Tag Archives: ankle pain

What You Should Know About Your Achilles Tendinitis

Ankle pain from achilles tendinitis in a runner

What is the Achilles tendon?

The Achilles tendon is one of the strongest tendons in the human body. Anatomically, it connects our calf muscles to the back of the heel bone. Its main action is to point the toes and ankle downwards when our foot is off the ground or raise the heel off the ground when our foot is on the ground.

Functionally, it is used whenever we are engaged in walking, running, or hopping-like activities and helps us with force production and shock absorption. The tendon is extremely strong and can withstand high amounts of stress Unfortunately, this can also predispose it to injury and cause ankle pain.

Stages of Achilles tendon injuries

Diagram showing the different stages of Achilles tendon problems

1) Achilles tendinitis: Inflammation has developed or is developing in the tendon.

2) Achilles tendinosis: There is now degeneration along with or as a byproduct of the inflammation. This is usually an issue that takes a long time to occur. For example, if an Achilles tendinitis is left untreated for months, it can eventually transition into the tendinosis.

3) Achilles tendon tear or rupture: As the tendon fibers are weakened from the tendinosis, it increases the chance that they can tear entirely.

What is Achilles tendinitis?

Achilles tendinitis means inflammation has developed in the tendon. Potentially, due to overuse of the tendon or a trauma like a fall or sport injury. Inflammation is the human body’s natural and healthy reaction to any kind of injury or disease. However, when it lasts for too long it can start to have negative effects. The inflammation can be rated as minimally painful to severely painful. At this last stage is where a patient’s walking ability can be compromised.

Causes of Achilles tendinitis:

1) Trauma: Direct trauma on ankle during car accident, fall etc

2) Running, dancing, jumping: Constant high impact movements increase the risk of injuring the Achilles tendon

3) Flat feet: Having flat feet may change the weight distribution in the foot and put extra pressure on the tendon

4) Playing Sports: Playing less frequent sports does not allow their body to take pressure regularly and increases the chances of injury

5) Heavy standing job: Constant being on feet increase the chances of injury

6) Bony spur in heel / Plantar Fasciitis/ Ankle fracture:
Extra fluid from swelling or bony protrusions in the ankle can rub against the tendon causing an injury.

7) Calf, knee, or hip muscles weakness:
Muscle strength imbalances can cause compensations in the tendon and increase the stress it is exposed to.

Sign and symptoms of Achilles tendinitis:

1) Pain and inflammation in back of heel bone
2) Stiffness and tenderness in ankle
3) More pain after any strenuous activity
4) Leg weakness
5) Worse in the morning, might improve as day goes by

Diagnosis

Book your assessment with a registered physiotherapist. They will assess your posture, leg alignment, range of motion of joints, muscular strength and determine the source of your pain.

Additionally, diagnosis may be achieved through imaging like Diagnostic Ultrasounds and MRIs.

How do I treat it?

In the beginning, non-invasive therapy will help to treat the condition.

1) RICE protocol

Rest: Stop doing activities that stress your tendon. Switch to low-impact activities, such as swimming, that put less stress on the Achilles tendon.

Icing: Put ice on your tendon for up to 20 minutes, as needed throughout the day.

Compression: Compress, or put pressure on, the tendon using an athletic wrap or medical tape.

Elevation: To reduce swelling, lie down and raise your foot on pillows so it’s above the level of your heart.

2) Shockwave therapy:

Shockwave therapy achilles tendinitis

Shockwave therapy can be an effective treatment for this condition.

Shockwave therapy may help improve the condition, especially for stubborn conditions that have lasted over 6 weeks.

3) Physiotherapy:

Muscle release, stretching and strengthening exercises will help improve the tendinitis.

4) Orthotics:

Proper footwear and the use of custom orthotics will help support the foot and ankle, putting less stress on the tendon.

Achilles pain? Look for PhysioNow!

If you are looking for treatment for your Achilles pain, or any other type of foot, ankle, or sport injury, look no further. PhysioNow has many expert Registered Physiotherapists prepared to help you with diagnosis, treatment, orthotics, bracing, shockwave therapy and more. With locations across Burlington, Oakville, Mississauga , and Etobicoke we have you covered. Book PhysioNow today for your first assessment and treatment.

Chronic Ankle Instability Could Cause Your Ankle Not To Heal

Chronic Ankle Instability

Chronic Ankle Instability

Ankle sprains are one of the most common injuries. Rest, ice, compression and elevation, or the RICE rule, are the go-tos for ankle sprains. In most cases, the ankle will heal between 4-12 weeks. Many people will allow the ankle to heal on its own but a failure to seek treatment and physical rehabilitation for the ankle after just one injury is enough to leave it weaker and more vulnerable to future sprains. Which in turn could result in chronic ankle instability.

What causes ankle instability?

After an ankle injury, there is damage to the ligaments, tendons, and potentially even the ankle joint itself. Ligaments function to limit the normal movement in the ankle, and once they are injured, they may get lax (stretched out). Resulting in the ankle being more unstable. Additionally, the injury results in a loss of strength in the muscles that control the ankle movement, further increasing the instability of the ankle. Finally, it also results in a loss of sensory receptors in the ankle that communicate to our brain where our ankle is in space. This decreased sensation makes it harder to balance and control the ankle which contributes to the ankle instability.

How do I know if I have chronic ankle instability?

Questions to ask yourself include:

  • Does my ankle ever give out?
  • Do I avoid walking on uneven surfaces out of fear of falling?
  • Do I feel like I can’t “trust” the ankle?
  • Do I try to avoid putting all my weight onto one ankle?

If you said yes to these questions and you have had a severe ankle injury or a history of multiple ankle sprains, you may have chronic ankle instability.

Is it permanent?

Chronic ankle instability is not permanent it can improve with the help of a physical therapist and individualize exercise plan. An untreated ankle injury may be chronic when it is not given sufficient time to heal and is constantly being reaggravated. Thus, the first step to treatment will be a proper rehabilitation program with a health professional.

Who treats ankle instability?

Physical therapists are the first step in conservative management of chronic ankle instability. Your physical therapist will perform an assessment on your ankle range of motion, strength, and balance and will assess for any laxity, or more movement than is normal, within the ankle and ankle ligaments.

After an ankle injury, there is a loss in strength and proprioception (awareness of the position of the body in space). So exercises are given to re-strengthen the muscles, increase ankle stability, balance, and retrain the body awareness of the ankle. Furthermore, a brace and/or taping is recommended to support the stabilization of the ankle, especially for individuals who engage in high-risk activities like sports.

Chronic Ankle Instability

Chronic Ankle Instability Brace and Tapping

Chronic Ankle Instability Exercises

Chronic Ankle Instability Exercises

However, not all injuries are capable of recovering with conservative management. Thus, in very severe cases, surgery may be an option to repair the injured ligaments and give the ankle stability.

What happens if its goes untreated?

Without treatment, an individual will continue to have difficulties balancing, walking on uneven terrain, and putting weight onto the ankle. Subsequently, the instability may worsen over time and will have a much greater risk of reoccurring injuries to the ankle. Thus making it more challenging to recover from these injuries. Additionally, it can result in damage to the bones and cartilage within the ankle joint as the muscles weaken and fail to support the joint.  Therefore, to avoid severe injury it is highly recommended that individuals seek expert treatment.

If you are having stability problems with your ankle, book with PhysioNow today for an initial assessment and treatment. We have many capable physical therapists that will be able to help your ankle recover!

Common soccer injuries

Ankle Sprain

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An ankle sprain is a common Sports injury which happens when the ankle stretches more than normal. This over stretch weakens the ligaments that hold the bones together. Ligaments are the fibrous bands that hold the ankle joint together.

The ankle consists of 3 joints. The joints are between the lower end of two long bones in your leg. They are called the Tibia and Fibula. They attach to the two bones in your feet called the Talus and calcanium.

Together with the muscles and ligaments, the bony ends on the sides of your long bones called malleoli provide stability to the joint. The ankle is least stable when the foot is down. Most stability is provided by the ligaments. As a result, the majority of ankle sprain injuries happen when your foot is in this position.

There are two types of sprains. An inversion injury happens when the foot rolls inwards. This causes injury to the ligaments on the outside of the ankle called lateral ligaments. Most of the time a ligament called anterior talofibular ligament (ATFL) is injured. The ATFL is the weakest of the lateral ligaments.   

An eversion injury happens when the foot is rolled outwards. This causes injury to the ligaments on the inside called the Deltoid ligament. As the medial ligament requires a greater force to be injured, these sprains always take longer to rehabilitate.

Risk Factors

Based on the severity of symptoms, an ankle sprain is classified into 3 grades.

If you have a previous history of ankle sprain, you will have more chances of re injury. This happens because the strength and integrity of the muscles and ligaments around the ankle joint will be affected.

The other risk factors are poor balance, sudden change in direction , age, poor condition of playing surface and inadequate warm up. Lastly, inappropriate footwear and a lack of external ankle support in case of recent injuries can cause increased risk.

Grade 1 – Mild swelling and tenderness with little impact on function.

Grade 2- Moderate swelling, pain and impact on function. You will have reduced range of movement and instability of the joint.

Grade 3 -Large swelling, loss of function and marked instability at the joint.

Symptoms

Symptoms of Ankle Sprain

Pain, bruising, swelling and difficulty to weight bear are the initial symptoms. As a result, pain is usually worst in the first two or three days. The location of pain indicates which ligament is injured.

In severe injuries where there is complete rupture of a ligament, you will feel instability in the ankle joint. If you have suffered from a severe ankle sprain, there is a chance of associated fractures. As a result, you may require an x ray to determine the possibility of broken bones.

Physiotherapy Treatment

Physiotherapy Treatment for Ankle Sprain

Your physiotherapist will be able to assess the possibility of some of the common fractures using a special palpation method.  The other aims of ankle examination are to check for any instability. Lastly, we look for loss of range of motion, reduced strength, reduced proprioception and associated injuries.

Exercises for Ankle Sprain

Initial treatment is focussed on Protection and optimal loading. That means the right amount of activity to stimulate healing. In addition, Ice, compression and elevation(POLICE) are also recommended in the first 48 hours after injury.


Protection of the joint?

 Taping, bracing, or crutches if needed. In addition, we also recommend the use of an aircast boot. As a result, this will restrict movement and allow for more rapid healing. PhysioNow stocks aircast boots in all sizes at the Applewood Office.


Optimal Loading ?

Optimal Loading

Avoid activities which cause pain. Minimize the amount of walking you do. Use of crutches, air cast boots, braces or taping  may be advised by your Physiotherapist on assessment.


Ice

 It is recommended that you Do Apply ice cubes or ice packs in a damp towel up to 15 minutes every 3 hours for the first 48 hours when you are awake. Do not apply ice directly to your skin. Please, Do not apply ice if you have cold intolerance due to any medical condition.

We do not recommend the use heat in the early phase of injury.


Compression

Compression involves using a bandage from toes to just above the ankle joint. Make sure that the compression does not cause more pain or restrict the circulation. If you are in doubt, your Physiotherapist can teach you how to apply the bandage in the early phase of injury.

Compression


Elevation

Elevate your injured leg above your heart level using pillows while resting.

Ultrasound therapy, Laser acupuncture, taping, bracing, and exercises are used to reduce pain and inflammation. In addition, manual therapy and exercises are used for improving the range of motion, strength and joint position sense (proprioception).

Once all the movements are pain free and there is adequate muscle strength and proprioception, functional exercises can be started. These exercises will be directed to your normal Sports Activities and Activities of Daily Living.

Bracing for Ankle Sprain

Healing Time for Ankle Sprain


  The healing of ligaments takes about 6 weeks, but also depends on the severity of the injury and other medical problems which you might have. Consequently, everyone recovers from the injury at different rates. As the ligament is healing it is important to do specific exercises advised by your Physiotherapist to improve flexibility and strength.

It is very important to complete the whole rehabilitation process. If you do this, it will reduce the chances of re injury. In conclusion, we want to get you back to your pre-accident Sports Activities as soon as possible!

How to reduce the risk of Ankle Sprain

To reduce the risk of ankle sprain, make sure that you:

Warm up before exercise or activity.

Cool down with slow stretches after the exercise or activity

Wear supportive shoes

Take extra care when you walk or exercise on slippery or uneven surfaces.

 Adequate stretching and strengthening of your muscles if you have a history of previous injury.

Give enough time to recover between training sessions.

 Use the right sports gear.

 Taping or use of brace in competitive games if you had a recent ankle sprain.


How to book an appointment with a Physiotherapist at PhysioNow?

Locations for PhysioNow clinics

We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. https://www.physionow.ca/locations/

You can call 289-724-0448 to book for a same day appointment with one of our highly trained Physiotherapists. Most of the time we can arrange your initial visit on the same day in a location which is nearest to you. Your initial appointment will be a one to one 40 minutes session. This appointment will be with a Physiotherapist and includes initial assessment, education and treatment.

You will have 40 minutes of follow up, which will be usually 2 to 3 sessions a week depending on the factors identified on initial assessment, treatment plan and your goals.

Call today to get started on your Physiotherapy for Ankle Sprain!

Ankle Sprains – Causes & Treatment

Ankle Sprains

Stretching before a walk or run

Ankle Sprains

Ankle sprains are very common.They occur in many of our favourite sports like soccer and running. They can also occur from simply stepping on tree root. The most common way that ankle sprains occur is by rolling the foot so the sole faces the opposite leg. This is called an inversion sprain.

Ankle Sprain

There are three ligaments, or thick bands of tissues, that join the outer leg bone, the fibula, to the bones of the foot. When you get ankle sprains, you can stretch or tear all three of these ligaments. This results in stiffness, swelling and pain!

What should you do? If you are unable to walk on it immediately following the injury, try again 5 minutes later. If you are still unable to walk on it, seek medical attention immediately. It is important that you make sure you did not break a bone.

If you can walk on the foot, even with a limp, then the treatment for the first 48 hours is rest, ice, compression and elevation.

Although there has been a lot of discussion lately regarding ice, it is still the best option for a new injury, especially a new injury that swells. If discomfort, stiffness and limping lasts more than three days then a referral to a physiotherapist is appropriate.

Physiotherapists will use modalities to decrease swelling. They should also use manual or hands on techniques to increase movement of the foot and ankle. Exercises are critical. Strengthening will help to build muscle around the foot. Balance exercises will help to restore the balance reflexes of the foot and leg. This is a critical component of preventing a second injury to the ligaments.

If you are an athlete (even a weekend warrior), proprioception exercises will also help you return to sport earlier. Physiotherapists can also help you to determine if bracing would be helpful, and if so, which one.