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Ankle

The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the ends of the tibia and fibula (shin bones) in the lower limb with the proximal end of the talus bone in the foot. The joint between the tibia and the talus bears the vast majority of the body's weight while the fibula keeps the talus under the tibia.
The term "ankle" is used to describe structures in the region of the ankle joint proper. The joint under the ankle allows side to side movement while the ankle joint proper allows the foot to hinge up and down. Together they allow the foot to move as it were connected to the leg with a ball joint. Listed on the left are some of the most common pathologies written by our staff and local physicians.

Caution

 

Disclaimer:

This website is an information and education resource for health professionals and individuals with injuries. It is not intended to be a service for patients and should not be regarded as a source of medical or diagnostic information, or used as a substitute for professional medical instruction or advice. Not all conditions and treatment modalities are described on this website. Any liability (in negligence or otherwise) arising from any third party acting, or refraining from acting, on any information contained on this website is hereby excluded.

Achilles Tendonitis

Achilles Tendonitis is an inflammation of the thin sheath-like structure around the achilles tendon. This tendon attaches to the back of our heel and allows the muscles in the calf move our foot down so that the toes can point towards the ground (plantar flexion). The Achilles Tendon is a long and thick tendon, which moves our foot down, so that the toes point to the ground (plantarflexion). The pain can be shooting, piercing, and burning pain. The first few steps in the morning many times are the worst. It is important to treat this condition as soon as possible as it may progress to the point where it causes permanent damage to the achilles tendon proper. Ruptures and the need for surgical repair may be avoided by early diagnosis and treatment of this very common condition.


Possible Factors:

1. Overuse, such as too much running, especially up or down hill.
2. Trauma, such as a kick to the tendon.
3. Shoe or boot (ski/snowboard) pressure, especially at its attachment to the heel, or just above it.

Treatments:

a. Ice, Anti-inflammatories, rest,
b. Heel lifts

c. Removable Cast Boot or CAM Walker
d. Achilles Heel Guard
e. Custom Orthotics

 

Authors:

Washington Foot & Ankle

Peter Vincent, DPM

Lake Washington Physical Therapy

Benjamin Wobker, PT, MSPT, DPT

 

Achilles

 

Starting blocks

Ankle Ligaments

Inversion Sprain

 

Ankle x-ray

 

Kelly McGivern

Ankle Sprains & Hiking

Ankle injuries are a top reasons for search and rescue deployment in the backcountry. The American College of Sports Medicine estimates 25,000 American’s suffer ankle sprains each day; many of these injuries take place on local trails. Ankle sprains result from forceful movements causing damage to ligaments that maintain ankle joint integrity. Ligaments, similar to a rigid rubber band, are able to withstand resistance but with exponential force they become damaged. The most common place for ligamentous injury in the ankle is on the lateral surface (outside) of the ankle, called the anterior talo-fibular ligament. This damage is caused during inversion, where the foot rolls beneath the leg.

 

If you are an unfortunate subject of an ankle sprain, H-RICE is the go to! Hydrate, Rest, Ice, Compression, and Elevation multiple times a day. Take a break from the activities that put stress on the ankle and work to reduce swelling. Start with ankle pumps and circles. Try spelling the alphabet with your foot. The less swelling you have, the less pain!

 

A critically important aspect of sprain recovery involves proprioception. Proprioceptors are small sensors found in the body’s ligaments and musculature responsible for joint position sense. They notify the brain where joints are is in space. Close your eyes…you are still able to tell where your foot is in relation to your body even without visually watching it! After an ankle injury the likelihood of re-injury increases due to proprioceptive damage during the trauma. These little organs need retraining in conjunction with the strengthening of key musculature crossing the ankle to increase stability.
Prevention and recovery are key:
• Seek help from a Physician and Physical Therapist after injury
• Check your hiking boots out for sufficient tread
• Opt for a stiff boot to provide more stability on uneven ground
• Watch your step when hiking in slick or rocky conditions

 

If you do injury yourself in the backcountry and cannot walk, do not hesitate to call for help. Stay in the same location, this allows search and rescue personnel to locate you more easily. Search and Rescue volunteers are highly trained in assisting injured hikers and will protect the ankle until the hiker is able to receive full medical assistance.

 

Authors:

ProOrtho

Dr. Jonathan Hall, MD

Lake Washington Physical Therapy

Kelly McGivern, PT, DPT
Benjamin Wobker, PT, MSPT, DPT

 

 

 

Ankle Ligaments

Inversion Sprain

 

Ankle x-ray

Ankle Sprain

A common musculoskeletal injury in which the ligaments of the ankle are stretched, partially torn, or completely torn due to sudden over stretching. This most often occurs when the ankle is suddenly "twisted" in a sports activity or by stepping off an uneven surface. Most ankle sprains involve the ligaments on teh outside of the ankle as the foot folds underneath the body. This is referred to as an inversion mechanism. Ankle sprains are very common in sports involving rapid side to side movemnts ("cutting"), such as basketball, soccer, and tennis.


Sprains are graded based on teh extent of the damage to the ligament.

Grade 1 Sprain: An injury without macroscopic tears. No mechanical instability is noted. Pain and tenderness is minimal.
Grade 2 Sprain: A partial tear. Moderate pain and tenderness is present. Mild to moderate joint instability may be present.
Grade 3 Sprain: A complete tear. Severe pain and tenderness, inability to bear weight, and significant joint instability are noted.


Treatment: R.I.C.E – Rest, Ice, Compression, Elevation. The best first step to this injury before you can see a doctor of physical therapist. Depending on the severity of the sprain, you might or might not even be able to walk without pain, so the best thing to do is stay off of the injury as much as possible, and see a doctor as immediately for evaluation.

Once in physical therapy, common first stages of treatment are to restore your basic range of motion and reduce swelling, begin a strengthening regimen, normalize gait (walking pattern), and then begin a return to normal activities. Only after success in all these stages are patients ready to begin agility and plyometric exercises and activities that begin to mimic game and competition.

 

Authors:

Washington Foot & Ankle

Lawrence Maurer, DPM

Lake Washington Physical Therapy

Benjamin Wobker, PT, MSPT, DPT

Arch Pain

Arch
Fallen Arches
Arches

 

Arch Pain

The arch functions as a shock absorber for our entire body. Each time we step down, we place up to 5 times our body weight on the foot, depending on whether we are walking, running, or jumping. If there was no shock absorber in the foot, the force of each step would fracture or dislocate the bones of the foot, leg, and lower back. When pain occurs in the arch, it is telling us it is "sick" and cannot function properly. If left untreated, this will lead to a fallen arch, which will cause constant pain throughout the entire foot, and eventually the knee, hip, and lower back.

Description:

The most common causes of arch pain are:

1. Repetitive activities, such as walking or running too far; jumping; or standing on hard surfaces for long periods of time.

2. Injury.

3. The natural aging process.

4. Biomechanical defects of the foot, or abnormalities we are born with, such as very high or low arches, or pronation (a turning out of the foot, causing us to walk more on the inner border of the foot).

Cause:

The normal arch is made up of bones and joints which are held tightly together, in a precise relationship. When this relationship is subjected to repeated abnormal weight, or the normal weight of a lifetime, the force breaks up this normal relationship, causing bones to shift and joints to buckle. This allows the arch to collapse, and produces pain. The ability of the arch to absorb the shock of each step is reduced, so that continued walking will eventually produce pain in the knee, hip, and lower back. All four of the above categories will eventually cause this to happen.

Treatment:

Treatment must be directed to supporting the individual bones and joints which make up the arch, and to aid the arch in its job as a shock absorber. This in turn alleviates the arch pain, and prevents the further collapse of the arch. This is accomplished through the use of orthotics and proper footwear. Custom-made orthotics gently support not only the arch, but each individual bone and joint which makes up the arch. This not only relieves the arch pain, but prevents it from returning, and keeps the arch from collapsing further.

Foot anatomy
Plantar Fasciitis
Pronation
Plantar Fasciitis
Jumping

 

Plantar Fasciitis

Description:

The two most common causes of pain in the bottom of the heel and arch are heel spurs and plantar fasciitis. The plantar fascia is the thick ligamentous band in the bottom of the foot which is attached to the heel, and runs forward to insert into the ball of the foot. Plantar fasciitis is an inflammation of this band at its attachment to the heel.

Symptoms:

Plantar fasciitis pain is usually located in the center or the inner side of the bottom of the heel. The pain is most intense when first standing, after any period of rest. Generally, people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this pain may radiate into the arch or the ankle.


Causes:

Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little "give" to the plantar fascia, so as it stretches only slightly, it pulls on its attachment to the heel. If the foot is properly aligned this pull typically causes no problems. However, if the foot is "pronated" it causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel.

The same pathology occurs with "supination" (the rolling of the foot outward, causing a break down of the outer side of the shoe). Supinated feet are relatively inflexible, usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia does not stretch at all, and pulls with great force on its attachment to the heel.

In both cases, the abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a heel spur results.


Treatment:

Treatment must be directed towards realigning the foot as it goes through the gait cycle, and reversing the abnormal effects of pronation and supination on the plantar fascia and heel. In doing this, the abnormal pull of the plantar fascia on the heel will be made to disappear. This in turn, alleviates the pain and inflammation at the heel. Realignment, or proper postioning of the foot, is accomplished through the use of orthotics. Custom-made orthotics gently hold the foot in a proper or neutral alignment when it strikes the ground, preventing pronation or supination. Custom-made orthotics will also: reduce the pull of the plantar fascia on the heel, by supporting the arch; and cushion the heel, to provide an immediate decrease in pain. Custom-made orthotics will not only relieve the pain, but they will also prevent it from returning.

Jumping

Shin Splints

 

Bone Scan

MRI


 

Shin Splints

This term applies to pain in the front of the leg, occurring anywhere between the ankle and the knee, usually with prolonged walking or running. In extreme cases one can have pain in this area with just standing.


Symptoms:

Shin splints usually begin as a dull aching pain in thefront of the lower leg after prolonged walking, running, or jumping. If left untreated, the pain becomes sharp and intense with all weight-bearing activities. Other serious problems of the lower leg, such as stress fractures, are usually painful even while resting.


Causes:

The muscle in the front of the leg which usually becomes painful is the Anterior Tibial Muscle, which is encased in a thin sheath. This muscle attaches to the foot; and as long as the foot is properly aligned, the muscle functions efficiently and painfree. However, when the foot is pronated (the foot rolls outward and you walk more on its inner aspect), the Anterior Tibial Muscle twists within its sheath. This twisting of the muscle within its sheath can cause tiny tears in the muscle, or the muscle rubs abnormally against its sheath, and produces inflammation and pain.

Pain relievers and Permanent

Cure:

"The best treatment is prevention or early intervention." This is best accomplished by orthotics. Custom-made orthotics will realign your feet, correcting pronation; and they will provide you with the shock-absorbency needed to cure and prevent shin splints from occurring. If you have tried other methods of treatment, and they have failed, custom-made orthotics are the answer to your problem. It is no coincidence that serious amateur athletes, as well as most professional athletes, wear custom-made orthotics to keep them painfree and "in the game."

 

Authors:

Washington Foot & Ankle

Peter Vincent, DPM

Lake Washington Physical Therapy

Benjamin Wobker, PT, MSPT, DPT



 

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