Covid 19 Update

Foot and Ankle Pain

If you have very recently sprained your ankle it will probably be very painful; this is normal, but you should be able to put some of your weight through it. If you cannot put any of your weight through it you will probably need an X-ray.

Ankle injuries are among the most common injuries to sporting and non-sporting people, and are responsible for over 300,000 visits to A&E each year. Most ankle injuries involve ‘going over’ on the ankle, causing injury to the ligaments and tendons on the outside of the ankle. A simple ankle injury generally heals well over a period of 4-6 weeks. In the early stages you should follow the RICE advice on our Recent Injury Management page, then after the first few days you should begin gentle range of movement exercises which you will be able to progress as pain allows. It is important to rehabilitate the ankle properly, especially in the sporting population, to prevent prolonged symptoms, decreased performance and the risk of recurrence. See our video below for more information.

The main cause of recurrence comes from inhibition of the vital muscles that control the position of the ankle following injury, especially if there is ligament damage. Injury around these muscles can inhibit their action, causing delayed firing and further ankle injuries. In order to protect an ankle following injury it is important to perform increasingly challenging exercises to re-educate the muscles of the ankle to do their job properly. In the meantime return to contact and field sports, within the same season, are recommended with additional support only (taping or bracing).

What if it is not getting better after 6 weeks?

Some ankle injuries do not progress well; patients generally complain of persistent pain, stiffness and giving way or instability. This may be due inadequate rehabilitation or damage to another structure sustained at the time of injury.

If your ankle pain is not settling after 4-6 weeks it is important to have a thorough assessment to discover why improvement is not being made.

Achilles tendinosis

We used to think that ongoing pain in the Achilles was caused by inflammation; however we now know that this condition is caused by an aging process within the tendon. It is most common in male runners in their 40’s and 50’s, but also occurs frequently in women and in people who do not exercise. The condition can be very debilitating and in the past has been hard to treat.

No-one is quite sure why some people suffer with this problem, however it is more common in people who:

  • run a lot
  • have flat feet
  • have weak calf muscles
  • have stiff feet and ankles
  • wear poor quality running shoes

Recently there has been a lot of research into a very specific exercise regime to progressively stress and remodel the tendon. It has shown encouraging results over a twelve week period that has long lasting effects.

In addition to this exercise program the most effective treatment for Achilles tendinosis is currently thought to include:

  • a program to stretch the muscles of the calf
  • assessment of biomechanics and correct excessive foot motion using tape or orthotics to reduce unnecessary forces through the tendon
  • activity modification and shoe assessment
  • soft tissue treatment to muscle spasm (trigger points) and areas of fibrosis to increase the flexibility and protective abilities of the muscles.