Foot and ankle pain are some of the most common ailments our patients suffer from and seek treatment for at our clinic.
The truth is most of these conditions and their associated pain are fully treatable without surgery, resting, or dangerous drugs.
If you’ve recently experienced or struggled with ongoing foot or ankle pain, then continue to read below as we reveal/explain exactly how we treat 6 of the most common foot conditions by a Doctor of Physical Therapy.
Foot Condition #1: Bunions
What are bunions?
Most people think that a bunion (called hallux valgus) is just a bump at the side of your foot, near the big toe.
It’s actually a deformity in the framework of the bones in the front part of your foot and it’s usually inherited.
It’s not the bunion, but the foot type, with a specific mechanical structure that is genetic, which usually causes the bunion. Rather than being parallel to the other toes, the big toe points in towards the second toe, causing a misalignment of the bones, which is what produces the bump.
While some people go through life unaffected, pain can develop over time and make walking difficult. Although wearing tight shoes doesn’t actually cause bunions, it can make an existing misalignment worse and become painful sooner.
Signs and symptoms of bunions:
The most common symptoms associated with bunions include:
- Pain or soreness
- A burning sensation
- Possible numbness
- Inflammation and redness
Shoes that are tight around the toes or have a high heel can bring on or exacerbate the problem. Because of this, women more often suffer from this condition, but anyone who is on their feet for extended periods of time can also experience a worsening of these symptoms.
Treatments for Bunions:
Although the faulty mechanical structure of the foot cannot be changed if the bone has ossified, there are treatments, exercises, and movement instruction that can alleviate or reduce the pain, and actually correct the bunion without surgery, if the joint is still malleable!
These may include self-help like icing, padding, and/or recommendations about footwear. Certain types of stretches, mechanical manipulation, and exercises can also aid in reducing or eliminating pain and restoring normal alignment of the bunion.
Once properly diagnosed by our experienced physical therapists, the right combination of therapies will get you back to better health because feet are such a key factor in our daily routines. The goal is to get you there, without unnecessary drugs or surgery.
Foot Condition #2: Ankle Sprains
What is an ankle sprain?
An ankle sprain occurs when the ligament that connects your leg and foot bones is overstretched and torn. Aside from simply taking a “bad step,” your sprain was likely the result of an underlying problem.
Types of ankle sprains:
There are two very different types of ankle sprains, eversion, and inversion. When the ankle rolls outward and tears the deltoid ligaments, it is referred to as an eversion ankle sprain. When you twist your foot upward and the ankle rolls inward, that’s called an inversion ankle sprain.
Inversion sprains are more common, involving injury to the anterior talofibular ligament (ATFL), which is one of the 3 ligaments that make up the lateral collateral ligament (CFL) in the ankle. The ATFL is the shortest and weakest of the ligament complex, so the majority of sprains involve only this ligament.
Since eversion stresses the joint medially, because the foot is turned outward, it usually results in an avulsion fracture of the medial malleolus, rather than a ligament sprain, since the deltoid ligament is pretty strong. But eversion can also cause a sprain.
Minor injuries cause stretching or microscopic tears in the stabilizing ligaments. A major injury can compromise the high ankle (syndesmotic) structure, involving the ligaments that bind the distal tibia and fibula at the distal tibiofibular joint. These injuries may lead to complete tendon disruption and fractures of the ankle and foot.
What causes an ankle sprain?
The most common underlying cause of an ankle sprain is weak muscles around the ankle. Your muscles support your ankle, and when they’re not strong enough, the ankle can go through extreme ranges of motion, which may compromise the ligaments that surround it.
Other common underlying causes for ankle sprains include:
- Limited ankle flexibility (e.g., ankle dorsiflexion)
- Too flat or too high of an arch (the higher your arch, the more likely you’ll have an inversion sprain, and the flatter your feet, the more likely you’ll have an eversion sprain)
- Not performing ankle strengthening, stretching, and mobility exercises
- Unsupportive footwear (such as flip flops, heels, or worn-out sneakers)
- Exercising/Walking on an uneven surface (such as sand, a slant, or a rocky trail)
- Not warming up before exercise
- Sitting, standing, lifting, and/or exercising with poor posture
Signs and symptoms of an ankle sprain :
The most telltale sign of an ankle sprain is an awkward foot movement, together with a rolled ankle and immediate pain. Other symptoms include:
- An inability to bear weight on the affected ankle without pain and/or loss of stability
- A lack of mobility (the ankle will feel stiff and lose its full range of motion)
- Tender to the touch
- Movements that stretch the irritated ligaments
Your symptoms can range from mild to severe and can last a week to several weeks or more (depending on whether you get the proper treatment).
There are three grades of an ankle sprain:
- Grade 1: (Mild) Microscopic tearing of the ligament. You may have a little bit of swelling, pain, and tenderness.
- Grade 2: (Moderate) Partial tearing of the ligament. You may have moderate swelling, pain, tenderness, and looseness in the ankle joint.
- Grade 3: (Severe) Full tear of the ligament. You may have severe swelling, pain, tenderness, and instability in the ankle joint.
Treatments for Ankle Sprains:
If you suffered an ankle sprain, you were probably told to rest until it feels better. Your doctor may have prescribed painkillers.
These “solutions” aren’t really solutions at all. They simply treat the symptoms and not the underlying cause.
Symptom-masking methods of treatment are dangerous and will inevitably lead to repeated pain and frustration.
Some of the best ankle sprain treatments are:
- Manual Therapy
- KT Taping
- Functional exercise and strengthening
- Blood flow restriction training
Foot Condition #3: Peroneal Tendon Dysfunction
What is the peroneal tendon?
The peroneal tendon is actually a group of 3 tendons that start on the lateral shin and travel distally to the foot. These three muscles are called the peroneus longus, peroneus brevis, and peroneus tertius.
Depending on what caused it, this type of dysfunction could be an inflammation (tendonitis), a degradation of the tendon (tendonosis), a tear, or a “subluxation”, which means that one or both of these tendons have slipped out of position behind the lateral ankle.
It can be sudden (acute) or develop over a period of time (chronic) and is usually caused by participating in a sport that has repetitive ankle motion or just abrupt increase inactivity.
People with high arches are also susceptible to peroneal tendon conditions because it places these tendons in a constant stretched position.
Signs and symptoms of peroneal tendon irritation :
- Swelling if tendonitis (inflammation) is present – no swelling if tendinosis (damage)
- Warm to the touch
- Pain with contraction (eversion or plantar flexion of the foot and ankle) or when stretching the peroneal muscles (inversion or dorsiflexion of the ankle)
Proper examination and analysis are important because the entire treatment and plan of care, depending on the diagnosis, is completely different!
Treatments For Peroneal Tendon Dysfunction:
Once properly diagnosed, it is critical to initiate the proper treatment to address the actual cause.
This may include a more conservative approach initially and, as symptoms improve, specific exercises will be added to strengthen the muscles and improve range of motion and balance.
Since there are fine lines between each of these conditions and they will vary by individual and cause, we make sure that you receive the right combination of therapies to recover and get on with life.
Some of the most common peroneal tendon treatments we provide may include:
- Foot orthotics
- Patient education
- Dry Needling
- Active Release Technique (ART)
Foot Condition #4: Achilles Tendonosis & Tendonitis
What is the achilles tendon & how does it get injured?
The achilles tendon is one of the thickest and strongest tendons in the human body and rightfully so since it has to support all of your body weight! It is located at the back (posterior) of your calf and is attached to the calcaneus or heel bone. The achilles tendon is made up of three muscles; the gastrocnemius, soleus, and plantar muscle. This group of muscles is called the triceps surae.
Achilles tendonitis and achilles tendonitis are often caused by a sudden increase in repetitive activities involving the achilles tendon.
This activity puts too much pressure on the tendon, causing micro-damage to the tendon fibers.
Due to the constant pressure on the tendon, the body cannot repair the injured tissue. Then the tendon structure changes, causing constant pain.
People with excessive internal rotation or excessive pronation (flattened arches) are more likely to develop achilles tendonitis and tendinosis due to increased demand on the tendon when walking. If they wear shoes without proper stability, the excessive internal rotation/pronation may further aggravate the achilles tendon.
Signs and symptoms of achilles tendon dysfunction:
The most common symptoms of achilles tendon dysfunction include:
- Pain/Stiffness above the heel or behind the ankle (especially in the morning)
- Pain that worsens with on-foot exercise
- A visible bump in the heel area
- Pain when standing on tiptoe
- Feeling that the heel is “spongy” when you press on it
- Pain when pushing off while walking
Treatments for the Achilles Tendon:
Proper treatment is absolutely crucial to a successful recovery. We use advanced achilles tendon treatments like these to get rid of achilles problems once and for all…
- Specific strengthening and stretching exercises
- Manual therapy
- Technique modifications
- Postural adjustments
- Patient education
- Shoe inserts
- Dry Needling
These are just a few of the ways that we successfully treat achilles pain and injuries.
We’ll work with you one-on-one to design your personalized treatment plan, based on your specific underlying causes.
Foot Condition #5: Posterior Tibial Tendon Dysfunction
What is a posterior tibial tendon?
One of the major supporting structures of the foot, the posterior tibial tendon helps it to function when walking.
Changes in the tendon, impairing its ability to support the arch, results in posterior tibial tendon dysfunction, resulting in the flattening of the foot.
Although this typically occurs in one foot, it can develop in both. It is usually progressive, so it will likely get worse if not treated early.
Since it’s at a mechanical disadvantage, overuse of the posterior tibial tendon, due to flat feet, is often the cause. Symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
Signs and symptoms of peroneal tendon dysfunction :
People suffering from this condition complain of pain on the inside of the foot, usually in the middle or rear of the foot. This pain tends to follow the path of the tendon, behind the ankle bone, on the inside of the foot.
There will also be a considerable amount of weakness in the foot. One telltale sign is the inability to do a single “heel raise”, sometimes known as a calf raise.
When the heel doesn’t invert or supinate during the calf raise, chances are you may have weakness of this muscle and tendon.
Another strong indicator of the condition is called the “too many toes” sign. This happens when an observer stands behind the patient and looks down at their feet. From this angle, if you see more toes sticking out on the outside of the foot than you normally would expect, it is an indication that the arch has collapsed and the toes have rotated out to the side.
At more advanced stages, a clear foot deformity can be seen.
Treatments for Posterior Tibial Tendon Dysfunction:
If treated early enough, your symptoms may resolve without the need for surgery, and the progression of your condition can be arrested.
A properly designed physical therapy program involving highly specific strengthening and flexibility work is very effective in mild to moderate cases of this condition.
Posterior tibial tendon treatments may include specific exercises may also be prescribed, to help rehabilitate the tendon and muscle, following immobilization.
Foot Condition #6: Plantar Fasciitis
What is the plantar fascia?
The plantar fascia is the band of tissue that extends from the heel to the toe and plantar fasciitis is usually an irritation first and then an inflammation of that tissue, resulting in heel pain.
Overly flat or high-arched feet are more likely to develop plantar fasciitis.
Wearing non-supportive footwear on surfaces that are hard and flat puts an increased strain on that band of tissue and causes the condition, especially if your job requires you to be on your feet for long periods of time.
There is also evidence that obesity and overuse may contribute to plantar fasciitis.
Signs and symptoms of plantar fasciitis:
- Pain on the bottom of the heel
- Pain in the arch of the foot
- Pain that is usually worse on rising
- Pain that increases over a period of months
- Swelling on the bottom of the heel
You may find that the pain is worse, first thing in the morning or after you’ve been sitting for a longer period of time.
The pain might lessen after a few minutes of walking, because that will stretch the fascia, and then returns when you spend a longer period of time on your feet.
Treatments For Plantar Fasciitis:
The majority of treatments for plantar fasciitis are conservative but when it doesn’t resolve, more advanced techniques and methods are available.
Although surgery, injections, and pain meds may be prescribed from time to time to manage plantar fasciitis, it usually comes right back. This is because the plantar fascia irritation is the symptom and not the cause.
Some treatments your Doctor of Physical Therapy may provide for your plantar fasciitis include:
- Ankle or foot mobilizations
- Active Release
- Dry Needling
- Foot orthotics
- Function strengthening and stretching exercises
Some interesting facts about knees and ankles and how they are related
As we age, everything starts to wear out, including the cartilage that cushions your joints. This can cause bones to rub together and this action can lead to inflammation in those joints.
Ankles are one of the most complex and important joints in your body and very easy to ignore in terms of care.
There are a lot of moving parts, so frankly, a lot can go wrong.
A lot of your mobility is tied to your ankles and they can easily lose range of motion and flexibility as we age, without the proper attention.
You might have knee pain that is a direct result of a problem in your ankle. Lack of mobility in the ankle can also cause pain in the knee.
So ignoring an issue in your ankles can affect how your knees move. If the ankle doesn’t move the way it’s supposed, guess what? That will force the knees to move incorrectly as well. This can result in knee pain and even travel further up into the hip.
So fixing your ankle might be the road to getting rid of knee (and possibly also hip) pain. At Back In Motion, we fully understand all of the complexities in these joints, how they should work, what causes them to malfunction, and how to fix the problem.
It’s not unusual for primary care practitioners to blame joint pain, especially with people in their 50’s, 60’s and 70’s (and beyond) on various forms of arthritis, when it’s quite possible that you had a minor sprain or a fracture, that your talus (heel bone) was injured or you’ve got a form of achilles tendonitis (strain/inflammation) or tendinosis (overuse). So, they’ll prescribe rest and pills, when often that’s the last thing you need to get better.
At Back In Motion, we have a lot of experience with a wide variety of issues, based on many years of working with a wide range of clients, from elite athletes to couch potatoes.
It’s most important when helping you get better that you work with someone who has “seen it all” or, more importantly, can say to you “I know exactly what the problem is and this is how we’re going to fix it.”
This approach actually means that you don’t have to resort to pills, which is always better, especially because a lot of them have side effects AND in a lot of cases, rest only serves to prolong the healing period.
At Back In Motion, depending on the actual source of your pain, you’ll probably be moving the affected area in a very particular way, as recommended, so that you can recover faster. Moving promotes circulation and prevents stiffness; rest does not. Make sense?
Now we’re not saying that everything we see can be resolved right away with treatment.
It’s possible that our examination results in a recommendation for further studies, like an x-ray or an MRI, to make absolutely sure that we derive the cause.
Sometimes there is an issue in another part of the body that is either contributing or causing the problem!
It’s important to ensure that we consider all aspects of the condition. That is how we get you back to health the best and fastest way.
Are You Worried About or Frustrated with Ankle and/or Foot Pain?
As you can see, we’ve laid out the most common conditions, their causes, and how they can be successfully treated by seeing a Doctor of Physical Therapy.
Maybe you injured yourself and it’s just not healing…
Walking for any distance causes discomfort or real pain…
One side has a problem bearing weight, even when you’re just standing…
You notice a burning, tingling, or numbness more often or it’s becoming constant…
Sometimes you feel unstable or it’s difficult to push off from your toes…
An overall feeling of stiffness, especially first thing in the morning, making it tough to get out of bed…
You Don’t Have to “Live” with Foot or Ankle Pain & Help is Within Your Reach
Most foot and ankle problems are a result of an injury, extended periods of rest, footwear that doesn’t fit properly, activity, overuse, or abnormal foot biomechanics.
The pain might be signaling an underlying issue like inflammation or an unattended fracture. Since the infrastructure is complex, it’s important to isolate the cause, so that proper treatment can be provided to resolve the issue.
If you’ve been thinking that it will eventually go away, you might be doing more harm than good.
BACK IN MOTION has extensive experience in treating these types of pain, thanks to many years of working with clients at all levels of professional and casual sports, couch potatoes, and workout warriors, especially for those in their 50’s, 60’s and 70’s who want to be healthy and active.
Our system, the GRAY METHOD™, not only treats all of these conditions, we actually go that one step further and figure out what the cause is so that you will actually get the right approach and resolve the issue!
Let’s discover the root cause of your foot & ankle pain and get you back in motion!
Call our office at 239-223-0484 and schedule your appointment today or fill out this quick & easy form to get started!
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