"Completely recovered, no pain and can stand on my leg normally and naturally. Been for two runs this last week without any problems. The difference is huge!" - Caroline B.

Foot and Ankle Pain

Ankle Sprain

An ankle sprain occurs when soft tissues surrounding the ankle joint are overstretched during excessive movement. The most common ankle sprain is an inversion injury (‘going over’ on the outside of your ankle). On the outside of your ankle lies the lateral collateral ligament which includes the anterior talofibular ligament, the posterior talofibular ligament and the calcaneofibular ligament. Spraining these ligaments is a common occurrence in sports which involve running, jumping and changing direction quickly. Other common causes include falling off the kerb of a pavement, and walking over undulating ground.

 Sprains are graded on a scale indicating the severity of the injury. A grade I sprain is mild, the ligament is overstretched, it has not torn, and therefore there is no loss of stability or joint function. The joint may be tender and slightly swollen.

A grade II sprain is more severe as the ligament is partially torn, although there is no significant instability. The ankle will be swollen, bruised and painful. It may be difficult to walk.

A grade III sprain is the most severe and means the ligament has been completely torn resulting in joint instability. The ankle will be very painful and you will not be able to walk on it. There will be excessive swelling and bruising.

After any ankle sprain it is important to protect the joint from further damage, for example by keeping your shoe on and laced, and in the days following injury wearing supportive footwear. You should rest your ankle for the first 2-3 days following injury, refraining from substantial activity. Applying ice to the ankle can reduce swelling and bruising if used during the first 2-3 days following injury. Ice should not be applied directly to the skin. Place a cloth between the icepack/ bag of frozen peas to prevent an ice burn. Apply the ice to an elevated ankle for approximately 20 minutes every few hours. Also, swelling can be reduced by applying compression to the ankle using an elasticated tubular bandage. Ensure this is not too tight and never wear overnight. Keeping your ankle elevated as much as possible will help reduce any swelling and therefore help reduce pain.

It is beneficial to the healing process, as well as regaining range of movement, to begin gentle movements at the ankle 3 days after your injury as long as they are relatively pain free.

What kind of physiotherapy you receive after an ankle sprain will depend on the severity of the sprain. A physiotherapist will provide appropriate treatment to regain range of movement, strength and stability at the ankle. Undergoing proper rehabilitation after an ankle sprain is important in order to reduce the risk of reoccurrence of injury.

Plantarfascitis

Plantar fasciitis is an inflammatory condition of the plantar facia, a thick band of fibrous tissue which runs along the sole of the foot from the heel to the toes. Continued overstretching of the plantar fascia can lead to micro tearing at the point where the plantar fascia inserts into the heel. This micro tearing can cause an inflammatory reaction in the local area, resulting in heel pain.

There are a number of reasons for the overstretching of the plantar fascia which can in turn lead to plantar fasciitis. These include foot arch problems, obesity, a tight Achilles tendon, wearing unsupportive footwear, and standing/walking on hard surfaces for long periods of time.

A possible symptom of plantar fasciitis is a heel spur (bony growth) which may eventually develop as a result of continued overstretching of the plantar fascia and associated ‘pulling’ at the insertion into the heel. A heel spur is not the cause of plantar fasciitis and is not what causes the heel pain. The vast majority of heel spurs grown parallel to the heel bone so don't get in the way and don't cause an problems. It is now considered pointless X-raying the heel looking for a heel spur as most that exist are insignificant anomalies. A very small number of heel spurs do grow vertically downwards and can be a source of pain but an examination by a physiotherapists will be able to inform you if an x-ray is appropriate.

If suffering from plantar fasciitis you will have pain on the underside of the heel which is often worse in the morning, during the first steps of the day. This sharp pain usually reduces to a dull ache throughout the day and reduces with rest, but may be quite painful to get going again after long periods of sitting down. In some cases the pain can also spread to the arch of the foot. The inflammation at the heel will also cause mild swelling, occasional redness, and it may be difficult to walk due to pain.

Applying ice to the local area can help reduce inflammation. Ice should not be applied directly to the skin. Place a cloth between the icepack/ bag of frozen peas to prevent an ice burn. Apply the ice to an elevated heel for approximately 20 minutes every few hours. Avoiding substantial activity and resting as much as possible will also help reduce inflammation and therefore the heel pain.

Following an assessment, a physiotherapist will be able to diagnose plantar fasciitis and provide the appropriate treatment, which may include periosteal pecking, orthotics and the provision of specific exercises and advice on how to prevent recurrence.

Spinal Physiotherapy
& Sports Medicine Clinic
124 Gilbert Rd, Cambridge, CB4 3PD