TENDONITIS OF THE ANKLE

The ankle consists of a hinge joint between the bones of the lower leg (tibia and fibula) and the foot (talus) which allows you to point and lift your foot. A second joint between the heel bone and the talus allows you to move your foot inward and outward. Several ligaments stretch between the bones of the ankle to stabilize them while many different tendons connect the muscles that move the foot and ankle to the nearby bones. One cause of pain in the ankle is tendonitis, a condition that affects the structure and function of the tendons around the ankle. Tendons in the ankle that may be affected by tendonitis include:

• Achilles tendon which connects the calf muscle to the heel bone
• Flexor hallucis longus tendon, which runs along the inside of the ankle and attaches to the big toe
• Flexor digitorum tendon, which runs along the inside of the ankle and attaches to the other toes
• Peroneal tendons, a set of three tendons which run along the outside of the ankle and attach at the shaft of the small toe and the bottom of the foot
• Posterior tibialis tendon, which attaches at the mid-foot and helps maintain the foot's arch
• Anterior tibialis tendon which runs down the front of the leg and attaches to the bones of the midfoot. This tendon pulls the foot toward the body and help control its motion

• Tendons help to move our bones and amplify the effect of muscle contractions
• They also play an important role in attenuating and absorbing shock that is transmitted from bone into muscle
• Tendons are strong but they are not designed to stretch or deform easily
• They can become weaker or stronger/stiffer in response to a training stimulus
• Training can make a tendon more prone to or more resilient against, injury.

• Pain over the involved tendon when the muscle is contracted
• Pain over the involved tendon when the muscle/tendon is stretched
• Swelling or inflammation over the injured tendon
• Stiffness when moving the ankle near the involved tendon
• A feeling of weakness in the ankle when contracting the involved muscle

PHYSICAL THERAPY INTERVENTIONS FOR PIRIFORMIS SYNDROME

Conservative treatment for piriformis syndrome is the first line approach. This may include pharmacological treatments like NSAIDs or muscle relaxers and almost always physical therapy. Treatments for piriformis syndrome will always be individualized to address a patient’s impairments but several physical therapy interventions have been shown to be helpful in the management of this condition:

Lifestyle modification: lifestyle modification to reduce compression or irritation of the sciatic nerve can be helpful in reducing symptoms. Avoiding sitting for prolonged periods and daily stretching for example are often recommended.

Modalities: modalities like ultrasound, hot or cold therapy can be utilized to reduce inflammation, promote tissue healing and reduce pain and spasms which may be beneficial early on in a treatment session.

Manual therapy: addressing myofascial restrictions, trigger points and other restrictions in soft tissue around the glutes may be important to address your symptoms. Your therapist may perform these interventions using their hands or may employ other tools like dry needling, foam rolling or IASTM.

Stretching: stretching of the piriformis muscle can address muscle length issues and may help alter pain sensations and decrease muscle spasms to reduce compression on the sciatic nerve.

Lumbar and sacral spine-focused treatments: your therapist may direct their treatment to the spine itself if they feel this is a contributing factor to symptoms. Manual therapy techniques and exercises may be prescribed to address these impairments.

Muscle strength and performance exercises: if biomechanical factors are thought to be contributing to piriformis syndrome your therapist may prescribe a series of functional hip and gluteal strengthening exercises to ensure the small piriformis muscle isn’t trying to do the work of these larger muscles.

Functional training and restoration of activity: as underlying factors are addressed and symptoms subside, your therapist will incorporate more functional activities to ensure proper biomechanics, motor control and coordination when performing these activities. They will also educate you on how to return to your prior level of activity with an eye on prevention of piriformis syndrome in the future.

The symptoms of piriformis syndrome can surely be a pain but you should feel confident that the physical therapists at Evolve Physical Therapy know how to help. Call today to schedule an initial evaluation.