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FOOT & ANKLE

Often caused by a sudden twisted ankle through a slip or trip, or incorrect footwear/ foot mechanics leading to long-term chronic pain in the feet.
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SIGNS AND SYMPTOMS

  • All age groups can be affected

  • Pain or ache after or during exercise

  • Instability of the ankle joint

  • Tightness in the back of the calf muscles or at the front of the shin often brought on by sudden bouts of running

  • Areas of tenderness along the outside of the ankle joint, top of the foot, under the big toe, and near the base of the heel

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If you suspect any of the following, then please contact your doctor or GP immediately:

  • A fracture : an inability to weight-bear or walk 4 steps/ severe tenderness along the inside or

  • outside of the ankle/ the base of the outer part of the foot/ inside of the arch of the foot.

  • Dislocation- an instability of the foot and ankle- an inability to walk.

  • Damage to nerves or circulation- discolouration of the foot and ankle.

  • A ruptured tendon/ muscle- severe weakness and pain, with moderate swelling.

  • Wound penetrating the joint.

  • Known bleeding disorder.

  • Signs of septic arthritis or haemarthrosis - if the joint is moderately swollen or hot and tender/painful to touch.

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WHAT CAUSES IT?​

  • Repetitive overload of muscles, tendons, ligaments, and joints of the foot and ankle- more than the strength they have to cope with the load:

    • Heavy continuous exercise with little rest.

    • Insufficient rest- when exercising or performing an activity

    • Starting an exercise programme at a high advanced level more than the strength of the body can cope with

  • Sudden rapid slips or trips resulting in sprains or strains.

  • Incorrect footwear for activities

 

HOW TO SELF MANAGE

  • Taking anti-inflammatories if it is safe for you to take (take anti-inflammatories only if it is a chronic long-term issue, or there is a severe amount of swelling- do not use if there is an acute rupture, strain or sprain.

  • Painkiller as long as these are safe for you to take.

  • P R I C E: Protect. Rest. Ice. Compress. Elevate.

    • Heat packs or hot water bottles may relieve pain and muscle spasm (do not use if red, hot and swollen already).

    • Icing for any pain and swelling- no direct ice to skin.

    • Compression by self adhesive bandages- follow guidelines- making sure the taping/strapping is breathable and your toes are not loosing circulation by going purple- check regularly.

    • Elevation- keep feet elevated above the level of the heart for 30 minutes if moderately swollen.

  • Modify or temporarily stop your activities or running.

  • Have a gradual return back to exercise.

  • Use appropriate footwear- speak to specialists regarding this.

 

PROGNOSIS

  • Depending on the severity of the injury- most minor spains take approximately 2 weeks to

  • improve with more moderate sprains taking approximately 6 weeks to improve.

  • Once you return back to training on this- be sure to progress gradually.

  • Injuries such as a twisted ankle can lead to further instability and or other related problems

  • with foot and ankle pain- so it is wise to get expert opinion via a physio or consultant on this.

  • Physiotherapy can last between 6-12 weeks for more moderate injuries depending on the severity of the injury.

  • It is still helpful to get physiotherapy advice on an injury even if it is a minor injury, as they can show you tips and training techniques to help with injury prevention.

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HOW PHYSIO HELPS?

  • Usually consists 6-12 weeks of a personal management plan discussed with your

  • physiotherapist.

  • Exercise programmes: aerobic activity, stability and movement advice, muscle strengthening, and proprioception

  • Assessments and screening to determine which structures have been affected and what symptoms can be addressed.

  • Foot biomechanics/ footwear review

  • Soft tissue massage and trigger point release.

  • Acupuncture and dry needling.

  • Injury prevention exercises

  • Mobilisations and manipulation (manual therapy)

  • Referral to an orthopaedic specialist for advice on management with more severe or chronic

  • injuries

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References

  • Bachmann, L.M., Kolb, E., Koller, M.T., et al. (2003) Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. British Medical Journal 326(7386), 417-419.

  • Behm, D.G., Blazevich, A.J. and Kay, A.D. et al (2016) Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Applied Physiology, Nutrition, and Metabolism.

  • Braund,R. and Haxby Abbot,J. (2007) Analgesic recommendations when treating musculoskeletal sprains and strains. New Zealand Journal of Physiotherapy. 35(2), 54-60.

  • de Bie, R.A., Hendriks, H.J.M., Lenssen, P.T., et al. (2006) Clinical practice guidelines for physical therapy in patients with acute ankle sprain. Royal Dutch Society for Physical Therapy. www.kngf.nl

  • Jonckheer, P., Willems, T. and De Ridder, R. et al (201) Evaluating fracture risk in acute ankle sprains: any news since the Ottawa Ankle Rules? A systematic review. European Journal of General Practice 22(1), 31-41. [Abstract]

  • Jones, P., Dalziel, S.R. and Lamdin, R. et al (2015) Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Library. www.cochranelibrary.com

  • NICE (2015) Key therapeutic topics - medicines management options for local implementation. National Institute for Health and Clinical Excellence. www.nice.org.uk

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