There is not one body part that when it is hurting, everything else starts to hurt. The foot and ankle are no different. In a lot of ways, having foot or ankle pain limits our ability to do one simple thing – walk. Walking is key to daily movement and once we start to compensate due to pain, the whole system can get out of whack. What first comes to mind with the foot and the ankle are ankle sprains. Only about 50% of ankle sprains seek medical consultation and are the most common ankle and sport related injury (1).
With the foot and the ankle there are several key injuries that physical therapy can help with: lateral and medial ankle sprains, chronic ankle instability, Achilles tendinopathy, and plantar fasciitis.
Sprains:
- Lateral ankle sprains are common. Ankle stability is provided by the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL) and the calcaneofibular ligament (2, 3). Once there is an injury the goals are to 1) limit the degree of the injury, 2) restore range of motion, balance, and strength, 3) increase agility and endurance and 4) facilitate return to sports (3, 4).
- Medial ankle sprains are less common than lateral ankle sprains. The sprain occurs due to an injury to the deltoid ligament and/or the spring ligament (5) when the foot is excessively moved outward with force or even a significant force applied from the outside to the inside of the ankle.
Chronic ankle instability is a term used to describe consistent reinjury of the ankle ligaments, even to the point where some ligaments may be completely torn. This occurs with the person who states: “I am always rolling my ankles.”
Achilles tendiopathy – includes Achilles tendinitis and Achilles tendinosis – is generally associated with a sudden increase in activity but overall causation remains unclear (6). Treatment for Achilles tendinopathy consists of one very important factor – exercise (7). New insoles, heel lifts, taping, ultrasound and shockwave therapy do not have enough evidence to support using those tools to properly treat the tendon (6, 7). Dry needling specific to the Achilles tendon is currently being researched by the American Academy of Manipulative Therapy (AAMT) with positive outcomes for treatment based on the raw data. We have and implement these protocols and they have very good outcomes though the research is ongoing.
Plantar Fasciitis is heel pain with the first step out of bed that tends to decrease with more activity, but increases again with low activity. The most tender spot is pain on the underside (plantar) aspect of the heel toward the inner aspect of the heel. Treatment for plantar fasciitis is focused on restoration of active range of motion, improve muscular, tendon, and soft tissue length, and improving foot and ankle strength.
When we tear a ligament or a tendon, the conversation of “Should I have a surgery or not” comes up. The answer is, how much pain are you having? When there is minimal to no pain, a surgery may not be required. Certain ruptures like an Achilles rupture may or may not require surgery based on the surgeon. If there is significant pain, an inability to walk, and loss of function, a surgery is probably needed. We would recommend in either case a conversation with an orthopedic foot and ankle specialist.
