Tag Archives: Foot Pain treatment Mississauga

Acute Ankle Sprains

Acute Ankle Sprains

Acute Ankle Sprains

Acute Ankle Sprains

How do Acute Ankle Sprains happen?

Acute Ankle sprains are common injuries in people of all ages. They can happen in many different circumstances. However, they always involve some type of fall or twisting movement to the ankle. For example:

  • Going downstairs and missing the last step resulting in twisting the ankle
  • Landing on the ankle in a twisted position after coming down from a lay-up in basketball or in a Sports Injury
  • Slipping on an icy street while walking

In all of these situations, the ankle gets a sudden movement and/or trauma that causes it to twist more than its normal range of movement allows.

Acute Ankle Sprains

Acute Ankle Sprains

What structure gets injured with an acute ankle sprain?

The structures that are injured with acute ankle sprains are the ligaments around the ankle joint. Ligaments are soft tissue structures that connect two bones together. Their function is to prevent the bones from moving too far away from each other. Ligaments help maintain normal movement between the bones.

With ankle sprains, the ligaments get over-stretched beyond what they can tolerate which causes tears in their fibres. The ligaments that are involved in acute ankle sprains are present on the outside (lateral), inside (medial), and top of the ankle.

Are there different types of acute ankle sprains?

There are three main types of ankle sprains:

  • Inversion
  • Eversion
  • High Ankle Sprain

The terms relate to the direction of ankle movement that caused the injury to occur.

INVERSION ANKLE SPRAIN

  • An inversion sprain occurs when the ankle is forcefully turned inwards.
    • This type of acute ankle sprain is the most commonly occurring of the three because the ligaments on the outside of the ankle are generally weaker than the rest.
    • Another name for an inversion ankle sprain is lateral ankle sprain
    • A lateral ankle sprain injures the ligaments on the outside of the ankle.

EVERSION ANKLE SPRAIN

  • An eversion sprain occurs when the ankle is forcefully turned outwards.
    • This type of force injures the ligaments on the inside of the ankle.
    • The ligaments on the inside of the ankle are called the deltoid ligament
    • An eversion ankle sprain is also called a medial ankle sprain

HIGH ANKLE SPRAIN

  • A high ankle sprain is the rarest of the three types and it occurs when there is excessive twisting of the shin.
    • The ligaments that are injured with this type of injury are located above the ankle.
    • The location of the ligaments is why this injury is called a ‘high’ ankle sprain.

 

Are some people more at risk for Acute Ankle Sprains than others?

There are certain risk factors that may make ankle sprains more likely to happen. However, the research is a little inconclusive on why this is so. Some of these possible factors include:

  • Poor muscle strength/fitness
  • Increased weight
  • Decreased muscle-reaction time
  • Previous history of ankle sprains resulting in poor balance

Can there be different severities of Acute Ankle Sprains?

The severity of the ankle sprain depends on how much the ligament was overstretched in the process of the injury. Sprains are classified by different grades to explain the severity:

  • Grade I: mild stretching or tear of the ligament, with little or no instability at the joint
  • Grade II: incomplete tear of the ligament, with some instability in the joint
  • A Grade III: ligament is completely torn or ruptured and there is no stability in the ankle
Acute Ankle Sprains

Ligaments affected in Ankle Sprains

What should you do if you think you have sprained your ankle?

In all three types of Acute Ankle Sprains, it is important that you see a health care provider. The health care provider, whether it is a doctor or a Registered Physiotherapist, will first rule out the possibility of fracture. There is always the possibility of a fracture with Acute Ankle Sprains. The ligaments attach onto a bony area and if the twist is severe enough, it can pull off a chunk of the bone.  When this happens, it can cause a fracture. Signs and symptoms of a potential fracture include:

  • Lots of swelling
  • Increased bruising
  • Increased tenderness over specific areas of the ankle
  • Difficulty or inability to put weight through the injured ankle

When the signs and symptoms are suspicious of a fracture, then an X-ray must be completed. If there is no evidence of fracture, then your doctor may send you for an ultrasound.  In the end,  they should refer you for Physiotherapy treatment.  So ask your doctor to send you to Physiotherapy if they don’t think to recommend it themselves.

What will happen during my first Physiotherapy appointment?

During the Physiotherapy assessment, your Registered Physiotherapist will assess everything to do with your Acute Ankle injury, including:

  • Pain intensity and location
  • Swelling
  • Sensation
  • Range of motion
  • Ankle stability
  • Strength
  • Balance

This will provide some baseline information for your Physiotherapist.

How can Registered Physiotherapy help treat Acute Ankle Sprains?

The treatment for acute ankle sprains depends on the type of sprain as well as the severity of the injury.

Immobilization

  • Because of their affect on ankle stability, a Grade II or III injury will require some immobilization. This is usually done through a removable walking cast.
  • The purpose of the immobilization is to protect your injured ligaments from movement and external stressors, so that they can heal.
  • The period of immobilization will depend on the injury and your health care provider will provide specific instructions.
  • A grade I sprain will not require any immobilization because the stability of the ankle is still intact. However, your Physiotherapist will recommend activity modification to help with the healing process.

Physiotherapy Treatment in the acute phase?

  • In the initial phase of the treatment, the Physiotherapist may focus on pain relieving modalities
  • Electrical modalities like IFC and Ultrasound can help relieve pain and swelling
  • The Physiotherapist will also prescribe gentle mobility exercises to help improve or maintain movement through the ankle
  • The length of the acute phase depends on the severity of the sprain
Registered Physiotherapy for Acute Ankle Injuries

Ankle Rotations for movement Recovery

Treatment in the later stages of Acute Ankle Sprains

  • Once the ligament healing is underway and the patient feels a little better with their pain, the treatment will get more progressive
  • It will focus on regaining mobility, strength and function through the ankle
  • Your Physiotherapist will prescribe exercises that are going to help regain the lost range of motion and strength.
  • Over several weeks, the exercises will be progressed as you improve.
  • Another important aspect of treating an ankle sprain is including balance re-training in the program.
  • Balance is very much affected after an ankle sprain and it is something that must be improved with specific exercises. This is very important no matter whether you are returning to Sports or just everyday living!  Balance Retraining is key to Falls Prevention!
  • We use our balance ability on a regular basis with walking on uneven surfaces or when trying to recover from a stumble. Therefore, it is important to improve balance ability to prevent any possible re-injury of the ankle.
  • If you have had an acute ankle sprain before, and DID NOT attend Physiotherapy, it is likely that you are at increased risk of reinjuring your ankle or falling again!
Acute Ankle Injuries

Physiotherapy Mobilizations

Do I need to get Physiotherapy treatment after Acute Ankle Sprains?

There are some people who have sprained their ankle multiple times and never sought out treatment for the injury. They usually give themselves some time for the pain to get better and then go about their usual activities.

This type of management is not usually recommended because multiple ankle sprains can affect the stability of your ankle. As a result, this may create problems in the future. Also, the reduced stability in your ankle may cause compensations in your knees and hips. This can complicate the picture and make your injury more complex.

It is therefore recommended that you seek out proper Registered Physiotherapy care to address an ankle sprain soon after it occurs. This ensures that your acute ankle sprain heals in a timely manner without added complications.  The most important part of treatment is regaining your balance.  If you do not do this, another injury in quite likely.

To get started on your Acute Ankle Sprain Treatment, Give PhysioNow a call Today!

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome

            Patellofemoral pain syndrome

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome happens when your knee cap does not track properly.  The knee joint consist of two joints.  The tibiofemoral joint which is between the two long bones in your leg and the second one is the patellofemoral joint.  This  is between the femoral condyle (end of thigh bone) and the knee cap. The cartilage on the back of the knee cap glides on the cartilage on the front of the condyles of the femur. The knee cap usually sits in a snug groove at the end of the thigh bone.

Knee movements are controlled by a number of muscles connected to the knee cap. Your  thigh muscle helps to stabilize the knee cap and enables it to move smoothly in the groove.  When this is pulled out of the groove, you can develop Patellofemoral pain syndrome.

Causes of Patellofemoral pain syndrome or Anterior knee pain

Patellofemoral pain syndrome, is one of the most  common causes of pain in the knee. Pain is usually felt under the knee cap.  This is where it glides on the femur/thigh bone. If you have patellofemoral pain syndrome, it hurts when you bend and straighten your knee . There are a number of factors which can cause the pain.

Common Causes of Patellofemoral pain syndrome

  • Weakness in the hip and thigh muscles-Weakness in the thigh muscles can cause increased load which may lead to pain. Pain in your knees will further limit the activity of your muscles and over time can cause further weakness. Weakness of the inner thigh muscle  will affect the movement of the knee cap as you do your normal activities. Weakness in your hip muscles also can affect activities like climbing stairs and walking.
  • Excessive loading or rapid increase in the load for muscles around the knee-Depending on your usual activities, your knee will have a level of activity that is tolerated by your joint. Rapid increases in loading of activity may lead to a highly irritable or sensitive joint. This can cause Patellofemoral pain syndrome.
  •  Posture or position of hip, knee and feet-Flat feet or excessive turning in of feet can change movement mechanics further up the leg and cause excessive strain in your knee cap.
  • Tight muscles around the knee-Tightness in the muscles can reduce the movement of your knee and affect  how your joint works . This will lead to excessive loading during activities. The common muscles that become tight are your hamstrings, Quadriceps, Iliotibial band and calf.
  • Previous injury or dislocation of knee cap
  • Desk top work, where a lot of sitting can cause pressure on the kneecap.
  • Irritation of fat pad around the knee
  • Tendinitis of quadriceps tendon
  • Bursitis around the knee
  • Osteoarthritis

When poor biomechanics are repeated with each step of your walking and running it may lead to a highly sensitive joint and Patellofemoral pain syndrome.

Symptoms

  • The onset of  knee cap pain is normally gradual rather than traumatic.
  • Pain at the front, back and sides of the knee with or without swelling.
  •  Bending and straightening of knee can cause pain.
  • Pain after prolonged sitting or when you keep the knee bent for longer periods of time.
  • Clicking or grinding when you bend or straighten your knee.
  • Pain when you go up and down the stairs, up hill /down hill, squatting, running or jumping.
  • Poor knee control or stiffness

Physiotherapy Treatment

Patellofemoral Pain Syndrome treatment

  • Physiotherapy is the most effective treatment for short- and long-term management of Patellofemoral pain syndrome. Your Physiotherapist will fully assess you on your first visit to identify your functional limitation. They will also help to set goals and identify contributing factors for the pain.   They will  provide a customized rehabilitation program.
  • In the initial phase of rehabilitation, treatment is directed towards reducing the pain, swelling and muscle inhibition. To do this PhysioNow will  use electrotherapy modalities, acupuncture, rest, taping, gentle motion or joint mobilization and muscle setting exercises.
  • Once the pain and swelling reduces, treatment is focused towards modifying the  factors that have been identified as a cause for the problem.
  • Rehabilitation typically emphasizes increasing strength and pain free movements.  It also will address postural correction, improving the  stability of the pelvis, balance and functional abilities.
  • Stretching exercises to address the tight muscles and strengthening the weak muscles will improve your load tolerance.
  • Successful rehabilitation requires adherence to your exercise program .
  • You will also need to reduce the aggravating movements and slowly build the endurance and strength for those activities over time.
  • Prior to discharge you will be given a safe progression of exercises and functional activities.
  • For long term management, your foot and knee control will be assessed by your Physiotherapist.
  • As a result, you may require  custom foot orthotics to correct your foot position.
  • This will  help to improve foot and knee control.
  • Others might need a hip stabilization program and your Physiotherapist will be happy to discuss with you the long term rehabilitation plans if this is needed.Custom orthotics for Patellofemoral Pain syndrome

How long it will take to get better?

We expect to see improvements with Physiotherapy over a 3 to 6-month period.   Further improvements continue beyond this period. Adherence to your specific exercise program is important in maintaining the improvement. Most people will get back to their normal function with rehabilitation in the short term. Many patients can continue in their chosen activity during rehabilitation.  Some modification of activity may be all that is needed.

If you play sports, you will need to do sports specific exercises to ensure a safe return to sports. It is good to wear proper supporting footwear to help keep your feet in a good position.  This will  improve alignment of your knees.

How to book an appointment with a Physiotherapist at PhysioNow?

We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. You can call 289-724-0448 to book into any of these clinics  for an appointment with a Physiotherapist.

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 40-60 minute session with a Physiotherapist which includes treatment as well on the first day.

Your follow up appointments  will typically take  40 minutes.  Normally, we would recommend 2 to 3 sessions per  week depending on the factors identified on initial assessment, treatment plan and your goals.  If you have limited funding available, we will be happy to work with you to develop a home exercise program.

Please call today to get started on your treatment for Patellofemoral Pain Syndrome at PhysioNow!

Fracture Rehabilitation

Fracture Treatments Mississauga & Etobicoke _ PhysioNow

Fracture types

Fracture Rehabilitation


Fractures are common injuries .  They can happen to people of all ages, from the very young to the very old.  The majority of fractures occur with trauma to the bone.  It could be  either from a fall or a blunt force.  Most people can readily feel that they have a broken bone. This is because the signs and symptoms can be very obvious.

Some of these indicators of Fracture are:

  • Swelling or bruising over a bone
  • Deformity of an arm or leg
  • Pain that gets worse with any movement or added pressure
  • Inability to put any weight through the injured area
  • Protruding bone through the skin (in the case of open fractures)

In some cases, however, fractures can be less obvious.  Some ankle fractures may look a lot like ankle sprains. You may not even know that it was a fracture until it shows up on an X-ray.

Spine Fractures

Fractures through the spine may feel a lot like back pain initially.  This is due to the  make-up of the spine.  Bony injuries to the back do not produce any of the obvious signs and symptoms .  However, one of the key components of a spinal fracture is that it occurs after some sort of trauma. This is most commonly a fall.  Therefore, if there is a traumatic event reported, the physiotherapist  will rule out any potential spinal fracture. They will  do a thorough assessment.  If the   Physiotherapist suspects a potential fracture, we will refer you back to your doctor to get X-rays done.

Fragility Fractures

In people with osteoporosis, fractures can happen with very minor stumbles or movements.  Osteoporosis is a condition where the bones become fragile or brittle from loss of bone.   Fractures associated with osteoporosis are called fragility fractures.  They occur due to the weakness of the bone itself.

If you have Osteoporosis, your bones can be injured with small traumas that would not normally affect the average person.  If you have  back pain and you have had trauma, the Physiotherapist will ask whether you have osteoporosis. This is to rule out potential fragility fractures.

Diagnostic tests for a Fracture

In any incident where there is a suspicion of a fracture, X-rays are necessary.  This will confirm the presence of the fracture, its exact location and severity.  However, in some cases, an X-ray may not be sensitive enough to show the fracture.   In these situations, if a fracture is still suspected, more sensitive tests like a CT, MRI or bone scan may need to be completed.

Fracture Classifications

There are 4 main classifications of fractures:

  • Displaced – the bone snaps into 2 or more parts and moves so that the two ends are not lined up straight.
  • Non-displaced – the bone breaks partly or all the way through, but the ends remain lined up
  • Closed – the bone breaks but there is no puncture wound in the skin
  • Open –the  bone breaks through the skin

Types of Fractures

There are also 7 different types of fractures to describe the specific nature of the break line:

  • Greenstick – incomplete fracture, where the broken bone is not completely separated
  • Transverse – the break is in a straight line across the bone
  • Spiral – the break spirals around the bone, common in a twisting injury
  • Oblique – the break is in a diagonal line across the bone
  • Compression – the bone is crushed, causing the broken bone to be wider or flatter in appearance
  • Comminuted – the break is in three or more pieces
  • Segmental – the same bone is fractured in two places, so there is a ‘floating’ segment of bone

Fracture Treatment

In terms of management of fractures, the treatment depends on the type of fracture.  The fractured ends of the bone must be set in their proper place and held there for the bone to heal properly.  This process is called reduction.

Fracture Repositioning

Most fractures are repositioned without the need for surgery. This  is called closed reduction.  Once the bones are positioned properly, the joint is casted .  The length of casting is usually 6 weeks.  This is how long it typically takes the fractured bones to heal.  There are circumstances where the period of casting may be either shorter or longer. This depends on the nature of the fracture.  If it is an ankle or foot fracture, the doctor may also recommend that you wear an aircast boot to stop your foot from moving.

PhysioNow carries a full supply of these aircast boots if you need one.

Open Reduction (Surgery) after Fracture

Open reduction (surgery)  is done for fractures that are more complicated. The repositioning of the bones wil be done with surgery in this case.   The surgeon will use screws and or plates to keep the bone fragments in proper position. This  allows for proper healing.   Following open reduction, you will have a period of immobilization .  The length of time for a fracture thathas required surgery will depend on the bone that was fractured. It also depends on  the severity of the fracture.  Also, depending on the fracture and the needs of the patient, the hardware may either be left in permanently or taken out with another surgery.  If removal of the hardware is necessary, it will happen once the fractured bone has completely healed.

Spinal and Rib Fractures

There are however some fractures that cannot be effectively immobilized such as spinal and rib fractures.  For these types of fractures, the affected area is protected with avoiding certain activities or postures.

Healing times for Fractures

In terms of healing times, most uncomplicated fractures take approximately 6 weeks for the bones to fuse.  Although medically, the fracture would have healed,  there may still be a lot of limitations. For fractures that are more complicated and required surgery, the healing times may be a little longer due the surgery.

Delayed Healing of Fractures

There are also some people who will heal at a slower rate because of various health conditions or medication use.  So, if you have diabetes, osteoporosis or are a long time user of prednisone, you may fall into this category.  Scaphoid Fractures also may have delayed healing because there is a poor blood supply to the bone.

Registered Physiotherapy after Fractures

Once the fracture itself is healed, there may still be some remaining problems from the injury.  Since the fracture would have been immobilized for several weeks, there will be a significant loss of movement and strength around the broken bone.

It is important to follow up with Physiotherapy for Fracture Rehabilitaton.  This helps to ensure that there can be a safe return to all previous activities.  A Registered Physiotherapist will be able to assess the limitations.  They will prescribe the necessary range of motion and  strengthening exercises and  then you can get back  to  all of your normal activities quickly!

PhysioNow Etobicoke and Mississauga

PhysioNow has highly trained Registered Physiotherapists on staff to help you after a Fracture.  We are open evenings and weekends to help meet your needs.  We also do direct billing to your insurance plan if you have one and if they allow us to do so on your behalf.

Call today to get started on your Fracture Rehabilitation!

Peroneal tendinopathy

Peroneal tendinopathyPeroneal tendinopathy

Peroneal tendinopathy or peroneal tendonitis is characterized by an aching pain and swelling in the perineal tendons. These are located in the lower, outside portion of the ankle. A tendon is soft-tissue that attaches a muscle to a bone. The muscles involved in this condition are the 2 peroneal muscles in the lower leg, called the peroneus longus and the peroneus brevis.

¬ Anatomy

​There are two peroneal tendons that run along the back of the fibula. The first is called the peroneus brevis. The term “brevis” implies short.  It is called this because it has a shorter muscle and starts lower in the leg. It then runs down around the back of the bone called the fibula on the outside of the leg and connects to the side of the foot.  The peroneus longus takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to connect on the other side of the foot. Both tendons, however, share the major job of turning the ankle to the outside. The tendons are held in a groove behind the back of the fibula bone.

¬ Causes of Peroneal Tendonitis

♣ A sudden increase in weight bearing activities, particularly walking, running or jumping
♣ Inadequate or unsupportive footwear
♣ Muscle imbalances of the lower limb
♣ Poor lower limb biomechanics
♣ Incomplete rehabilitation following an acute ankle injury, such as an ankle sprain

¬ Symptoms of Peroneal Tendinopathy

♣ Gradual worsening pain over the outside of the ankle
♣ Pain during and/or after weight bearing activities
♣ Pain with turning the foot in and/or out
♣ Instability around the ankle when weight bearing

¬ Diagnosis

• A full examination from a physiotherapist can be all thats needed to diagnose peroneal tendonitis
• Patients with this condition usually experience pain behind the outside ankle during activities putting stress on the perineal tendons. Pain can also be noticed following these activities or following a rest period. This may be noticed especially upon waking in the morning. There may be swelling when the injury first happens. There will also be pain when testing resisted foot movements.  Stretches into various positions of the foot inversion, and resisted movements can cause pain behind the outside ankle.
• Diagnosis may be confirmed with an MRI scan or ultrasound investigation
• a diagnostic Ultrasound may be used for detecting all types of peroneal injuries.

ϖ What else could it be?:

Symptoms of peroneal tendinopathy mimic various other conditions of the ankle joint. So, before diagnosing peroneal tendinopathy we should rule out other possible injuries by doing the following tests:
• Ankle Sprain: ligament testing by the Physiotherapist
• Ankle fractures: special tests by the Physiotherapist
• Os trigonum syndrome: MRI, physiotherapy testing
• Chronical lateral ankle pain with other cause: MRI
• Longitudinal peroneal tendon tear: MRI
• Peroneal subluxation: ultrasonography, CT, MRI or peroneal tenography
• Flexor Hallucis longus tendon injury

¬ Physiotherapy rehabilitation

• Treatment for peroneal tendonitis includes a program of stretching, strengthening, mobilisation and manipulation. It also includes proprioceptive exercises, icing, ankle bracing or k-taping during contact sports. If symptoms are severe, a cast or ROM boot immobilization may be worn for 10-20 days. After symptoms resolve, you will begin a progressive rehabilitation programme along with a gradual increase to full activity.

• The use of a biomechanical ankle platform (BAPS), deep tissue friction massage, ultrasound electric stimulation can also be included in the physiotherapy
• Also, shock wave therapy (ESWT), acupuncture is used to treat tendinopathy. But there is only limited evidence from studies for these treatments.
• There is evidence for using manual therapy, specifically the lateral calcaneal glide.

If you have any further queries please call PhysioNow. Our experienced physiotherapists would be happy to help you. Call Today to get started 289-724-0448.!

Registered Physiotherapy Mississauga

Registered Physiotherapy Mississauga
Foot Pain Management Mississauga
Pain in the foot can result from a sprain of a ligament. It can come from inflammation of a tendon or bony changes from arthritis. It can also come from dropped arches or irritation of the plantar fascia. These are just some of the reasons that a person can develop foot pain.
The anatomy of the foot can make this body part a difficult one to treat well. The key lies in diagnosing the source of the pain correctly. A Registered Physiotherapist Mississauga has the knowledge and expertise to get this information from the assessment.

Foot pain Management Mississauga: Registered Physiotherapy Mississauga of course depends on the injury. It usually consists of modalities for pain. It can include hands on Physiotherapy treatment to treat the pain and stiffness. This is followed by an exercise program that includes a stretching and strengthening program to improve flexibility. Another important component of Foot pain Management Mississauga is education. The Registered Physiotherapist provides education regarding the injury. They will also give you the expected outcome for the injury. Having this knowledge is very important since it allows you to understand what is happening.

One other possibility with Registered Physiotherapy Mississauga is that it helps you to prevent it from getting worse and/or coming back again in the future. For example, if your dropped arches are potentially causing your ongoing pain, the Registered Physiotherapist will suggest that you get orthotics. This will help to correct the positioning of your foot. PhysioNow can make custom foot orthotics for you if you need them.

Foot pain can be very painful if left untreated. It is important to seek treatment as soon as symptoms arise. Like with any other injury, pain can become chronic the longer that it is left untreated. There is also the possibility that secondary injuries can arise. This is mostly from the fact that the longer a person is in pain, the longer they are walking differently. This can cause additional strain on other joints, such as the knees and hips. This will make the overall injury even more complicated. Therefore, getting treatment at the earlier stages of the injury will result in a quicker and more effective outcome.

Registered Physiotherapy Mississauga is a great option to treat Foot pain. PhysioNow has many well trained Registered Physiotherapists in Mississauga at several convenient locations to serve you. Check us out. Take care of your Foot pain today!