Ankle and foot pain

What is it?

The Achilles is the large tendon that runs behind your ankle and attaches to your calf muscle. It plays an important role in running, walking and jumping.

An Achilles tendinopathy is often brought about by a change in how much the tendon is working day to day. We get pain as a protective mechanism to say that the tendon is struggling to keep up with what we are asking of it.

How is it managed?

The key principles of treating any tendon related condition are to progressively strengthen the tendon with a gradual increase to load. If you suspect you have an Achilles tendinopathy, the first step in managing the injury is to identify aggravating factors. Try and take note of when your pain it worse, for example, it may become painful after a long walk or run. We would then want to reduce the length or intensity of these activities initially (decreasing the load on the tendon) to allow your pain to settle. We then need to gradually strengthen the tendon with some targeted strengthening exercises.

Exercises:

You may get a small amount of discomfort when completing the exercises - this is normal. As long as this settles within an hour or so of completing the exercises then we are at an appropriate intensity.

https://versusarthritis.org/about-arthritis/conditions/achilles-tendinopathy/

Exercise images owned by: Wibbi (https://wibbi.com)

What is it?

A sprain refers to an injury to a ligament. The most commonly injured ligament in the ankle is the anterior talofibular ligament (ATFL). This can happen if you roll over on your ankle, turning your foot inwards. There may be swelling and bruising around the outside of your ankle, which may be tender to touch. Your ankle may feel unstable, and it might be painful when putting weight through the foot.

How is it managed?

There are different degrees of ankle sprain, and the recovery time will change depending on the severity.  This can range from several weeks to several months. Most ankle sprains are generally managed conservatively, without the need for surgical intervention.

For the first 2 weeks you will want to adopt the RICE protocol: Rest, Ice, Compression and Elevation to help with swelling and pain. You can also take over the counter pain relief, such as paracetamol.

Depending on the severity of the injury, the ankle may need to be supported for a few days or until the pain settles. This can be done with an ankle support or brace that can be purchased if recommended by a healthcare professional.

A mild ankle sprain -This can heal within weeks with self-management

A moderate ankle sprain - With pain lasting longer than 2 weeks - This can take a couple of months to regain full function

A severe ankle sprain - This can take several months to recover and, in some cases, require surgery.

Once the pain is under control, range of movement exercises can be completed to get the ankle moving again:

As pain allows you can progress to the following:

• Standing heel raises
• Single leg stand - balance

What is it?

Plantar fasciitis is caused by an irritation to the connective tissue that runs from the heel the toes. The purpose of this connective tissue is to support the arch of your foot and to help with weight distribution when walking. It will present as pain in the bottom of your foot, most commonly around the base of the heel. It may be more painful just after resting and may settle with activity.

It can be cause by:

• a sudden increase in the amount of activity you do
• being on your feet for too long
• exercising on hard surfaces
• overstretching the sole of your foot
• being overweight, as it increases the strain on your heels
• an injury or weakness in the ankle
• high or low arches
• ageing, as it is more common in people over 40
• shoes that do not cushion or support the soles of your feet.

How is it managed?

The initial management will be activity modification. If possible, a reduction in activity should be made to offload the area. Ice can be used to help with pain, placing it on the affected area for 10 minutes at a time (do not use ice directly on the skin), three to four times per day. Try to wear supportive and cushioned shoes, avoiding flip-flops or flat shoes.

Exercise has been shown to be an effective treatment for this condition. The aim of the exercise is to increase the load tolerance of the connective tissue and decrease its irritability. See below links for further information.

Weight management - weight plays a factor in how much load is placed through the plantar fascia day to day. Reducing your weight by a small amount can help to improve your pain levels.

https://versusarthritis.org/about-arthritis/conditions/plantar-fasciitis/

https://www.versusarthritis.org/media/21790/plantar-exercise-sheet.pdf