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
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All age groups can be affected
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Pain or ache after or during exercise
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Instability of the ankle joint
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Tightness in the back of the calf muscles or at the front of the shin often brought on by sudden bouts of running
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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:
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A fracture : an inability to weight-bear or walk 4 steps/ severe tenderness along the inside or
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outside of the ankle/ the base of the outer part of the foot/ inside of the arch of the foot.
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Dislocation- an instability of the foot and ankle- an inability to walk.
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Damage to nerves or circulation- discolouration of the foot and ankle.
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A ruptured tendon/ muscle- severe weakness and pain, with moderate swelling.
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Wound penetrating the joint.
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Known bleeding disorder.
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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?​
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Repetitive overload of muscles, tendons, ligaments, and joints of the foot and ankle- more than the strength they have to cope with the load:
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Heavy continuous exercise with little rest.
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Insufficient rest- when exercising or performing an activity
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Starting an exercise programme at a high advanced level more than the strength of the body can cope with
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Sudden rapid slips or trips resulting in sprains or strains.
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Incorrect footwear for activities
HOW TO SELF MANAGE
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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.
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Painkiller as long as these are safe for you to take.
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P R I C E: Protect. Rest. Ice. Compress. Elevate.
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Heat packs or hot water bottles may relieve pain and muscle spasm (do not use if red, hot and swollen already).
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Icing for any pain and swelling- no direct ice to skin.
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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.
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Elevation- keep feet elevated above the level of the heart for 30 minutes if moderately swollen.
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Modify or temporarily stop your activities or running.
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Have a gradual return back to exercise.
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Use appropriate footwear- speak to specialists regarding this.
PROGNOSIS
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Depending on the severity of the injury- most minor spains take approximately 2 weeks to
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improve with more moderate sprains taking approximately 6 weeks to improve.
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Once you return back to training on this- be sure to progress gradually.
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Injuries such as a twisted ankle can lead to further instability and or other related problems
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with foot and ankle pain- so it is wise to get expert opinion via a physio or consultant on this.
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Physiotherapy can last between 6-12 weeks for more moderate injuries depending on the severity of the injury.
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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?
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Usually consists 6-12 weeks of a personal management plan discussed with your
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physiotherapist.
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Exercise programmes: aerobic activity, stability and movement advice, muscle strengthening, and proprioception
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Assessments and screening to determine which structures have been affected and what symptoms can be addressed.
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Foot biomechanics/ footwear review
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Soft tissue massage and trigger point release.
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Acupuncture and dry needling.
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Injury prevention exercises
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Mobilisations and manipulation (manual therapy)
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Referral to an orthopaedic specialist for advice on management with more severe or chronic
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injuries
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References
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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.
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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.
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Braund,R. and Haxby Abbot,J. (2007) Analgesic recommendations when treating musculoskeletal sprains and strains. New Zealand Journal of Physiotherapy. 35(2), 54-60.
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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
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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]
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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
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NICE (2015) Key therapeutic topics - medicines management options for local implementation. National Institute for Health and Clinical Excellence. www.nice.org.uk