Foot and Ankle Pain | Pain Treatment Recomendations & Info | IMPACT Physical Therapy

Foot and Ankle Pain

Ankle Sprain

Ankle sprains are common injuries that occur when the foot twists or turns beyond its normal range of movement, causing the ligaments of the ankle to overstretch or tear. It is estimated that 23,000 Americans experience ankle sprains daily. Of all sports injuries in the United States, 45% are ankle sprains; basketball players are the athletes most often affected. People who have an increased risk of spraining an ankle include younger athletes, members of the military, and anyone who frequently runs, jumps, and changes direction quickly, while performing an athletic activity (“cutting motion”). Physical therapists help people who have experienced ankle sprains reduce their pain; regain their strength, motion, and balance; return to normal activity levels; and avoid reinjury.

What Is Ankle Sprain?

Sprains are injuries to ligaments (the bands of tissue that hold joints together). Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments connecting the bones of the leg, ankle, and foot to overstretch or tear.

The ligaments on the outer (lateral) side of the ankle are the ones most commonly injured. Ligaments on the inner (medial) side of the ankle, or above the ankle bone, can also be sprained, but are injured less frequently.

An ankle sprain usually takes between 2 weeks to 2 months to heal. The ankle will feel better after a few weeks, and be fully strengthened in a few months. A severely sprained ligament, however, can take 9 months to 1 year to heal.

Recurrent ankle sprains are common; once an ankle ligament is sprained, it is often reinjured. In fact, 73% of people who have sprained an ankle once are likely to do so again. Reinjury is especially likely if muscle strength and balance are not fully restored to, or improved beyond, preinjury levels.

Did You Sprain Your Ankle? How Does it Feel?

Right after an ankle sprain, you may experience:

  • Pain
  • Swelling
  • Inability to stand or walk on the affected foot
  • Throbbing
  • Stiffness
  • Weakness
  • A feeling of instability in the ankle joint

After most sprains, you feel pain right away at the site of the ligament stretch or tear. Often, the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch, and when you move the ankle, it hurts. In more severe sprains, you may hear or feel something tear, along with a “pop” or “snap.”

How Is a Sprained Ankle Diagnosed?

If you see your physical therapist first, the physical therapist will examine your ankle, take your health history, and ask questions such as:

  • How did you get injured?
  • Did you feel a pop, snap, or tear?
  • What activities are you having trouble doing?
  • What activities do you want to get back to doing?

Your physical therapist will gently press around your ankle to see if it is painful to the touch, and may use additional tests to determine if other parts of your foot are injured. Your physical therapist will test your strength and flexibility, observe how you can move your foot and leg, and watch how you walk.

Depending on how badly a ligament is damaged, or how many ligaments are injured, your ankle sprain may be classified as:

  • Grade 1 (mild). The ligament is overstretched.
  • Grade 2 (moderate). The ligament is overstretched or partially torn.
  • Grade 3 (severe). The ligament is completely torn.

Your physical therapist also will test and screen for other, more serious conditions that could be causing the pain and swelling. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray, to confirm the diagnosis and to rule out other damage to the ankle, including a fracture.

How Can a Physical Therapist Help Foot and Ankle Pain?

Physical therapists help people with ankle sprains recover more quickly than they would without treatment. The time it takes to heal an ankle sprain varies, but results can often be achieved in 2 to 8 weeks. Your physical therapist will work with you to design a specific treatment program that meets your needs and goals.

During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:

  • Rest the area by avoiding any activity that causes pain.
  • Apply ice packs to the area for 15 to 20 minutes every 2 hours.
  • Consult with a physician for further services, such as medication or diagnostic tests.
  • Walk on the affected foot as soon, and as much as you are able, without making the pain or swelling worse.
  • Use crutches or other walking aids to help alleviate pain and support balance.
  • Wrap your ankle or use an ankle brace for support and to prevent swelling.

These self-treatments will allow you to be as active as possible with the least amount of pain, and will help speed healing.  

Your physical therapist will work with you to:

Reduce Pain and Swelling. You will learn how to avoid or modify your daily and sports activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, specific exercises, and hands-on therapy, such as specialized massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the ankle. These might begin with “passive” motions that the physical therapist performs for you to gently move your ankle and foot, and progress to “active” exercises and stretches that you do yourself.

Improve Flexibility. Your physical therapist will determine if any foot, ankle, or lower leg muscles are tight, begin to stretch them, and teach you how to stretch them.

Improve Strength. Ankle sprains may be related to weak, injured, or uncoordinated leg muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use, to steadily and safely restore your strength. These may include using cuff weights, stretch bands, and weight-lifting equipment.

Improve Endurance. Regaining your muscular endurance in the ankle and leg is important after an injury. Your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as treadmills or stationary bicycles.

Improve Balance. Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance ability.

Restore Agility. Speed and accuracy of leg movement is important in athletics and in many daily activities. Your physical therapist will help you regain these skills in preparation for a return to sports and to your daily routine.

Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.

Return to Activities. Your physical therapist will discuss activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

If Surgery Is Necessary

Surgery is not commonly required for ankle sprains. But if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible

Shin Splints (Medial Tibial Stress Syndrome)

Medial tibial stress syndrome (MTSS) is a condition that causes pain on the inside of the shin (the front part of the leg between the knee and ankle). MTSS is commonly referred to as “shin splints” due to the location of pain over the shin bone; pain can be felt on the inside or the front of the shin bone. MTSS is one of the most common athletic injuries. It affects both the muscle on the inside of the shin and the bone to which it attaches, causing the connection between them to become irritated or even develop minor tears due to overwork. MTSS may affect up to 35% of athletes who run and jump, such as distance runners, sprinters, basketball or tennis players, or gymnasts. Military personnel, dancers, and other active people also can develop MTSS. Physical therapists help people who develop MTSS recover pain-free movement and learn exercises and tactics to prevent reinjury.

What are Shin Splints (Medial Tibial Stress Syndrome)?

Medial tibial stress syndrome (MTSS) develops when too much stress is placed on the tibia (main shin bone). The muscles that attach to the tibia can cause an overload of stress on the bone, and strain themselves at their insertion onto the bone as well. These muscles include the posterior tibialis muscle, the soleus muscle, and the flexor digitorum longus muscle.

The most common risk factors of MTSS include:

  • Flattening of the arch of the foot (overpronation) while standing and walking/running
  • Participation in a sport that requires repetitive jumping and/or running
  • Excessive hip motion (moving the hip through a greater range than is typical)
  • A high body mass index (>20.2 BMI)
  • A previous running injury

How Do Shin Splints Feel?

If you have developed MTSS, you may feel pain in the middle or bottom third of the inside of the shin. The pain may be sharp when you touch the tender area, or occur as an ache during or after exercise. Generally, however, the pain is initially provoked with activity and lessens with rest. When MTSS is developing, the pain may be present during the beginning of exercise and less noticeable as exercise progresses. Over time, the condition can worsen and pain may be felt throughout any exercise regimen and continue after exercise.

How Are Shin Splints Diagnosed?

Your physical therapist will perform a thorough examination that will include taking a full health history and observing you as you walk and perform the activity that causes your symptoms, such as running or jumping.

Your physical therapist will further perform a series of tests and measures of your musculoskeletal system that assess your strength, mobility, flexibility, and pain response. The most reliable symptom of MTSS is pain felt when pressure is applied to specific locations on the shin.

If the results of the examination suggest MTSS, your physical therapist will discuss with you the goals of treatment and develop a specialized rehabilitation program for you. If a more serious condition could be contributing to your pain, you may be referred to a physician for further tests.

How Can Physical Therapist Help for Shin Splints?

Your physical therapist will determine what risk factors have caused your MTSS and will teach you how to address those causes. A treatment plan will be developed that is specific to you and what your body needs to recover and to prevent reinjury.

To relieve pain, your physical therapist may prescribe:

  • Rest from the aggravating activity or exercise
  • Icing the tender area for 5 to 10 minutes, 1 to 3 times a day
  • Exercises to gently stretch the muscles around the shin
  • Taping the arch of the foot or the affected leg muscles
  • Hands-on massage of the injured tissue

To help strengthen weak muscles, your physical therapist may teach you:

  • Exercises that increase the strength of hip rotation, hip abduction (lifting the leg away from the other leg), and hip extension (lifting the leg behind your body) to decrease stress to the lower leg
  • Exercises that increase your arch and shin muscle strength to decrease the overpronation (flattening out) of the arch of the foot

Your treatment also may include:

  • Calf and foot muscle stretches
  • Single-leg exercises including squats, reaching exercises, or heel raises
  • Modified take-off and landing techniques for jumping athletes
  • Modified leg and foot control during walking and running
  • Suggestions for footwear that provides better support when walking or exercising

Your physical therapist also may prescribe orthotics or shoe inserts that support the arch of the foot if your feet flatten out too much, or if your foot muscles are weak.

Physical therapists help athletes with MTSS alter their training schedules to safely return to sport, and offer specific guidance for reducing the possibility of reinjury. 

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) is a condition that develops when a nerve within the tarsal tunnel of the inner ankle is compressed. TTS can lead to alterations in sensation and movement of the foot, ankle, and lower leg, and/or pain. It is often associated with conditions causing increased compression or swelling in the lower leg. Physical therapists help people experiencing TTS to relieve their pain and restore their normal function.

What is Tarsal Tunnel Syndrome?

Often described as the carpal tunnel syndrome of the lower extremity, tarsal tunnel syndrome is a condition that results from the compression of the posterior tibial nerve as it runs through the tarsal tunnel (a structure made up of bone and tissue (retinaculum) on the inside of the ankle). As it passes through the tarsal tunnel, the tibial nerve divides into 3 branches that provide sensation for the heel and bottom of the foot, and aid in the foot’s function. When this structure becomes compressed, symptoms, such as pain, numbness, and/or tingling may occur and radiate into the lower leg, foot, and toes. Individuals may also experience muscle weakness in the area.

How Does TTS Feel?

The most common symptoms of TTS result from irritation of the tibial nerve and its branches. People with TTS may experience:

  • Pain, numbness, or tingling in the foot or ankle, which may radiate into the lower leg, foot, and toes
  • Weakness in the muscles of the lower leg and foot
  • Weakness of the big toe
  • Foot swelling
  • Symptoms that increase with prolonged standing or walking
  • Symptoms that decrease with rest
  • Altered temperatures of the foot and ankle
  • Pain that disrupts sleep

How Is TTS Diagnosed?

There are several tests that can help a clinician determine if TTS is present. Your physical therapist and/or physician will first take a comprehensive health history, and inquire about your current symptoms. Then your physical therapist may conduct tests, such as:

  • Gently tapping over the posterior tibial nerve in an attempt to reproduce your symptoms.
  • Tensing of the posterior tibial nerve, a maneuver that looks and feels like a “stretch,” in an attempt to reproduce your symptoms.
  • Conducting a nerve condition study—a diagnostic test to determine the speed at which a nerve conducts information.
  • Ruling out other conditions, such as plantarfasciitis (inflammation of the tissue that runs along the bottom of the foot).

How Can a Physical Therapist Help with TTS?

Physical therapists play a vital role in helping people experiencing TTS to improve and maintain their daily function and activities. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.  

Because the signs and symptoms of TTS can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

Nerve Gliding Activities. Gentle exercises that move and “glide” the nerves may help reduce symptoms and improve function.

Muscle Strengthening Exercises. Strengthening activities for any muscles affected by TTS, such as the tibialis posterior muscle in the back of your lower leg.

Balance and Coordination Activities. Work to improve your balance and coordination, which are often affected by TTS.

Orthotics/Taping/Bracing. Apply ankle taping, a custom orthotic, or bracing to position the foot to decrease stress on the posterior tibial nerve.

As with many conditions, education is key. Understanding the underlying mechanisms of TTS, and learning to recognize early signs and symptoms of stress may help you better manage the condition.

Plantar Fasciitis

Plantar fasciitis is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. You experience pain when you put weight on your foot—particularly when taking your first steps in the morning. The pain can be felt at the heel, or along the arch and the ball of the foot.

Plantar fasciitis is a common foot condition. It occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.

Factors that contribute to the development of plantar fasciitis include:

  • Age (over 40 years)
  • A job, sport, or hobby that involves prolonged standing or other weight-bearing activity
  • Rapid increases in length or levels of activity, such as beginning a new running program or changing to a job that requires a lot more standing or walking than you are accustomed to
  • Decreased calf muscle flexibility
  • Increased body weight (Body Mass Index greater than 30)
  • Tendency to have a flat foot (pronation)

Plantar fasciitis affects people of all ages, both athletes and non-athletes. Men and women have an equal chance of developing the condition.

Treatment generally reduces pain and restores your ability to put weight on your foot again.

Plantar Fasciitis: See More Detail

What is Plantar Fasciitis?

Plantar fasciitis is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. The condition develops when repeated weight-bearing activities put a strain on the plantar fascia. People who are diagnosed with plantar fasciitis also may have heel spurs, a bony growth that forms on the heel bone. However, people with heel spurs may not experience pain.

Plantar fasciitis occurs most frequently in people in their 40s but can occur in all age groups.

The condition can develop in athletes who run a great deal and in non-athletes who are on their feet most of the day, such as police officers, cashiers, or restaurant workers.

Signs and Symptoms of Plantar Fasciitis

The onset of symptoms of plantar fasciitis frequently occurs with a sudden increase in activity. You might feel a stabbing pain on the underside of your heel, and a sensation of tightness and/or tenderness along your arch.

People with plantar fasciitis may experience pain:

  • In the morning, when stepping out of bed and taking the first steps of the day
  • With prolonged standing
  • When standing up after sitting for awhile
  • After an intense weight-bearing activity such as running
  • When climbing stairs
  • When walking barefoot or in shoes with poor support

As your body warms up, your pain may actually decrease during the day but then worsen again toward the end of the day because of extended walking. Severe symptoms may cause you to limp.

How Is Plantar Fasciitis Diagnosed?

The physical therapist’s diagnosis is based on your health and activity history and a clinical evaluation. Your therapist also will take a medical history to make sure that you do not have other possible conditions that may be causing the pain. Sharing information about the relationship of your symptoms to your work and recreation, and reporting any lifestyle changes, will help the physical therapist diagnose your condition and tailor a treatment program for your specific needs.

To diagnose plantar fasciitis, your therapist may conduct the following physical tests to see if symptoms occur:

  • Massaging and pressing on the heel area (palpation)
  • Gently stretching the ankle to bend the top of the foot toward the leg (dorsiflexion)
  • Gently pressing the toes toward the ankle

How Can a Physical Therapist Help with Plantar Fasciitis?

Physical therapists are trained to evaluate and treat plantar fasciitis.

When you are diagnosed with plantar fasciitis, your physical therapist will work with you to develop a program to decrease your symptoms that may include:

  • Stretching exercises to improve the flexibility of your ankle and the plantar fascia
  • Use of a night splint to maintain correct ankle and toe positions
  • Selection of supportive footwear and/or shoe inserts that minimize foot pronation and reduce stress to the plantar fascia
  • Application of ice to decrease pain and inflammation
  • Iontophoresis (a gentle way to deliver medication through the skin)
  • Taping of the foot to provide short-term relief

Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required.

Bunion (Hallux Valgus)

A bunion (hallux valgus) is a large bump on the side of the foot that develops at the base of the big toe. It is common for a bunion to become inflamed and swollen, causing foot pain. Although anyone can develop a bunion, the condition most often occurs in women and older adults. Over time, the joint may enlarge and become stiff and painful, causing problems with shoe fit, pain, and difficulty walking. Physical therapists help people with bunions improve the angle of the big toe, improve their muscle strength and walking ability, and reduce their pain.

What is a Bunion?

A bunion is a bump on the side of the foot that develops at the base of the big toe when the toe deviates inward. A bunion is classified as mild, moderate, large, or severe, depending on the size of the measured angle at the toe. An angle of 20° or greater is considered abnormal.

There are several factors that may cause bunions, including:

  • Heredity
  • How the foot is shaped
  • Flat arches
  • Joint laxity (too much flexibility in the joint at the base of the big toe)
  • Osteoarthritis

Tight footwear has often been blamed for bunions, but recent research suggests that footwear may not be a factor in their development. However, tight footwear can irritate a bunion by rubbing on the tissue at the joint, creating more swelling and pain.

How Do Bunions Feel?

How a bunion feels varies with each individual. There is no relationship between the severity of a bunion and the symptoms experienced. Not all bunions cause symptoms; however, people with bunions report mild to severe symptoms, including:

  • Pain and swelling in the big toe joint that worsens with standing and walking.
  • Gradual enlargement of the bump on the side of the foot, which can become inflamed and swollen causing foot pain.
  • Pain when wearing shoes, making it difficult to find comfortable or stylish footwear.
  • Changes in how you walk.
  • Increased difficulty walking.
  • Changes in balance, increasing the risk of falling, particularly in older adults.
  • Crossing of the big toe and lesser toes, causing crowding of the toes, and possibly causing additional deformities and pain.
  • Reduced quality of life related to foot pain.

Signs and Symptoms of a Bunion

If you see your physical therapist first, the physical therapist will ask about your medical history, how your symptoms developed, and how they are currently affecting you. Your physical therapist will observe your walking pattern, particularly how you bear weight on the affected foot, and examine the foot and the big toe to observe any swelling, deformity, or tenderness. Your physical therapist will test the strength of your foot and big toe, and measure your foot’s flexibility and range of motion, and will check your footwear for proper fit, and for wear patterns. If your bunion is classified as severe, your physical therapist may recommend a consultation with an orthopedic foot surgeon.

How Can a Physical Therapist Help?

Your physical therapist will treat your bunion symptoms with pain management, exercise, gait training, and education regarding proper footwear and self-care for symptom management. The goal of physical therapy treatment is to improve the angle of the big toe, improve muscle strength, and reduce pain.

Your physical therapy treatments may include:

Manual Therapy. Your physical therapist may use manual (hands-on) therapy to help improve the position of the big toe Your physical therapist will gently move your big toe and ankle to reduce joint tightness and any stiffness of the surrounding tissues, and increase the big toe’s bending range of motion.

Exercise. You will be taught range-of-motion, stretching, and strengthening exercises to improve the alignment of the big toe when standing, and improve your walking pattern. Your physical therapist will design an individualized exercise program based on your specific needs.

Balance Training. To help reduce the risk of falling, your physical therapist will teach you standing and walking exercises to improve your balance during movement.

Symptom Management. You will learn how to use intermittent foot elevation, self-massage, and ice or heat packs to manage any inflammation/swelling and pain.

Your physical therapist may also apply specialized taping of the big toe to improve the big toe’s alignment, and reduce pain. Your physical therapist will recommend the best footwear for your condition.

Orthotics and Devices. Your physical therapist may recommend the use of splints, foot orthotics, or assistive devices, depending on your condition, and will train you in their use. They may include:

  • Splints and toe separators to reduce pain and pressure on the big toe.
  • Custom arch supports (foot orthotics) to help keep the foot and ankle in a midline position during walking.
  • A cane, walker, or crutches (assistive devices) to reduce pain and improve walking ability.

Activity Training. As you regain strength and flexibility, your physical therapist will provide activity training specific to your job, leisure activity, or sport.

After Surgery

If your bunion deformity progresses to a point where you cannot find comfortable footwear, or walking becomes difficult, you may choose surgery to correct the position of the big toe. A physical therapist can help after your surgery to restore the strength and flexibility of the big toe, reduce pain, and improve your walking ability.

Rehabilitation varies with each individual, based on their condition and the type of surgical procedure performed.

After most surgeries, you will wear a special postoperative shoe to protect your foot, and avoid putting pressure on the surgical area for about 4 weeks.

A hospital physical therapist will teach you how to walk with a cane, walker, or crutches to avoid putting weight on the surgical area, and to help ensure that the bones will heal well. You will also be given instruction in the use of ice packs and leg elevation to control pain and swelling.

Rehabilitation with a physical therapist should begin 3 to 4 weeks after surgery, and continue for 4 to 6 weeks. Treatments will include the elements listed above. The first session will focus on pain and swelling reduction with the use of mild ankle range-of-motion exercises, ice packs, and mild massage. You will begin gait training with specific instructions from your physical therapist, and perform exercises in the clinic and at home.

Postoperative physical therapy will emphasize walking and learning how to push off of your big toe properly to restore normal walking ability. It will also include exercise to strengthen the big toe and ankle, and movement to restore better bending of the big toe. It is important to regain strength and bending in the big toe to restore your full walking ability. You will be encouraged to perform a home-exercise program between physical therapy visits as well as after the visits are completed, to help you return to your job, leisure, or sport activities.

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