Foot & Ankle Injuries

Injury to the lateral ligaments of the ankle, also known as a “rolled ankle”, is one of the most common soft tissue injuries sustained worldwide. The lateral ligaments are 3 ligaments that sit around the outside ankle bone, and provide stability to that side of the joint. They are injured when the ankle rolls inwards with the toes in a pointed position (known as plantarflexion). 2 of the 3 lateral ligaments are usually involved in the injury: the ATFL which sits more towards the front of the ankle bone and usually tears first, and the CFL which sits more laterally and under the ankle bone and is usually torn once ATFL has been torn. Symptoms vary greatly depending on the severity of injury, which and how many ligaments are involved, and whether this is the first instance of injury or not. Symptoms may include swelling, pain, difficulty weight bearing, a loss of range of motion, bruising that tracks into the outside of the heel and foot, and feelings of instability. Conservative treatment should always be the first port of call, and no imaging is required to assist with diagnosis in the majority of cases. Following injury, physiotherapy should commence right away, with the goal of:

• Making an accurate clinical diagnosis

• Educating you about your injury

• Assisting you in acute injury management

• Protect the injured structure

• Commence early rehabilitation

• Plan out your return to sport and activity

Injury to the medial ligament of the ankle (the deltoid ligament) is far less common than the lateral ligaments. The deltoid ligament is a thick continuous ligament that attaches from the inside ankle bone to various attachment points in the foot and ankle, and has both superficial and deep components. It is injured during eversion movements - when the ankle rolls out - or during large inversion injuries where the deltoid ligament may be injured due to compression. It may also be injured in conjunction with a syndesmosis (high ankle) injury. Symptoms vary depending on severity, but usually include swelling, pain, difficulty weight bearing, a loss of range of motion, bruising that tracks into the inside of the heel and foot, and feelings of instability. Conservative treatment should always be the first port of call, and no imaging is required to assist with diagnosis in the majority of cases. Following injury, physiotherapy should commence right away, with the goal of:

• Making an accurate clinical diagnosis

• Educating you about your injury

• Assisting you in acute injury management

• Protect the injured structure

• Commence early rehabilitation

• Plan out your return to sport and activity

The Syndesmosis is the joint between the two leg bones (tibia and fibula) and sits directly above the ankle joint. It has four major stabilizing ligaments, and does not allow for movement or separation of the tibia and fibula. SYndesmosis injuries can occur in a number of ways, the most common being when the leg or body rotates medially above a foot that is planted, resulting in external rotation of the foot. Usually, the anterior ligament is injured first, and then depending on the severity of injury, each ligament may be injured front to back, and may also involve the deltoid ligament of the ankle in extreme cases. Symptoms vary depending on severity, and are graded I-IV. Low grade injuries may allow the individual to weight-bear with pain, whereas more severe injuries will not. Symptoms may include pain, swelling, a loss of range of motion, and an inability to bear weight. Pain and swelling is usually localized to the syndesmosis rather than the lateral ligaments of the ankle, and the mechanism of injury differs, which helps differentiate between these two injuries. This is an important distinction to make as treatment will differ depending on the diagnosis. Plain film X-rays are often requested to determine whether there is separation of the tibia and fibula, and further imaging may be required. Most syndesmosis injuries commence conservative management, and the majority will be successful. However more severe injuries with separation and instability may require surgical fixation. Physiotherapy should commence immediately regardless of the treatment pathway. The goals of physiotherapy are to:

• Make an accurate clinical diagnosis

• Educate you about your injury

• Assisting you in acute injury management

• Protect the injured structures

• Commence early rehabilitation

• Plan out your return to sport and activity

The Achilles is the thick, strong common tendon of the calf muscles located at the back of the ankle and attaching to the heel bone. Achilles pain is a common complaint, particularly in runners, and is usually related to the tendon itself or the surrounding structures.

Achilles Tendinopathy is the most common cause of Achilles pain. Tendinopathy is a degeneration of the collagen fibers that form the tendon. It is not an inflammatory condition, but a disease of load - even the smallest changes in the way the tendon is loaded can kickstart a tendinopathy. Running and jumping athletes are highly susceptible to developing achilles tendinopathy due to the repetitive nature of their activity and loading on the tendon. It is also more prevalent in individuals over the age of 40. There are many treatment modalities that are currently being used to treat achilles tendinopathy, but by far the most effective combination is load adjustment and gradual strengthening.

In some cases, other structures may be contributing to symptoms, such as the retrocalcaneal bursa, superficial bursa, or achilles sheath. In these cases other treatment modalities may be useful to assist with pain, although most individuals will also require periods of load adjustment and strengthening.

The majority of people who experience achilles pain wait more than 6 weeks before seeking help. It is beneficial for physiotherapy to start as soon as possible so that a diagnosis can be made, and the appropriate activity modifications put in place to halt the progression of the condition. The goals of physiotherapy are to

• Make an accurate diagnosis

• Identify any loading errors in your training or activity

• Educate you about your condition

• Provide manual therapy where appropriate

• Design a loading program specific to you

• Plan out your return to sport and activity

The plantar fascia is a thick band of connective tissue (fascia) located under your foot that connects the heel bone to the base of your toes. It supports the arch and plays an important role in our walking mechanics. The plantar fascia functions like a tendon in that it is highly sensitive to load. When overloaded, the collagen fibers disorganize and eventually degenerate, developing into a tendinopathy (the term plantar Fasciitis is misleading as it implies that the condition is inflammatory, whereas tendinopathies are actually degenerative conditions). Even the smallest changes in the way the plantar fascia is loaded can kickstart symptoms, for example, changes to footwear, changes to the amounts or intensity of activity, changes to surfaces you normally walk on or run on, and putting on weight. Running athletes are particularly susceptible, as are people over the age of 40. There are many treatment modalities that are used to treat plantar fasciitis, but by far the most effective combination is load adjustment and gradual strengthening. The goals of physiotherapy are to:

• Make an accurate diagnosis

• Identify any loading errors in your training or activity

• Educate you about your condition

• Provide manual therapy and acute symptom management where appropriate

• Design a loading program specific to you

• Plan out your return to sport and activity

A lisfranc injury is a disruption of the joint between the medial cuneiform (bone in the midfoot) and base of the 2nd metatarsal (long bone in our foot). These injuries are commonly sustained during axial loading of the joint, for example falling from a height, or landing from a jump on your toes, and so is prevalent in sports such as gymnastics and dancing. Severity of the injury can vary greatly from partial disruptions to full fracture dislocations that may also encompass the entire tarsometatarsal complex (the joint between the mid foot and forefoot). Symptoms may include pain over the joint, localized swelling, difficulty weight bearing, and bruising on the underside of the foot. Plain film X-rays are used to determine whether there is separation of the joint which may result in instability.