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Ankle injuries can be a real pain, literally and figuratively. Not only can they lay you up or make you hobble around, they may cause you to banish your favorite pair of stilettos to the closet or cancel that game of touch football that you had planned for the weekend.
If you are currently in pain and suffering from an ankle injury, it is important that you know the facts about this sensitive area. After all, if your ankle injury is not given the proper attention and healed completely, you run the risk of it occurring again.
Below Are Some Common Ankle Problems We Treat
Ankle Sprain and Instability
An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle.
Why do I have this problem?
A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain.
The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.
A severe form of ankle sprain, called an ankle syndesmosis injury, involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called a high ankle sprain because it involves the ligaments above the ankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting the tibia and fibula bones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.
How Physioflow Physical Therapy Can Help Ankle Sprain and Instability
Even if you don't need surgery, you will likely need to follow a program of rehabilitation and exercise for your ankle injury. When you visit Physioflow Physical Therapy in Vancouver and Camas, we can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle.
Reduction in swelling and pain are the first things we address. If swelling in the ankle is severe, Dr. Trinh will apply a technique called lymphatic drainage and perform a treatment called flossing compression. This is highly effective in getting the excess tissue fluid moving out of the ankle and back into circulation. Dr. Trinh may issue a compression wrap and instruct you to wrap your ankle and lower limb and to elevate your leg.
Many of the specific nonsurgical treatment options that we use at Physioflow Physical Therapy depend on whether your problem is an ankle sprain or ankle instability.
Dr. Trinh may also apply specific hands-on treatment called joint mobilization to improve normal joint motion. These treatments restore the natural gliding motion between the ankle bones that may be restricted following injury. This form of treatment speeds healing and improves function after an ankle sprain. It may also help clients to return more quickly to their activity or sport.
Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation called proprioception or position sense. Dr. Trinh will help you retrain your position sense as a way to steady the ankle joint and protect you from spraining your ankle again.
If the ankle ligaments do not heal adequately, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain. If your ankle ligaments do not heal adequately following an ankle sprain, Dr. Trinhmay recommend changes in your footwear to help keep your ankle from turning in.
Common in athletes who run and jump, shin splints involves pain along the front or inside edge of the shinbone (tibia). Doing too much, too quickly, usually causes it.
The runner with this condition typically reports a recent change in training, such as increasing the usual pace, adding distance, or changing running surfaces. People who haven't run for a while are especially prone to shin splints after they first get started, especially when they run downhill. Shin splints on the front of the tibia are called anterior shin splints.Posterior shin splintscause pain along the inside edge of the lower leg.
Why do I have shin splints?
Shin splints usually result from overuse. Repeated movements of the foot can cause damage where the tibialis muscles attach to the tibia. The tibialis muscles have tiny fibers that fasten the muscle to the bony surface of the tibia called the periosteum. With shin splints, these tiny fibers at the edge of the muscles may begin to pull away from the bone and become inflamed.
Overuse commonly happens after changes in training. Increasing running speed and distance as well as running on hard or angled surfaces can contribute to overuse. Overuse can also occur from running in flimsy footwear or in shoes with soles that are worn out.
Anterior shin splints tend to affect people who take up a new activity, such as jogging, sprinting, or playing sports that require quick starts and stops. The unfamiliar forces place a heavy strain on the anterior tibialis muscle, causing it to become irritated and inflamed. This commonly happens when people who aren't regular runners decide to go on a long jog. The anterior tibialis muscle must work hard to control the landing of the forefoot with each stride. Running downhill puts even more demands on this muscle in order to keep the forefoot from slapping down. People who run on the balls of their feet or run in shoes with poor shock absorption also tend to get anterior shin splints.
Posterior shin splints are generally caused by imbalances in the leg and foot. Muscle imbalances from tight calf muscles can cause this condition. Imbalances in foot alignment, such as having flat arches(called pronation), can also cause posterior shin splints. As the foot flattens out with each step, the posterior tibialis muscle gets stretched, causing it to repeatedly tug on its attachment to the tibia. The posterior tibialis muscle attachment eventually becomes damaged, leading to pain and inflammation along the inside edge of the lower leg.
Shin Splints or Tibial Stress Fracture
A stress fracture in the tibia is a serious problem that at first may have the same symptoms as shin splints. A stress fracture is a crack in a weakened area of bone. Continual stresses from running on hard surfaces or from heavy strain in the tibialis muscles can weaken and eventually fracture the tibia. People with shin pain who try to work through it sometimes end up developing a stress fracture in the tibia.
What is Compartment Syndrome?
A concerning complication of shin splints is compartment syndrome. Compartment syndrome is a condition where pressure from muscle damage and swelling builds up inside a section, or compartment, within the body. There are four compartments in the lower limb. As the pressure builds in the compartment, the small blood vessels (called capillaries) that supply blood to the muscles in the compartment are squeezed shut. This happens when the pressure in the compartment is higher than the blood pressure that keeps the small blood vessels open. When the muscle loses its blood supply, it begins to ache, like a muscle cramp.
If the pressure continues to rise, it can squeeze the larger blood vessels and nerves as well. Patients may feel coldness, numbness, and swelling in the lower leg and foot. If pressure builds up and is not treated, it can cause serious tissue damage in the leg and foot.
How Physioflow Physical Therapy Can Help With Shin Splints
Through treatments designed to reduce pain and inflammation and address the underlying problems causing your shin splints, Dr. Trinh at Physioflow Physical Therapy can help you recover. The length of the Physical Therapy program varies for each patient, but as a guideline, you might expect to devote four to six weeks to your recovery and rehabilitation.
The most important initial treatment will involve controlling inflammation. To speed your recovery, Dr. Trinh may also use deep tissue massage along the junction where the sore tibialis muscle meets the tibia, followed by gentle stretching of the calf and tibialis muscles.
Dr. Trinh will show you how to properly ice, rest, and if necessary, tape the injured area. Special taping techniques may be used to support the sore tissues and ease pain. However, we recommend that taping be used to help the area heal, not as a way to keep on training.
Dr. Trinh will evaluate your posture and alignment to see if you have problems with pronation (arch flattening), a condition that we commonly see associated with posterior shin splints. Sometimes a small heel wedge, placed under the inside edge of the heel, is enough to ease tension on the posterior tibialis muscle. For more severe problems of pronation, we may recommend foot orthotics to support the arch and reduce stresses on the posterior tibialis muscle.
Rest and Recovery
During your recovery, stop doing the activity that caused the problem and avoid heavy training and sports activity for three to four weeks, or at least until the symptoms are under control. Rest and the application of cold packs play a key role in decreasing pain and inflammation in the early stages of treatment. Only after the pain starts to go away, should you begin to resume your normal routine.
As your pain starts to reduce and you begin doing more normal activities, we will help you develop a recovery program to avoid overuse while training. This may include evaluating your running style, and suggesting tips on footwear and the use of shock-absorbing insoles. Knowing your training schedule, pace, and the surface you use can guide us in making personal recommendations as you attempt to safely resume your sport.
Peroneal Tendon Problems
Problems affecting the two peroneal tendons that lie behind the outer ankle bone (the lateral malleolus) are common in athletes. Peroneal tendon problems mostly occur where the two tendons glide within the fibrous tunnel that acts like a pulley behind the lateral malleolus. Their movement can cause irritation of the lining of the tendons. This condition is called tenosynovitis.
Why do I have this problem?
Repetitive ankle motions in sports, such as running and jumping, can lead to wear and tear on the tendons inside the groove. A high arch puts extra tension on the peroneal tendons within the groove and has also been found to cause peroneal tendon problems.
The irritation can often occur after an ankle injury, such as a blow to the outside of the ankle or an ankle sprain. aDuring the typical inversion ankle sprain, the foot rolls in. This type of injury sprains or tears the ligaments that support the lateral part of the ankle. The forceful stretch on the peroneals when the foot rolls in can also cause a lengthwise tear in the peroneal tendons.
An inversion ankle sprain can also cause the peroneal tendons to momentarily slip out of the groove. This is called subluxation. Peroneal tendonitis often occurs during the recovery period after an ankle sprain. Because the ankle is unstable, the peroneals may need to work harder to give needed support to the damaged lateral ankle ligaments. The overwork sets them up for subluxation.
In some patients, a peroneal tendon problem is caused by degenerative changes in the tendons themselves rather than by inflammation around the tendons. The tendon itself becomes abnormal. Doctors call this condition tendonosis.
In tendonosis, the tendon becomes weakened. Tendons are made up of strands of a material called collagen. (If you think of a tendon as a nylon rope, the collagen is the nylon strands.) Degeneration in a tendon causes a loss of the normal arrangement of the collagen fibers that join together to form the tendon. Some of the individual strands of the tendon become jumbled due to the degeneration, some fibers break, and the tendon loses strength.
Over time, the tendon thickens as scar tissue tries to repair the damaged tendon. The area of tendonosis in the tendon is weaker than normal tendon. The weakened, degenerative tendon may tear. This usually causes a lengthwise split in the peroneal tendons rather than a rupture. These splits or tears are most common in the peroneus brevis tendon, probably because it lies in front of the peroneus longus. It is more vulnerable to friction because it rubs against the groove in the fibula bone.
How Physioflow Physical Therapy Can Help With Peroneal Tendon Problems
At Physioflow Physical Therapy, we can create a program to help you regain normal ankle function, improving strength and coordination your ankle.
The initial goal is to reduce pain and swelling. Dr. Trinh will use Astym therapy paired with specific exercise to stimulate new collagen formation and improve the strength of the tendon over time. Stretching, strengthening, and ankle coordination exercises are also added as symptoms ease.
In less severe cases, we may prescribe a stirrup ankle brace, arch support, or lateral heel wedge to take tension off the sore tendons. In more severe cases, we may need to immobilize your foot and lower leg in a short-leg walking boot for two to four weeks to allow the tendons to heal.
Are you suffering from an ankle injury? Contact us today at Physioflow Physical Therapy to learn how we can help you. Dr. Trinh will design a treatment plan targeted to your type of ankle pain and symptoms.