Ankle and Foot

Arthritis is an inflammatory condition affecting the joints of the body. Pain can be mild in the early stages to severe and debilitating. The most common types include rheumatoid arthritis which affects the lining of the capsule of the joint and not the joint cartilage per se, and osteoarthritis, which erodes the cartilage on the joint surfaces. Both can greatly impact the joints in the ankle and foot, causing limited tolerance to weight bearing loads.

Plantar fasciopathy is a condition that affects the connective tissue on the bottom of your feet. The plantar fascia is a thick strong connective tissue that comes off the heel bone (calcaneus) and attaches to each of the five long bones of the toes. It’s main function is to support and stabilize the arch during weight bearing, and store energy once in weight bearing to allow the arch to recoil as we lift our heel off the floor and advance our weight to the big toe during walking and running. Plantar fasciopathy often occurs from overuse, such as a new job that requires one to stand for a long time whereas prior work didn’t require prolonged standing. Poor footwear, a sudden increase in athletic activity and weak intrinsic (deep) muscles of the foot as well as a weak calf muscle or tight achille’s tendon can also lead to plantar fasciopathy.

Tendons connect muscle to bone. Tendinitis in fact, debatably exists. What, you ask? There’s an abundance of research that supports that there is little to no inflammation with tendon injury, and the swelling and thickening that occurs in tendon when injured is water absorption what is known as prostaglandin. And since “…itis” means inflammation, tendonITIS is a misdiagnosis. “…opathy” means abnormal condition; hence, tendinOPATHY refers to an abnormal condition of the tendon.

At any rate, tendon injury, like most injuries to the muscle and tendons, occurs as a result of an acute injury that overloads the tendon, or repetitive low level overload that over time leads to a painful tendon.

A traumatic fracture, or break, occurs from excessive force or blunt trauma to the bone, causing it to crack or break entirely. A fracture to the ankle or foot could result in extended downtime to ensure proper healing. Casting or an immobilization boot, and crutches are often prescribed. Worst case, surgery may be necessary to repair the fracture., and can even result in having to leave work for a while.

Another type of fracture is a bone stress fracture, which is an overuse injury. A bone stress fracture occurs most commonly in female endurance athletes who are very lean and with dysmenorrhea or amenorrhea, and possible disordered eating. A precursor to a stress fracture is a bone stress reaction, which is edema within the marrow of the bone and weakening of the hard outer shell of the bone prior to fracture. Management of bone stress injury varies based on the degree of injury, i.e. low level stress reaction to higher level stress reaction and a full stress fracture.

Our physical therapists are Rose City Physical Therapy treat a lot of runners, from the high school all the way up to elite and professional runners, and bone stress injury care is something we treat regularly. Important is educating the athlete on bone healing time frames, managing the load progression on the bone, balancing weakness and/or limited motion patterns, and progessive active exercise to load the bone to stimulate new bone formation and growth.

A sprain is an injury to the ligament or capsule. Ligaments connect bone to bone – like a leather strap. The capsule is a strong fibrous tissue that surrounds, or encapsulates, our joints and allows movement into certain degrees and directions of motion, and restricts motion beyond normal ranges. Injury to either of these tissues is most often due to a forceful load or stress on the tissue such as from a fall, a tackle in sports, sliping, or other torque across the joint the ligament or capsule protects.

A strain is an injury to a muscle or a tendon. We all know what the muscle is. The tendon connects muscle to bone, so when we contract our muscle, the load is transferred through the tendon to induce motion on the bone it’s related to. Strains occur, like many other injuries to our musculoskeletal system, either from a one time forceful injury or trauma, or from repetitive load that cumulatively exceeds the muscles or tendons capacity.

A lot of what our orthopedic and sports clinical specialist physical therapists treat at Rose City Physical Therapy are sprains and strains. Education on the pathology of injury and ways to self-treat it is important in the early stages, as is an active approach to rehab through therapeutic and functional activity and exercise. Evidence concludes that active approaches to physical therapy lead to the best outcomes.

The bursa is a fluid filled sac located between two surfaces to prevent friction and wear. Often between a tendon and its adjacent tendon, or between a bone and the adjacent tendon. Think ‘rope-over-rock’ fraying – the bursa is located between that rope and rock to prevent the fraying. Bursitis occurs when a tendon rubs against the bursa, causing them to become irritated, inflamed, and painful. Most common at the ankle or foot is achilles tendon related bursitis; there are two main bursa adjacent to the achilles tendon; the retrocalcaneal and the subcutaneous bursa.

Each foot has several arches. These are the Transverse arch, the Lateral Longitudinal arch and the Medial Longitudinal arch. Think of the archway on a historical brick building. At the top of the arch is a wedged brick – the capstone – different in shape than the rest of the brick. The capstone provides stability through load bearing to support the entire arch. That’s how our foot arches are. At the top of each arch is a small wedge shaped bone that bears the brunt of the load to maintain the arch shape. Ligaments are attached to this bone and it’s adjacent bones and they are also important to help stabilize the system. Also, muscles and tendons cross and act directly on these archces to provide stability and support.

However, when the tendons crossing one of the arches are not doing their job due to fatigue, weakness, or strain, your foot will lose full arch support, allowing it to collapse into a very small arch, or no arch at all. This is referred to as “flat foot” or a “fallen arch” and can cause discomfort or pain, and limited tolerance to being up on one’s feet or affecting work, recreation or sport.

A neuritis is an inflamed nerve, often causing tingling along its distribution, and at times numbness or weakness if the nerve is quite affected.

The most common neuritis at the ankle or foot is that of the Posterior Tibial nerve as it courses along the inside (medial) ankle just under the bony prominence. Compression of this nerve is known as Tarsal Tunnel Syndrome.

Morton’s Neuroma involves the small nerves at the ends of the foot as they continue into the toes. It commonly affects the ball of the foot or the area between the second and third toe. Symptoms include pain, and at times burning sensation. People often report that it feels like they are stepping on a marble. Conservative treatment proves effective 80% of the time. Physical therapy can be effective as part of this care to help mobilize stiffness that can occur at the ankle, foot or toes, as well as provide stretches and strengthening exercises to the small intrinsic muscles of the foot. Education on proper footwear, the use of a metatarsal pad and/or orthotics )arch supports) is also a common course of care.