Ankle & Foot Pain

ankle pain

Most people’s first point of contact with the ground and the main shock absorber for the initial ground reaction force on weightbearing is the feet and ankle joints. Therefore they need to be functioning well and not used & abused to excess if you are to enjoy pain free feet & ankles. Dysfunction of the feet/ankles is also a common underlying cause of low back pain & knee pain. Common foot/ankle conditions such as plantar fasciitis, achilles tendonitis and shin splints are discussed in this article along with general foot/ankle care.

Plantar Fasciitis: Yes even us therapists struggle to say it correctly but its even harder to live with if severe. Characterised by sharp, burning pain under the heel especially on initial weightbearing first thing in the morning. It is often temporarily relieved by wearing heels although wearing heels is actually one of the main long term causes of it! Basically the plantar fascia is a long piece of connective tissue supporting the arch of the foot running from the toes to the heel. Repetitive tugging on this fascia usually occurs near the heel end and becomes increasingly more painful although people often have good & bad days with it.

The main reasons for the repetitive strain to the plantar fascia are, in no particular order, obesity, diabetes, over or hyper pronation of the foot, excessively tight calf muscles, too much walking/running (for your current level of fitness) and wearing high heels (tightens calf muscles). The symptoms can last anywhere from a few months to several years depending on what you do about them. Calf stretching is the most obvious self help remedy and you can also ice the plantar fascia regularly and massage it by freezing a small bottle of water and then rolling your foot over it a few times each day.

What can we do for you? Biomechanics of the feet/ankles/hips and pelvis are usually poor in people suffering plantar fasciitis so manipulation/mobilisation of any restricted areas in the lower limbs/pelvis can help reduce pressure on the plantar fascia. If you can bear the pain deep tissue massage to the calves is a great way to relieve plantar fascia tension and IASTM/kinesiotaping can also both help with this. Fortunately we offer all these treatments.

What can you do for yourself? Other than calf stretching and ice bottle foot massage described above you need to look at having appropriate footwear at least some of the time especially if you wear heels a lot. Trainers especially those with a supported arch will ease some of the repetitive strain on the foot. If you are overweight/diabetic then eating healthier will help. If you recently increased your physical activity significantly then reducing this will help and when you are ready to do more again try a more gradual increase in walking/running distances to allow your body more time to adapt.

Achilles Tendonitis: Not too different to plantar fasciitis in terms of causes. The pain will be in the achilles tendon behind the ankle. It will be worse with prolonged inactivity and get easier as you walk/run although if you do too much it will get worse again after. Basically the achilles tendon is being repetitively strained by overuse and/or poor biomechanics of the leg/pelvis. Tight calves is a more obvious cause but by the time achilles tendonitis has settled in it will be difficult to stretch the calves due to pain, eccentric calf stretches will work better.

The longer you put up with achilles tendonitis for the worse it will likely get and the more at risk you will become of snapping the achilles especially if you run a lot. This would be a serious injury requiring surgery ASAP. Another less obvious cause of achilles rupture is long term steroid use, the achilles tendon becomes so weak because the steroids stop it healing that one day it can snap from something as innocuous as turning whilst just walking around at home.

What can we do for you? Biomechanics of the feet/ankles/hips and pelvis are usually poor in people suffering achilles tendonitis so manipulation/mobilisation of any restricted areas in the lower limbs/pelvis can help reduce pressure on the achilles. If you can bear the pain deep tissue massage to the calves will help reduce tension on the tendon and IASTM/kinesiotaping can also both help with this. Eccentric stretches (see below) can be done at home but they are complicated to learn so at least one session in clinic is a good idea to get the hang of this technique under supervision.

What can you do for yourself? Other than calf stretching and icing the achilles you need to look at having appropriate footwear particularly when exercising. Trainers especially those with a supported arch will ease some of the repetitive strain on the ankle. Orthotics can help with this too, the cheap ones may fit your biomechanical dysfunction by chance, but you may need to have a proper assessment and have custom orthotics made. A podiatrist can help you with this. If you are overweight/diabetic then eating healthier will help. If you recently increased your physical activity significantly then reducing this will help and when you are ready to do more again try a more gradual increase in walking/running distances to allow your body more time to adapt.

Shin Splints: Basically another repetitive strain injury from poor biomechanics and/or overuse. With shin splints the tibia (shin bone) is the location of the pain and damaged tissue. It is not unusual by the way for any of the 3 conditions described on this page to co-exist as they all come from the same causes. Shin splints can progress to a tibial stress fracture or rupture of the shin muscles from the bone. Compartment syndrome is also another possible outcome from severe or prolonged shin splints.

What can we do for you? Biomechanics of the feet/ankles/hips and pelvis are usually poor in people suffering shin splints so manipulation/mobilisation of any restricted areas in the lower limbs/pelvis can help reduce pressure on the tibia. If you can bear the pain trigger point therapy massage to tibialis anterior/posterior will help reduce tension and IASTM/kinesiotaping can also both help with this. A review of your training program will also likely help identify any areas of overuse/poor form. Appropriate strengthening exercises can be given to reduce the strain long term.

What can you do for yourself? Other than calf stretching and icing the shins you need to look at having appropriate footwear particularly when exercising. Trainers especially those with a supported arch will ease some of the repetitive strain on the tibia. Orthotics can help with this too, the cheap ones may fit your biomechanical dysfunction by chance, but you may need to have a proper assessment and have custom orthotics made. A podiatrist can help you with this. If you are overweight/diabetic then eating healthier will help. If you recently increased your physical activity significantly then reducing this will help and when you are ready to do more again try a more gradual increase in walking/running distances to allow your body more time to adapt.

What does the evidence say? NICE do not offer much specific guidance on these topics but they did not find enough evidence to currnetly recommend blood injections for plantar fasciitis or extracorporeal shockwave therapy for either plantar fasciitis or achilles tendonitis. The Bronfort report supports the use of manipulation/mobilisation with exercise for plantar fasciitis. A small trial (60 people) found a benefit to physical therapy for plantar fasciitis particularly in those who had symptoms for less than 7 months before starting treatment.

Exercises for ankle/foot dysfunction – Even though this page deals with 3 separate conditions affecting the foot/ankle and there are several other conditions possible too the majority of them come down to similar dysfunctions. Therefore the exercises below are good for general ankle/foot rehabilitation with some specific exercises where mentioned.

Eccentric Calf Stretching for achilles tendonitis: Please note this is different from standard calf stretching or calf raises for strengthening. Begin on tip toes having used the other leg to raise yourself up to this point. Only use the bad achilles to slowly lower yourself (preferably with some weight) below the level of a flat foot. Therefore this is best done on a step. If at a gym the smith machine or a specific calf raise machine is best as these will help with balance during the stretch. Do not push back up with the bad leg, note the leg change in the picture below! Repeat up to 10 times per day.

eccentric calf stretch

General calf stretch: This is one everyone should really do daily as most of us have excessively tight calves. This will be especially true if you wear heels regularly, run a lot, have a sedentary job. Lower your heel off the edge of a step until you feel a stretch in the calves, if your achilles feels sore see the exercise above instead. If your feeling it more in the front of the ankle then you should see your chiropractor about ankle/foot manipulation. Hold the stretch for 30 seconds.

calf stretch

Foot flexor strengthening (arch): To build up the muscles of your foot arch simply try scrunching up a towel with your toes. This is particularly easy to do if you remember to do a few when you are stood on a towel/bath mat after a shower. For extra work try bending the toes up towards the ceiling whilst you push your big toe into the ground and vice versa.

Ankle Mobilisation: You could just draw circles in the air with your ankle but if you want more of a challenge try drawing letters or numbers.

Balance training: Start by standing in the corner of a room if you are worried about falling over it will be easy to catch yourself against the walls. Try and stand on one leg with a nice upright posture for up to 30 seconds. If this is easy try doing it with your eyes closed. If you have mastered the 30 second hold then try holding your balance whilst bringing the other leg up in front of you and then back behind you as if you were running. You could go into a hip hinge like the picture below but to begin with just try remaining upright while you swing the non stance leg. Repeat these leg swings 10 times each leg. If you have mastered that try it with your eyes closed!

1 leg balance