Category Archives: Ankle

Treatment Options for Achilles Tendinitis

November 8, 2023 Teresa Stockton - Ankle, Blog, Foot

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration. Achilles Tendinitis causes pain along the back of the leg near the heel. If you suffer from Achilles Tendinitis – try these pain relief methods.

Treatment Options for Achilles Tendinitis

REST: Cut back your training by decreasing your mileage and intensity. Also, avoid hills and speedwork. You may substitute running with swimming, running in water, and biking to reduce the irritation.

ICE: Apply ice to the affected area for 10 to 20 minutes with at least one hour between applications. Do not apply ice directly to your skin – a pillowcase or dish towel works well as a protective barrier. Frozen peas or reusable gel packs are flexible and conform well to the injured area.

PROPER FOOTWEAR/ORTHOTICS: This situation can be corrected with arch supports or custom orthotics. Orthotics allow your foot to maintain the correct position throughout the gait. Avoid walking barefoot and wearing flat shoes. If your pain is severe, your doctor may recommend a walking boot or to cast you for a short time. This gives the tendon a chance to rest before any therapy is begun.

NON-STEROIDAL ANTI-INFLAMMATORY MEDICATION: Drugs such as ibuprofen and naproxen reduce pain and swelling. They do not, however, reduce thickening.

PHYSICAL THERAPY: Achilles tendinitis can be a painful, chronic condition if left untreated. Physical therapists may use stretching, massage, custom orthotics, strengthening, and/or balance activities to help your body relieve pain and heal.

CORTISONE INJECTIONS: Cortisone, a type of steroid, is a powerful anti-inflammatory medication. Cortisone injections into the Achilles tendon are rarely recommended because they can cause the tendon to rupture (tear).

Common Types of Ankle Injuries

September 21, 2022 Teresa Stockton - Ankle, Blog

Ankle, such a funny-sounding word, but what exactly is it? A common misconception is that the ankle is the bony, ball-like structure that sticks out on the side of your foot— but that is only a part of your ankle. The ankle is where three of your bones meet: where the tibia & fibula of your lower leg meet with the talus (located at the top of the foot, aka. “ankle bone”). These bones are held together at the ankle joint by ligaments, which are strong elastic bands of connective tissue that keep the bones in place while allowing normal ankle motion. Tendons attach muscles to the bones to allow movement in the ankle and foot, keeping the joints stable.

Ankle injuries happen to be one of the most common reasons why you could end up in the emergency room, although they can be treated with physical therapy depending on the severity of the injury. These common types of ankle injuries can happen to anyone, at any age, for a number of reasons.

Certain situations make you more likely to injure your ankle. These include:

Accidents, such as tripping or falling
Walking or running on uneven surfaces
Landing awkwardly after a jump
Wearing shoes that do not provide any ankle support
Sudden impacts such as an automobile accident
Practicing sports that involve rolling or twisting your foot (basketball, football, soccer, tennis)

Not all ankle injuries require a trip to the emergency room, your body may have suffered a less severe injury such as an ankle strain. There are different kinds of ankle injuries, and here is a breakdown of them:

Ankle Strain

An ankle strain happens when the muscles or tendons around the ankle have been pulled or stretched too far. In the ankle, there are two tendons that stabilize and protect the ankle, called the peroneal tendons, which are often strained. They can become inflamed from overuse or trauma which can lead to inflammation of one or both tendons called tendinitis.

Ankle Sprain

A sprained ankle is a common injury that occurs when the ankle ligaments are stretched too far, resulting in small tears, often after a fall or if you roll or twist your ankle. Sprains are most common in athletes during sporting events but can happen during everyday activities.

There are three types of ankle sprains based on how much ligament damage occurred:

Grade 1 (Mild): The ligament fibers stretched slightly, or there is a very small tear, resulting in minor swelling and tenderness to the touch.
Grade 2 (Moderate): The ligament is torn, but it isn’t a complete tear, resulting in swelling over the injury, and it hurts to move.
Grade 3 (Severe): The ligament is torn completely. Your ankle has significant swelling, painful injury, and difficulty walking.

If you know you have suffered an injury to your ankle

and are experiencing symptoms but are not quite sure whether you have strained or sprained your ankle. Here are the common symptoms when experiencing each type of injury:

Common symptoms of Ankle Sprains

Bruising
Pain around the affected joint
Swelling
Limited flexibility
Difficulty using the joint’s full range of motion

Common symptoms of Ankle Strains

Muscle spasm
Pain around the affected joint
Swelling
Limited flexibility
Difficulty using the joint’s full range of motion

Most strains and sprains heal independently, but using physical therapy to strengthen the injured muscles can prevent future sprains. Although self-care measures and over-the-counter pain medications may be all you need, a medical evaluation may be necessary to reveal how badly you’ve damaged your ankle and to determine the appropriate treatment.

Ankle Fracture/Broken Ankle

A broken ankle is the most severe type of ankle injury and will need to be confirmed by your doctor using an x-ray. The telltale signs of a broken ankle are all the symptoms of a sprain, with the addition of:

Pale skin
Deformity (out of place)
Inability to move the toes or foot
Numbness.

If the bone is intact and stable, it needs to be immobilized with a cast or a boot to ensure proper healing and protection from bumping into anything. Surgery may be necessary to realign the bone if the pieces have shifted out of place and the ankle is unstable.

What do I do after an ankle injury?

The best way to treat your injury is to seek care as soon as possible. Remember, the first 48 hours are the most important when injuring your ankle. Whether you have a strain, or sprain, or think you have broken your ankle, follow these simple steps to help alleviate pain or prevent more damage before seeing your doctor.

Protection: Use crutches or a splint or brace to limit the use of your injured ankle.
Rest: Limit physical activities that may cause stress to the sprain (no running, jumping, exercising).
Ice: Apply ice or a cold pack in a towel to your ankle in 20-minute increments to reduce swelling.
Compression: Gently wrap your ankle in an elastic bandage to help decrease swelling.
Elevation: Raise your ankle on pillows while sitting or lying down so that it is higher than your heart.

You should visit your doctor if you can’t walk after an injury, or if your pain & swelling hasn’t improved or has worsened 24-48 hours after the injury occurred. Your healthcare provider will diagnose your ankle with a physical examination and an x-ray of your foot and ankle to identify your range of motion and determine which parts of your ankle are affected and in most cases, will recommend physical therapy. You may begin physical therapy after swelling has subsided, and you can walk without significant pain, typically two to three weeks after the injury. Physical therapy may include mobilizing the ankle joint and stretching the foot to improve the range of motion. If you’re looking for help recovering from these common types of ankle injuries we can help!

Sources:

https://www.healthline.com/health/sprain-vs-strain#symptoms

https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle

https://www.campbellclinic.com/how-to-tell-if-you-have-a-strained-sprained-or-broken-ankle/

https://nyulangone.org/conditions/foot-ankle-sprains/treatments/physical-therapy-for-foot-ankle-sprains

Common Basketball Injuries

March 10, 2021 Teresa Stockton - Ankle, Blog, Sports and Fitness

Whether you are a weekend warrior or involved in youth sports, athletes ages 5-75 can experience injuries from playing the games they love. Physical therapists are adept at working with patients suffering from common basketball injuries and can help in a variety of different ways.

One of the most common basketball injuries is an ankle sprain. An Ankle sprain is a partial or complete tear of the ligaments that support the ankle. Ankle sprains may be caused by falling or sudden twisting of the ankle, such as:
• Stepping on an uneven surface or in a hole
• Taking an awkward step when running, jumping, or stepping up or down
• Having your ankle roll over when playing sports or exercising called inversion of the foot

Physical therapy intervention is the standard for treatment of ankle sprains. Treatment for the acute ankle sprain is based primarily upon the RICE principles: Rest, Ice, Compression and Elevation. This is followed quickly by a program of exercises and functional training to reduce the likelihood of chronic ankle instability. Balance and “proprioceptive” training are critical components of the rehabilitation process. In the case of a severe sprain and subsequent chronic instability, surgical intervention may be indicated.

Stress fractures are also seen frequently. A stress fracture is a tiny crack in the bone from chronic overuse. It is typically caused by repeated stress or overuse.
Causes include:
• Increasing the amount or intensity of an activity too quickly
• Switching to a different playing or running surface
• Wearing improper or old shoes
• Stress fractures can worsen by continued physical stress. Smoking can also make

Rest is the first thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks. Once you are ready to restart activity your physician may prescribe physical therapy. They may begin with non weightbearing activities, such as swimming, cycling, use of an Alter-G treadmill. Next, weight-bearing, nonimpact exercise may be prescribed. Gradually, low-impact activity, starting with walking, will be added to your treatment. Once you can do fast-paced walking with no pain, your physical therapist will give higher impact activities, such as light jogging.

HAND INJURIES are also commonly seen in basketball. If you experience a finger injury, a hand therapist will work to make sure your fingers heal correctly and reduce the risk of long term damage.

A Boutonniere injury is usually the result of a forceful blow to the bent finger and causes a disruption of the central slip of the extensor tendon insertion at the level of the middle phalanx. The middle joint (PIP) is unable to fully straighten. If left untreated, a PIP flexion contracture can result and chronic deformity ensue. Acute boutonniere injuries are treated with PIP extension splinting continuously 4-8 weeks. Chronic boutonniere injuries with PIP flexion contractures are treated with dynamic splinting to improve passive PIP extension and static splinting for at least 4 weeks once full PIP extension is achieved.

Mallet injuries are seen commonly with ball sports and result when the terminal extensor tendon is torn from the attachment on the bone. When this occurs, a small fragment of bone may be avulsed from the distal phalanx and the end of the finger droops down and cannot be straightened actively. X rays are necessary to determine the course of treatment. Bony mallet injuries may require surgical correction. Most of these injuries can be treated conservatively with continuous DIP extension splinting for 6-8 weeks.

Achilles Tendon Care – New Therapy Can End Months of Pain

March 29, 2016 Teresa Stockton - Ankle, Blog, Foot

The Achilles tendon is the large cord-like structure at the back of the ankle. It is responsible for transferring the muscle forces generated by the calf, which in turn allows you to roll onto the ball of your foot during walking and running.

We don’t realize it, but this tendon can withstand tremendous stress. It can tolerate forces of greater than 1000 pounds. However, it is also a tendon that can become inflamed and injured. Symptoms include pain (in the tendon or where it attaches to the heel bone), swelling, weakness in the leg and morning stiffness. The discomfort that resolves as the day progresses is common.

Often, physical therapists see clients that experience chronic Achilles pain. New research concludes that there is hope for these patients. Recent studies have shown that a certain Achilles condition called tendinosis, responds very well to a specific program of, what we call, eccentric loading. Given enough time and proper technique, physical therapists can help these patients recover from a problem that may have been bothersome for several months.

Who do you know that is experiencing Achilles or some other type of foot pain? There is a good chance that physical therapy can help, and make dramatic changes in someone’s condition. Please, don’t hesitate to call your physical therapist.

PUT ICE ON A NEW INJURY
What should I put on a strained muscle or joint? This is a popular question. The answer is a simple acronym:

• R est
• I ce
• C ompression
• E levation

You need to rest an injured joint, muscle or ligament. Ice helps with pain relief and to some degree, decreases swelling. Compression and elevation help decrease the swelling that results from a soft tissue injury. Excessive swelling can cause additional cell/tissue damage.

VIEW A RICE PICTURE
Picture of a proper RICE technique on the knee:
http://www.ptclinic.com/downloads/1-1.pdf