“What’s Going on with My Ankle?” part 2

This is the second of two posts where we are going to discuss some of the more common ankle and foot injuries that we typically see.  If you haven’t already, check out our ankle anatomy post and the first part of our most common ankle injuries post.

Overuse Injuries

Plantar fasciitis, plantar fascia, foot pain

The Plantar Fascia is located along the bottom of the foot. © Serdar Corbacı | Dreamstime.com

Plantar Fasciitis: The plantar fascia is a thick band of tissue that runs on the bottom of the foot from the heel to the ball of the foot.   Plantar fasciitis is essentially an inflammation of that fascia causing primarily pain and swelling.

There is no one specific cause to plantar fasciitis, but it can be caused by various intrinsic (biomechanic and anatomic) and extrinsic factors such as obesity, flat feet or high arches, muscle weakness, limited range of motion, walking barefoot, or poor footwear. It does not target one population or age group over another and therefore, it can be present in thousands of  high level athletes, weekend warriors, or those with sedentary lifestyles.  A lot of times the onset is generally similar to a stress fracture in that it can start a few weeks after starting a new activity or with any sudden change in any activities.

Some of the most common complaints with plantar fasciitis is pain in the heel/bottom of the foot in the morning when first putting your foot on the ground, pain with the first few steps after getting out of bed, or pain with the first few steps after sitting for awhile.  Additionally, there can be pain after walking or standing for too long as well.  A lot of times people will have pain with dorsiflexion and/or toe extension (bending the foot/toes up).

Plantar fasciitis is commonly treated in physical therapy with a series of stretches and strengthening exercises; night splints and orthotics will help in worse cases.  Surgery is an option for the most severe cases of plantar fasciitis.

Achilles Tendinopathy: Moving up the leg from the plantar fascia is the Achilles tendon.  It is one of the largest tendons in our bodies and it connects our gastroc/soleus (calf) muscles to the heel.  It is the bridge from our calf muscles to our feet as when the muscle contracts it pulls on the Achilles tendon which will creat ankle plantarflexion (pointing our foot down).

Achilles tendinitis, Achilles Tendinopathy, Achilles tendinitis

Inflammation of the Achilles tendon is tendinitis, however it is more common to have no swelling in the painful tendon indicating tendinopathy. © Aksana Kulchytskaya | Dreamstime.com

The term Achilles tendinitis indicates that there is inflammation in the Achilles tendon that is causing pain and swelling.  However, as our research and technology have improved our understanding of Achilles tendinitis has too.  In fact, most experts now agree that Achilles tendinitis is as not as common as Achilles tendinopathy.

So what is tendinopathy?  Tendinopathy (or tendinosis) is a condition where the collagen fibers (that make up our tendons) begin to breakdown.  This causes pain, reduced flexibility, and decreased range of motion.  However, there typically is no swelling associated with tendinopathy.  Which is why many experts believe it is more common in the Achilles compared to tendinitis since the majority of these cases have little to no swelling.

It is one of the most common overuse injuries in the ankle/foot and it can be classified into 2 categories: insertional and noninsertional. Insertional tendonopathy occurs in the heel, where the tendon attaches, while noninsertional happens in the middle of the tendon or on the back of the ankle.

There are numerous causes with overuse being one of the top, if not #1.  However, just like other overuse injuries it can start a few weeks after starting a new activity or with any sudden change in any activity duration, intensity, or frequency.

Symptoms may include pain that increases with activity, stiffness, thickening of the tendon, difficulty with walking, running, jumping and any activity requiring pushing off.  Less frequently swelling of the tendon occurs.

Non surgical treatments depend on the presence of swelling.  If swelling is present then rest and ice are more warranted.  In the absence of swelling then heat, stretching, eccentric loading, and strengthening exercises tend to work better. Severe cases or ruptures are surgically treated.

Posterior Tibialis tendinitis/tendinopathy: The posterior tibialis tendon is located on the medial side (inside) of the leg and runs down into the foot. It supports the arch and turns the foot in and down.   If swelling is present then it is tendinitis, if no swelling is present then we are looking at tendinopathy.

Typically the symptoms may include pain that increases with activity, stiffness, thickening of the tendon, difficulty with walking, running, jumping and any activity requiring pushing off.

Non surgical treatments depend on the presence of swelling.  If swelling is present then rest and ice are more warranted.  In the absence of swelling then heat, stretching, eccentric loading, and strengthening exercises tend to work better. Severe cases or ruptures are surgically treated.

Peroneal Tendonitis: There are 2 peroneal tendons that run on the side of our lower leg, wrap under the lateral malleolus (outside ankle bone) with one tendon attaching at the base of the little toe and the other one running across the bottom and attaching on the inside of the arch. Together, those two stabilize the arch and turn the foot out.

Peroneal tendonitis is an inflammation of these two tendons due to repetitive movements/overuse, poor footwear, improper training techniques, direct trauma, or ankle sprains. Symptoms present are pain, swelling on the outside of the ankle, possible bruising, decreased range of motion of the ankle.

Shin splints also known as medial tibial stress syndrome (MTSS), is another injury caused by overuse. Typically it occurs on the inside border of the shin bone (tibia) along the side where tibialis anterior muscle attaches.

Shin splints (or Medial Tibial Stress Syndrome) occur on the inside aspect of the tibia in our lower leg. ©Vectormind | iStockphoto.com

It is common in those who have increased or changed their activity level, athletes who are required to run for either prolonged periods of time or have constant explosive movements such as with sprints or jumping. Improper footwear or foot alignment can also contribute to the injury.

Some symptoms may include sharp pain in the area, tenderness to palpation, increase in pain during and post activity and symptoms are commonly present bilaterally.

Best treatment is rest. Other ways to alleviate the symptoms are with ice, compression, stretching, strengthening exercises, and utilization of orthotic inserts.

In severe cases shin splints can progress to a medical emergency known as compartment syndrome.  Pressure in the lower leg can create severe symptoms represented by the 5 P’s : paresthesia (tingling/numbness) in the toes, paresis (foot drop), pain (anterior tibia), pallor (skin color changes), and pulseless (no pulse in the lower leg). Immediate referral out is needed to prevent permanent damage.

 

If you are having any symptoms described in this article or have a new pain, numbness, stiffness or tingling in any part of your body, arms or legs, contact us today!  With Direct Access in NJ we can get you in for an evaluation without you having to see your Doctor, probably quicker than you could get that appointment, while also saving you both time and money!  

Please, call us to schedule your evaluation at one of BeneFIT’s locations, Bridgewater (908.203.5200) or Chester (908.879.5700)  with one of our highly trained Doctors of Physical Therapy!

 

 

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