonly on the outside of the ankle joint. It normally occurs with a change of direction or landing from a jump and people complaining of rolling the ankle.

Ankle sprains vary from Grade 1 to 4 in severity. Grade 1 sprains are often a mild problem with people often continue playing on however a grade 3-4 sprain would be a severe injury requiring crutches to walk. It is important that the ankle is x-rayed the pain is severe enough as the fibula bone might be fractured or broken.

Like any ligament sprain the best treatment for the first 2-3 days is the use of rest, ice, compression and elevation (RICE). Physiotherapy can help speed the recovery in the early stages and help reduce the pain with ultrasound and interferential therapies.

Once the pain and swelling is controlled, physiotherapy skills are used to help get the ankle movements and then strength back, to help return the patient back to exercise. The most common problem when returning to activity after a sprain is re-injury. So make sure you do all the exercises to prevent this from happening.

Achilles tendon injuries
Info to follow

Plantar fasciitis
Plantar fasciitis (PF) is a common orthopaedic problem, affecting a wide range of adults, athletes, especially runners (10%), and children. It is an overuse condition that can be classified as a syndrome resulting from repeated trauma to the plantar fascia at its origin on the medial tubercle of the calcaneus, causing inflammation of the plantar fascia and the perifascial structures.

It commonly results from activities that require maximal plantarflexion of the ankle (pointing toes down) and simultaneous weight transfer up onto the toes, leading to dorsiflexion of the metatarsophalangeal joints, such as running, jumping and dancing.

Repetitive activities such as running, jumping and dancing lead to repetitive tensile overload of the plantar fascia. Forces generated during pronation and supination can increase plantar fascia tension on an inefficient foot function leading to increased tissue stress. This can progress to an inflammatory process and degeneration of the tissue structure (similar to that found in tendinosis), possibly with formation of a relative heel cord contracture in the medial region of the foot.

Patients with PF report pain and/or stiffness localised to their heel (mainly in weight-bearing) which may extend distally to the arch of the foot. Pain can be most noticeable first thing in the morning when putting your foot to the floor and taking those first few steps to the bathroom or descending stairs. The pain tends to ease during the day.

Biomechanical abnormalities of the foot may be significant contributing factors in the development of PF. A physiotherapy assessment must first differentially diagnose the underlying cause. Treatment is aimed at reduction of the inflammation, decrease of the tension on the plantar fascia, restoration of the tissue strength and mobility, and controlling any biomechanical impairment. This injury responds very well to injection therapy if conservative measures do not resolve the issues. We do injections here in the clinic. Ask reception for details.

Reconstructive foot surgery

My thanks to Body Logic Physiotherapy, Perth for kind permission to reproduce some text