Let’s Talk Feet!
Building a Good Foundation from the Ground Up

When building a house, or a fitness program, you need a good foundation on which to build. And your skeletal system is no different. Keeping your feet healthy and happy is an important step to ensuring a good foundation for skeletal health. Here are some of the most common foot and ankle conditions that we treat in our clinic:

PLANTAR FASCIITIS

This manifests itself as pain in the bottom of the heel or arch of the foot, and is often most painful when first getting up on your feet in the morning or after you have been sitting. It is a term specifically used for a condition in which the plantar fascia, the thick band of tissue connecting the heel to the ball of the foot, becomes inflamed. However, the actual source can also, or instead, be coming from:

• Muscle in the calf
• Muscles in the bottom of the foot
• Irritated nerve tissue
• An excessively flexible arch and a relatively stiff calf
• Weak muscles in the foot or calf
• A stiff arch
• A shoe that is inappropriate for that individual, such as too stiff, too flexible, or too minimalist
• Excessive loading due to inappropriate training in sports
• A combination of the above

Interestingly, the condition is as common in non-athletes as it is in athletes alike. Effective treatment requires accurate identification of the source of the pain and the perpetuating factors.

Did You Know?

Heel pain is a common complaint among approximately 2 million people per year, and nearly 10% of the population over a lifetime.

Check out our special stretch for plantar fasciitis:

ACHILLIES TENDINITIS/TENDONOSIS

The Achilles tendon, that connects the heel to the calf muscle, is the largest tendon in the body. It is prone to overuse, and when the tissue becomes inflamed it is called tendinitis. When it has been longstanding it might be termed tendonosis. It is often felt as a stabbing pain or soreness in the back of the ankle and into the calf. While it can be precipitated by an event, such as a sudden increase in running distance, or a long evening out in high heels, it is usually a condition that builds over time from repeated over stress of tissue.

While pain in the area of the Achilles is commonly called Achilles Tendinitis it can actually be pain from a bursa or even a muscle in the calf referring pain into the area or a combination. For some people, the contact of their shoe may rub against the tendon or bursa as the source. Yet for others, a shoe that is too loose and doesn’t grip the heel adequately results in excessive play and irritation.

Did You Know?
On any given day, more than 25,000 people will sprain their ankle.

ANKLE SPRAINS

The term ‘sprain’ specifically refers to the ligaments of a joint being stretched. They can range in severity and are a very common occurrence. The ligaments on the outside of our ankles are particularly vulnerable, but sprains can also involve the ligaments that hold the 2 bones of the lower leg together, the tibia and fibula. That is known as a ‘High Ankle Sprain’. The inside ligaments can also be injured but that is much less common.

In addition, you can injure muscles along with the ligaments. Ankle sprains can result in a significant amount of swelling. The swelling can be the source of a large amount of the disability of the injury and the delay in the return to normal use. The receptors that provide position sense and tell the body where it is in space, are located in the ligaments especially. So injury here, and swelling, reduce the function of these receptors. Restoring your ability ‘to balance’ can be essential, not only to initial recovery, but also in preventing a recurrence. Immediate and appropriate care can result in rapid improvement and full resolution, even with a very swollen ankle sprain (see the photos). Recent research indicates that recovery is improved with manual physical therapy and an exercise program specifically designed for the individual’s injury.

While the length of treatment may vary with the severity of the injury, left untreated, recurrent sprains can lead to a more permanent disability. The use of temporary taping, ankle supports and braces, and even orthotics, may each be helpful in the management of some cases, not all. And safely weaning off of supports is important in restoring normal function in all but the more severely injured joints. A treatment approach that is tailored to the specific needs of the individual injury is the key to an optimal result, and the most rapid safe return to full function.

Case Study in Ankle Sprain Treatment

Client: 18 year old male athlete.

Mechanism of Injury: Rolled playing basketball.

Presentation: Lots of swelling, bruising, pain, and limited range of motion.

Treatment Plan: Manual therapy and massage to reduce swelling and improve movement. Electric stimulation and Kinesio tape to help with swelling reduction. Therapeutic exercise to regain range of motion, strength, and reduce swelling. Restoration of movement patterns for balance and coordination. Functional testing for safe return to sport.

Outcome: Return to competition within two weeks and just five treatments!