Addressing Ankle Pain with Physical Therapy
What a Pain in the Ankle!
Looking for Answers to Ankle Pain?
Ankle pain, whether new or chronic, can seriously interfere with being on your feet. If sitting down all day isn’t an option, physical therapy is a great choice for identifying the cause of your ankle pain and taking steps to getting a handle on your symptoms.
LET’S EXAMINE THE ANKLE CLOSER
The ankle is a hinge joint where the primary motion is to lift and point the foot. If we look at an image of the ankle joint you will see the larger inner bone of the lower leg leg called the tibia and the thinner outer bone called the fibula articulate with a bone called the talus in the posterior part of the foot. Beneath the talus lies the calcaneus or heel bone. Many ligaments, muscles. and tendons travel between the bones of the lower leg and foot, crossing the ankle joint.
Because of the complex anatomy in the ankle area, there are many potential sources of ankle pain or discomfort. In this article we will take a look at some of the more common causes of pain and how physical therapy can treat these conditions.
COMMON CAUSES OF ANKLE PAIN
Posterior Ankle Pain
Posterior Ankle Impingement: symptoms of this condition include posterior ankle pain with forced plantarflexion (pointing of the toe or pushing off of the toe). It results from compression of the soft or bony tissue between the tibia and the calcaneus. Some people have a small extra bone in their ankle called an O’s Trigonum which can increase the compression. On occasion a large amount of force through the ankle joint can cause small fragments of bone to fracture and become compressed when the toe is pointed. Inflammation and swelling in this area leads to pain.
Achilles tendinopathy or rupture: pain felt behind the heel and up the back of the ankle may indicate an irritation of the achilles tendon, the long tendon that connects the calf muscles to the bottom of the foot. This irritation may be a result of an acute or sudden trauma or from repetitive microtrauma and can cause discomfort when walking, running, jumping, or climbing stairs. Tenderness when pressing the achilles tendon, stiffness and pain especially during first steps, and swelling in the back of the ankle are characteristic of this condition. In the case of a tendon rupture or tearing of the tendon, calf weakness, bruising, swelling, and pain result. A full rupture can typically be identified by squeezing the calf muscle with your hand and observing a lack of toe pointing indicating the connection between the calf muscle and foot has been disrupted.
Lateral Ankle Pain
Ankle sprain: rolling your ankle outward, can cause an acute ankle inversion sprain. There are three ligaments on the outside of the ankle that can be injured when stretched beyond their normal capacity. These ligaments are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). Tenderness over the involved ligament is common. Depending on the severity of the sprain you may notice bruising, swelling, stiffness, and if the sprain is severe, laxity or instability of the ankle.
Peroneal tendon injury: Two peroneal muscles run along the outer lower leg and their tendons travel behind the ankle bone (known as the lateral malleolus) and attach at the outer midfoot and beneath the foot. These muscles are tasked with stabilizing the foot and helping to prevent sprains and injuries. Symptoms of peroneal tendon injury can come on suddenly or over time and include pain or tenderness along the lateral lower leg or ankle. Warmth or swelling may be noticed in the lateral ankle and a pop may be heard with a sudden injury. Increases in activities such as running, jumping or walking, a sudden trauma to the ankle, having high arches and wearing inappropriate footwear can contribute to this type of injury
Sinus Tarsi Syndrome: this clinical syndrome is characterized by pain in the lateral foot just below the ankle in an area called the sinus tarsi. It is thought to be caused by inflammation and scar tissue formation possibly brought on by abnormal mechanics in the joint between the talus and calcaneus. Recurrent ankle sprains causing instability may be a predisposing factor.
Medial Ankle Pain
Ankle sprain: rolling the ankle inward so that the outer edge of the foot lifts up is called an eversion sprain. The primary ligament involved in this type of sprain is called the deltoid ligament, a strong, flat, triangular band composed of four separate ligaments. Tenderness over the deltoid ligament is common with this type of injury. Depending on the severity of the sprain you may notice bruising, swelling, stiffness, and if the sprain is severe, laxity or instability of the ankle.
Medial ankle stress fracture: a stress fracture refers to a weakening of one area of bone caused by repetitive breakdown of bone without sufficient rebuilding. It is considered an overuse injury and seen most commonly in track and field athletes and military recruits who walk long distances with heavy packs. In the ankle, pain and tenderness along the inner ankle bone called the medial malleolus may indicate a tibial stress fracture. Initially the pain is present during activity and will improve with rest but over time it may become more constant and be accompanied by tenderness to touch over the area and swelling or bruising.
Posterior tibial tendonitis: The tibialis posterior muscle runs along the inside of the calf muscle and its tendon travels behind the medial ankle bone and attaches under the arch of the foot. Pain or swelling along the inner ankle or arch of the foot especially with standing or walking and increased pronation or flattening of the arch are common with this condition. Overuse or sudden trauma can trigger this condition
Tarsal Tunnel Syndrome: Running parallel to the tendon of the posterior tibialis, the tarsal tunnel is a dense band of fibrous tissue that creates a tunnel through which the tibial nerve, several tendons, and the blood vessels traveling to the foot, course. Similar to carpal tunnel in the wrist, compression of the tibial nerve as it passes through the tarsal tunnel can cause burning, tingling, electrical shock pain, and numbness in the inner ankle and/or bottom of the foot
Anterior Ankle Pain
High ankle sprain: In contrast to the much more common lateral ankle sprain, the high ankle sprain involves injury to the ligaments that connect the tibia bone to the fibula bone just above the ankle. This ligamentous connection helps stabilize the ankle joint and typically has very minimal movement so a large force is needed to disrupt and injure this area. It is important to correctly diagnose this injury as it typically requires longer times to heal and can result in more chronic ankle instability than other ankle sprains.
Anterior Ankle Impingement: Ankle instability, bone spurs, and repeated stress at end range positions of squatting, jumping, or descending stairs can cause this condition that leads to pain in the anterior aspect of the ankle. A history of repeated ankle sprains may predispose one to this condition as scarred ligaments take up more room in the joint space leading to compression and inflammation.
PHYSICAL THERAPY FOR ANKLE PAIN
Identifying the cause of your pain is the first order of business when a physical therapist assesses your ankle. If your physical therapist suspects a more serious injury such as a tibial stress fracture or high grade ankle sprain they may refer you back to your doctor for imaging to determine if surgery, modifications to weight bearing, bracing, or casting are needed.
If you are being treated for an acute injury such as a tendon injury or sprain, your physical therapist will educate you on how to protect these newly healing tissues. Treatment may include compression or bracing, offloading the injured area through crutches, modalities such as ice, ultrasound or electrical stimulation to reduce pain and swelling, and activity modification.
In the case of well-healed tissues, chronic injuries like tendinopathy or ankle impingement, or a well-healed stress fracture your physical therapy program will focus not only on reducing or eliminating localized symptoms but on addressing factors that contributed to the onset of the symptoms. Often chronic injuries or pain in the ankle are caused by repeating faulty movement patterns or having an imbalance of muscle strength and length to carry out a task such as walking, running,or jumping. Optimizing muscle strength and flexibility and improving motor control and mechanics of the lower limb is important for returning to prior activities and reducing the likelihood of the injury recurring.
While some ankle injuries may require intervention by a doctor or surgeon, a physical therapist should always be a primary member of your care team. A physical therapist at Evolve can help you get on the road to recovery. Our therapists do not just treat symptoms, but we get to the root of the cause. We strive to enable our patients to live pain free, and prevent the recurrence of related issues
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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