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Foot and Ankle

Injuries and operative procedures to the ankle and foot can be some of the most painful, particularly if the ankle has to be immobilised. Immobility prevents muscle action in the lower leg. Muscle movement  is required for pumping blood and fluid out of the lower limb. Without this muscle movement, when the leg is down (“dependent position”) swelling can build up and the patient can perceive a great deal of discomfort. Using walking aids, splints or pneumatic walking boots will biomechanically challenge the other areas of the body and may limit your independence and functional ability as you are unable to walk very far or drive. Your physiotherapist will assess your pain, range of movement, muscle strength, balance and stability and then design a programme of rehabilitation specific to your needs.

  • Techniques to reduce swelling
  • Soft tissue massage
  • Scar tissue management
  • Mobilisation of bones in the foot/ankle
  • Gait re-education
  • Balance retraining
  • Weaning from crutches
  • Weaning from boots or splints
  • Stability exercises
  • Maintaining your current strength and  cardiovascular ability
  • Taping for proprioception and pain
  • Exercises to mobilise neural tissue
  • All types of post-operative management for foot and ankle  surgery

 

Examples of Conditions Treated

Tibialis posterior
This muscle runs down the back of your shin bone, the tendon comes around the bony prominence on the inside of the ankle and has a number of insertions on the base of the foot. It is responsible for pointing your foot downwards and turning your foot in towards midline.

Tibialis Posterior Tendonopathy
Just behind the bony prominence on the inside of the ankle is the tarsal tunnel. It is made of bone bridged with a strong inelastic thick band of tissue. The tunnel houses the tendon for Tibialis posterior.   Tiny tears in the tissue of the tendon occur with aging or overuse. During the healing process, scar tissue is laid down by way of repair. This process can continue to the extent that a nodule forms within the tendon. The area may be noticeably thickened and tender to the touch. Pain can be present in standing and walking, particularly as the foot rolls inwards. This degenerative condition without inflammation is called tendonosis. If there is inflammation present, the condition is called tendonitis. This can present as pain in the arch area of the foot and swelling along the course of the tendon.

The weakened, degenerative tendon increases the possibility of actual rupture. If the tendon ruptures it leads to a loss of the arch and a pronounced flat foot deformity that is easily recognisable.

Impingement syndromes
The ankle is a hinge joint formed by a connection between three bones. The two bones of the lower leg, the tibia and fibula, form a mortice that receives a bone in the foot called the talus. It is a very stable and strong weight bearing joint. The joint allows the foot to move up and down. The joint is enclosed in a capsule and supported with strong ligaments.  If these tissues are irritated or injured they can sustain tiny tears and will repair themselves with scar tissue.This new scar tissue can cause thickening; making them vulnerable to becoming nipped within the ankle joint as it moves. The nipping of tissues is called impingement. The repair process from past ankle injuries or repetitive loading can also lead to the formation of bony projections called spurs. They form along the base of the tibia or the top of the talus and can jab into the soft tissues supporting the ankle.

Impingement can be at the front, back or side of the ankle.

Tarsal Tunnel
Tarsal Tunnel Syndrome refers directly to the symptoms associated with compression of the posterior tibial nerve. Just behind the bony prominence on the inside of the ankle is the tarsal tunnel.  It is made of bone bridged with a strong inelastic thick band of tissue. The tunnel houses tendons,  an artery and the posterior tibial nerve. Anything that reduces the space in the tunnel can cause the tissues to become compromised. When entrapment compresses the nerve, symptoms may include ankle pain and a burning sensation. Occasionally there is numbness and tingling on the sole of the foot and it hurts when you feel along the course of the nerve. Symptoms may be worse at night.

Ligament sprains
Ligaments are strong bands of connective tissue that run from bone to bone. The bones of the foot and ankle are supported with numerous ligaments. If a ligament is stretched or torn it is known as a sprain. Ligament sprains are classified according to the amount of damage they have sustained.

Grade I: Damage to a few fibres producing a local inflammatory response. There is pain over the affected ligament.

Grade II: Damage to a more extensive number of fibres. Marked inflammatory response characterised by intense pain and swelling.

Grade III: The ligament is torn and is in two pieces. Intense pain, swelling and joint instability. May need surgical repair.

Plantar fasciitis
Running from the heel bone to the ball of your foot is a strong band of connective tissue known as the plantar fascia. You can feel the plantar fascia if you take hold of your foot and (gently) pull your toes back towards you. The broad sheet of tissue under the arch will go tight. The plantar fascia stabilises the foot in walking and helps transmit forces and load. Plantar fasciitis is the correct term to use when the tissue is inflamed. Plantar fasciosis is when there is no inflammation and relates to degeneration and tiny tears in the tissue presenting as pain.

The symptoms of plantar fasciitis include pain along the inside edge of the heel  and near the instep of the foot. The pain is worse when weight is placed on the foot especially after a long period of rest or inactivity. This is usually most pronounced in the morning when the foot is first placed on the floor.  Many people with plantar fasciitis have a bony spur on the heel bone. Bony spurs do not cause plantar fasciitis. There are some factors that may predispose you to getting plantar fascia pain:

  • It is more common in people who spend the majority of the day on their feet.
  • Being overweight may be a contributing factor
  • Tightness of the Achilles tendon.  Both the Achilles tendon and the plantar fascia attach to the heel bone. Force generated in the achilles tendon increases strain on the plantar fascia
  • Changes in exercise routines (Intensity, mileage, terrain)
  • Unsupportive footwear
  • Sufferers of  rheumatoid arthritis or ankylosing spondylitis are prone to inflammation anywhere a ligament is attached to a bone. Therefore plantar fasciitis may be part of the general condition.

Morton’s Neuroma
A neuroma is a thickening of nerve tissue, normally between the third and fourth toes. It can cause a burning pain and sometimes numbness in the ball of the foot and toes.