The foot and ankle help us to absorb the forces that result when our feet hit the ground (ground reaction forces). The foot and ankle also provides the brain with tons of sensory feedback about the environment around us. If you have ever experienced pain in this area you know getting around can be much more difficult. There are many types of injuries that can occur in this region of the body, some injuries are more traumatic such a sprain, while other injuries can gradually develop into a debilitating pain for no apparent reason, like plantar fasciitis. In all cases, it is important that you have your pain assessed by a physiotherapist, chiropractor or trusted orthopaedic health professional. The earlier you that you seek treatment the faster you will gain pain relief and the less likely you are to develop compensation strategies creating further problems up the kinetic chain like into your knee, hip and even your spine.
What Makes the Foot and Ankle Unique?
The foot and ankle are made up of multiple joints that work together but also function independently. The foot is built this way to adapt to the grounds surface as well as allowing it to act as a lever for force and energy.
The foot is divided up into four regions of joints:
- The ankle joint– the large joint at the top of the foot responsible for connecting the foot with the lower leg and contributes to extension (lifting the foot) and flexion (pointing of the foot).
- The subtalar joint or the hindfoot – sits below the ankle joint in the heel and helps the foot to move inwards and outwards.
- The mid tarsal region or midfoot – is the top of the foot where the largest arch is. Here there are five bones that interact to allow your foot to scoop and splay.
- The forefoot– consists of the long bones of the foot and toes commonly known as the ball of the foot.
There are numerous ligaments, smaller muscles and long tendons coming down from muscles in the lower leg that help to control movements in the ankle, foot and toes. There is a large connective tissue band called the plantar fascia that expands the bottom of the foot. All these bones and soft tissues are closely interconnected to each other and all work together to allow your foot to function with proper mechanics.
What are the Causes of Foot and Ankle Pain?
This is the most common foot/ankle injury we treat at Rebalance Sports Medicine. When the ankle rolls inward or outward and is taken past its normal range of motion the ligaments can be stretched beyond their capacity. These can also result in strains of the muscles, or even fractures to bones. Please click here to read more about ankle sprains.
There are multiple ways to fracture the foot. Most commonly, a fracture will occur with a traumatic event, like a severe sprain or fall. There is also a risk of developing a stress fracture from repetitive loading in a dysfunctional manner. In some cases, you may be placed in an ankle boot and be instructed to avoid weight bearing for a period of time until the bone starts to heal. In other cases, the fracture may call for a surgical intervention as there can a crack in the bone that has shifted or even bone fragments that need to be repaired with pins, screws and plates. Your orthopaedic specialist will request an X-ray if they think you may have a fracture and will use the X-ray results together with their expertise to make a decision regarding surgery. If you have traumatically injured your foot or ankle and are unable to put weight through the injured ankle (ie stand up and put pressure), it is very important that you be seen by a doctor as they may require an X-ray to evaluate the bones of your foot.
This is a term used to describe inflammation of the sesamoid bones at the base of the big toe. These bones about the size of a kernel of corn and are floating bones imbedded under the big toe (one on either side) within the tendons. Their purpose is to improve the force transmission through the tendon during the “push off” phase of gait when the toe is extended. If the tendon and bones are being subjected to repetitive forces, they can become warn, swollen and irritated making it painful to push off the big toe. Please click here to read more about Seasamoiditis.
Tarsal Tunnel Syndrome
The tarsal tunnel is the name of a pathway on the inside of ankle area above the inner ankle bone where tendons and the tibial nerve travel. It is protected and contained by a strong connective tissue band called the flexor reticulum. The tibial nerve divides in the tarsal tunnel to provide sensation and innervation to different parts of the foot. In the case of tarsal tunnel syndrome, the tibial nerve becomes irritated in this space due to compression or friction. Pain develops and sensation disruption on the sole of the foot can occur. Please click here to read more about Tarsal Tunnel Syndrome.
This tendon is the largest in the body and connects the muscles of our calf to the heel bone. The calf muscles are very active muscles that are firing whenever we are standing, walking or performing activities in weight bearing. This tendon can become irritated or inflamed with excessive loading, tight calve muscles, stiffness in the heel bone and/or improper load transfer through the lower extremity. It is important to build strength and adjust to new activities gradually to allow the Achilles tendon (as well as other joints and soft tissues) to adapt to the new loads and become resilient. If you build up too quickly, injuries can occur. Please click here to read more about Achilles Tendonitis.
The plantar fascia is a strong connective tissue band that spans the bottom of the foot. It plays an important role in the “push off” phase of gait by tightening all the structures along the arch of the foot to form a rigid lever (an energy efficient way to propel forward). If you have been overloading the plantar fascia by walking excessively with new footwear, along uneven ground or walking bare foot more, than you may experience a situation where the fascia becomes injured and inflamed. Plantar fasciitis can be quite painful on the bottom of the heel and can be particularly sore with the initial steps in the morning or after resting. The pain is present when standing or walking especially during the push off phase of gait. Please click here to read more about Plantar Fasciitis.
Flat Foot Deformity
Clinically there are many causes for flat feet. Some common causes include weakness of the muscles in the foot and up the kinetic chain, past injury, ligament sprains, poor footwear and/or inactivity to name a few. Whatever the reason it is important that you work of your strength and in some cases, have a pair of custom made to better align your foot and improve shock absorption and weight transfer through the lower body.
This condition occurs when there is an entrapment of the nerve at the bottom of the foot that runs in the web space between the 2nd and 3rd toes. It can cause burning, tingling and a numbness pain over this area and ball of the foot. It is made worse with the toe off (push off) phase of walking. It can be made worse with barefoot walking, when the balls of the feet are flattened and when there is stiffness in the big toe joints.
This is the common term used to describe an overuse syndrome that involves the tibialis posterior and/or the tibialis anterior muscles which insert onto the shin bone. It is a cause for pain and inflammation at the site of the attachment of these tendons onto the shin bone. These muscles control the foot and ankle and are active with walking, running and jumping. It is a condition often seen in runners as the repetitive force absorption through the foot creates pain. Stiffness in the mid foot, poor mechanics, flat feet, tight or weak caves can all contribute to the onset of this painful condition.
Peroneal or Tibialis Posterior tendinopathy
These two muscles groups are located along the sides calf and tendons loop around either side of the ankle to control movement and produce force. Both tendons play a role in supporting the arches of the foot and work together to balance the forces. When there is a movement dysfunction one tendon will typically become overworked as the other weakens. This will result in irritation of one or both of the tendons located most commonly where they loop around the sides of the ankle. Strengthening and balancing these muscles are an important part of the recovery. Click here to learn more about Tibialis Posterior tendinopathy.
The metatarsals are the long bones in the forefoot. The term “algia” originates from the Greek word for pain. Therefore, this condition presents as pain on the bottom of the forefoot (along the “ball of foot”). It comes from inflammation and irritation of the joints and soft tissue structures of the area. This can be due to weakness, poor mechanics, improper footwear or repetitive dysfunctional load transfer. Click here to learn more about metatarsalgia.
How can Physiotherapy, Chiropractic, Massage Therapy and a Sports Medicine Doctor Help your Foot and Ankle Pain?
A team of healthcare professionals can personalize and direct your treatments to address your specific injury and help you recover faster. Treatments at Rebalance Sports Medicine with a Physiotherapist or Chiropractor can include controlling pain with therapeutic modalities, acupuncture or dry needling, manual/hands on therapy to improve joint stiffness in additional to strength, flexibility and motor control through individualized therapeutic exercises. Soft tissue release is also important and may require massage therapy treatment to reduce muscles tone and relax the nervous system. If your ankle injury is severe or appears to not be improving your physiotherapist or chiropractor will suggest you get assessed by our in-house Sports Medicine Doctors who can refer out for imaging if deemed necessary.
How Long Does it Take to Recover from Foot and Ankle Pain?
Depending on the cause, severity and what tissue is damaged, recovery can take a few weeks up to months. It is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your exercise program and follow their advice. Keep in mind that your physiotherapist and/or chiropractor treats these types of conditions regularly and will help you recover as quickly as possible.
What are the Best Exercises to Help with your Foot and Ankle Pain?
A well-rounded program should include range of motion, strengthening, flexibility and balance. These exercises should be individualized to your particular needs and goals. If you are returning to a particular sport the final exercise program will be catered to movements and forces that are needed to perform the specific activity.
Some of the most common exercises are listed below. These will help you get started. However, these exercises should be performed only if they feel comfortable and should be modified and/or stopped if pain increases during and/or after. Always listen to your body and consult with your physician or trusted allied health professional for more individualized guidance.
When focussing on motor retraining, please preform the exercises paying close attention to form, in a slow and controlled fashion. Try to aim for 3 sets of 10-15reps.
- Resistance band strengthening exercises – Using a resistance band tied in a loop around either side of your midfoot, turn your foot in and out against the resistance. Move at tempo that is slow and controlled about one sec in and out. Make sure to not rotate the leg and you are focusing on achieving the movement through your ankle.
- Calf raises– On both or just the injured foot (as long as this is pain free) raise up onto the ball of your foot. Perform this exercise slow and controlled. The tempo should be one second up and one second down. Watch that you do not use momentum and the that you keep your foot/ankle in proper alignment.
- Single leg balancing – standing barefoot on the injured foot for a period of up to 1 min. You should find that you have a lot more movements in the foot, knee and hip when you start this exercise but as your balance improves this happens less and less. You can challenge your balance further by adding an unstable surface under your foot like a pillow. Or try closing your eyes. ONLY perform this if you feel safe to do so and it is pain free.
- Calf stretching two ways 3x30sec holds. Click here to watch a demostration of two types of calf stretches.
How to Treat Foot and Ankle Pain at Home?
- If you have a recent, acute injury of your ankle, you may first want to try a contrast bath. This will help to control the swelling and bruising. To prepare you will need two buckets, one with ice cold water and the other with warm water. Place your foot in one bucket for 2 min then then other. Always end with cold. This will help you control swelling. If there is minimal swelling but the tissue is warm and painful, then ice might be the best choice. Apply ice with mild compression to the tissue for up to 10min then remove for 10min and repeat up to 3x or as needed.
- Protect your foot and ankle. There is tissue that has been damaged and you do not want to continue to add strain to this area. There are numerous bracing options that we sell in clinic that can help you protect and support the area as it heals. You also need to make changes to your footwear they are conducive to healing and provide the support you need. We also recommend limiting or completely removing aggravating activities and pace yourself accordingly. Please keep in mind that you will not need to apply these cautious strategies indefinitely. As the tissue heals, it becomes imperative to gradually introduce new and progressive stresses to stimulate bone and soft tissue recovery.
- Try the above-mentioned exercise program as tolerated.
- If the pain continues and does not respond to the aforementioned strategies, then over the counter pain or anti-inflammatory medication might be indicated, talk to your pharmacist or doctor to help direct you.
If your foot or ankle pain persists or if you are unable to move naturally once the pain subsides, a visit to your trusted Physiotherapist and/or Chiropractor is highly encouraged. If you are looking for expert care in the Downtown Toronto financial district, be sure to contact us. We would be happy to help.