Common ankle and foot injuries include:
Lateral Ligament Sprain
Lateral ligament sprains are one of the most common ankle injuries, occurring when the ankle rolls inwards. Symptoms commonly include significant swelling, bruising and pain with weight-bearing. Patients will also commonly experience a deficit in strength, control, balance and proprioception.
Lateral ligament sprains generally have good functional outcomes, even in the presence of a complete tear. Following the initial inflammatory phase, treatment may consist of range of motion and strengthening exercises, balance work and eventually rehabilitation for return to sport if required.
Chronic Ankle Instability
Chronic ankle instability refers to repeated ankle sprains, most commonly of the lateral ligaments. Patients often develop chronic ankle instability when the deficits in strength, control, balance and proprioception associated with an ankle sprain are not treated effectively. As such, treatment for chronic ankle instability is focused on addressing these deficits. Taping or soft braces may also be used to provide external support to the ankle.
Achilles Tendinopathy
Achilles tendinopathy is a common overuse injury that can affect either the midportion of the Achilles, or the insertion of the Achilles onto the calcaneus (heel bone). Commonly, Achilles tendinopathy develops following a sudden increase in training load or intensity. Symptoms may include pain that is worse in the mornings and that eases with exercise, as well as tightness and weakness in the calf. Pronated feet, or “flat feet”, are also a risk factor for developing Achilles tendinopathy.
The treatment for Achilles tendinopathy varies, depending on whether the tendinopathy is in the middle of the tendon or where the tendon inserts into the heel bone. However, with a well-planned and appropriate exercise protocol, patients with Achilles tendinopathy can return to full function and, if desired, high-level sport.
Plantar Fasciitis
The plantar fascia is a band of fibrous, connective tissue on the sole of the foot that supports that provides arch support and shock absorption. Plantar fasciitis refers to inflammation or pain in the plantar fascia and may be associated with a sudden increase in load or activity. Common symptoms of plantar fasciitis include heel pain (particularly with the first few steps in the morning), pain with ascending stairs, limited ankle range of motion and calf tightness.
Treatment of plantar fasciitis may include avoiding aggravating activities, release of the plantar fascia, taping, stretching and strengthening of supporting muscles.
Fractures
Ankle fractures most commonly occur during sport or as the result of a fall. Common locations of ankle fractures can include the base of the fifth metatarsal, above the lateral and medial malleoli and across the tibial plafond (at the end of the fibula or tibia). Following a fracture, significant swelling and bruising may occur and patients will often experience pain with weight-bearing. Suspected ankle fractures should be confirmed with imaging as soon as possible. Treatment often consists of immobilisation while the fracture heals, then progressive range of motion, strengthening and balance or proprioception exercises. Fractures of the foot are less common than ankle fractures, however, treatment principles are often similar.
Osteoarthritis
Osteoarthritis in the ankle or foot occurs less frequently than in other joints of the body. Up to 70% of cases of ankle and foot osteoarthritis are secondary to a trauma, such as a fracture or a severe ankle sprain. Symptoms of osteoarthritis are generally similar across all joints of the body, including morning stiffness, pain with weight-bearing, muscle weakness, stiffness and “clicking” or “crunching” noises.
Physiotherapy treatment for ankle and foot osteoarthritis may include targeted strengthening exercises, range of motion exercises, balance or proprioception training and hydrotherapy. Massage, heat and passive mobilisation may also be used, however, these should only be used as short-term, adjunct treatments.
Post-surgical Pain & Stiffness
Following ankle or foot surgery, patients will often experience pain and stiffness, particularly if the joint has been immobilised. Treatment for post-surgical pain and stiffness may include passive joint mobilisation, range of motion exercises, strengthening exercises and balance or proprioception training. Treatment can also include gait re-training and specific rehabilitation for return to sport or pre-injury activities.
