Common Conditions Affecting Foot and Ankle

Lateral ankle sprain

The most common foot and ankle injury which occurs when you go over on your ankle and strain/rupture the ligaments on the outside of your ankle.
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Ruptured ankle ligaments

Ligament rupture occurs following severe sprains, strains and high energy impacts. Patients usually describe “painless instability”, where they describe the foot and ankle just giving way without warning. Following assessment the experienced Physiotherapists at Fay Pedler Clinic will get you started on progressive strengthening exercises to compensate for your instability. Occasionally theses injuries do require surgical stabilisation and if this is required we can refer you onwards to the orthopaedic surgeons either privately or into the NHS system.

Achilles Tendinopathy

A common foot and ankle complaint, along with Plantar fasciitis. The Achilles tendon is the biggest tendon in the human body which tolerates huge amounts of loading and stretching. Initial onset of symptoms are usually after a sudden increase in load or repetitive training errors developing slowly over time until they eventually become problematic over several months.
The tendon goes through a normal wear and repair cycle however, in tendinopathy, this process is disturbed and the tendon goes into a failed healing state where it thickens and swells, becoming painful and loses tensile strength. Treatment is mainly focused on progressive strengthening and loading of the tendon so it is able to tolerate the load required. This process is painful and can take a while (months).
The team at FP utilise techniques such as massage, acupuncture and shockwave therapy , to reduce pain and make the important exercises a little easier to perform.

Plantar Fasciitis

Pain centred underneath the heel which is usually much worse in the morning or after periods of rest.
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Post Fracture

Fractures (broken bones) can occur at the ankle, hindfoot (heel), midfoot and forefoot. Any fracture can cause ongoing pain, stiffness and loss of function therefore early mobilisation of stiff and painful joints helps regain range of motion and strength as soon as possible.

Osteoarthritis/Rheumatoid Arthritis

May affect any joint in foot and ankle causing pain, stiffness and swelling. Most prevalent at ankle hindfoot, midfoot joints, 1st Metatarsal or big toe joint.
Tibialis Posterior Tendinopathy
The most important tendon on the inside (medial) of the ankle which serves to stabilise the ankle and the medial arch of the foot. If left untreated and allowed to weaken further, it can lead to Adult Acquired Flat Foot or flat foot. Initial treatment is focused on offloading the tendon with wedges, insoles and massage techniques. Taping and support can help also however, extensive strength and balance work is the mainstay of treatment. Occasionally this condition may require ultrasound scans and guided steroid injections.

Peroneal Tendinopathy

Commonly an overuse injury that affects the tendons on the outside of the ankle which may also occur following a severe ankle sprain or as a result of long-standing ankle instability. The peroneal tendons have to work extra hard to stabilise the ankle in the absence of good ligament stability. Peroneal tendinopathy usually responds well to manual therapy and massage alongside extensive balance retraining exercises.

Forefoot Overload

This is an umbrella term for excessive pressure on the front of your foot and toes which can cause interdigital neuritis, more commonly known as Mortons neuroma. This is where the nerve between the toes becomes thickened and inflamed causing severe pain, feeling of standing on a pebble and sometimes tingling/numbness between the toes. Treatment will target the typical causes, for example tight calf muscles and inappropriate footwear. Insoles can be really helpful with some patients requiring ultrasound-guided injections and/or orthopaedic opinion if symptoms persist.

Hallux Rigidus

Stiffness and pain affecting your big toe which is usually caused by arthritic changes within the joint. First-line treatments include stiffened insoles or orthotics which helps to take pressure of the joint. Joint mobilisations, ultrasound, acupuncture and steroid injections may also provide relief.

Stress Fracture

Most common site of stress fractures is at the metatarsals however stress fractures can also affect the heel and ankle. Stress fractures usually occur due to training errors, sudden increase in training load and poor footwear, however, it can also be linked to low bone density/Osteopenia and poor diet. Initial physio management is centred around looking at biomechanics, assessing strength/control at hip and knee and looking for any calf/hamstring tightness. All of these can be a causative factor and your physio can help highlight any issues that may have contributed to the injury and prescribe corrective exercises. The main treatment is rest and gradual reloading as and when the fracture has sufficiently healed. Often the foot/ankle needs to me immobilised in an Aircast boot to support the injury whilst allowing weight-bearing.