FOOT & ANKLE

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

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.

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.

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

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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