Foot and Ankle

*If you are experiencing persistent pain, diminished function, loss of strength, range of motion, and/or sensation, BCPT recommends that you contact your physician, as a serious underlying physical condition may be present.

Fractures

Ankle fractures are common and result from forces applied directly to the ankle or, more commonly, forces applied indirectly through the foot. Regardless of the specific injury, restoring normal anatomical alignment is imperative in order to make optimal recovery, and prevent neurovascular complications. Depending on the severity and type of injury, either a closed or open reduction will be required to restore proper alignment. Whereas a closed reduction does not require surgical intervention, an open reduction involves a surgical procedure to align the fracture. Often, an open reduction procedure requires internal fixation (ORIF) to maintain anatomical alignment. Following the reduction, a period of immobilization is required to allow appropriate healing to take place. Progressive physical therapy after immobilization is then needed to help restore maximal range of motion, strength, and functional independence.

Ankle Sprains

The ligaments of the ankle are often sprained in a variety of situations from athletic competition to walking on uneven surfaces. The ligaments on the outside (lateral) of the ankle are injured much more frequently than the medial, or inside. In general there are three grades of sprains. Grade 1 is a mild sprain in which the ligamentous integrity is maintained and involves localized tenderness, minimal functional loss, little swelling, and mild pain. Grade 2 is a moderate sprain with some functional loss, difficulty with ambulation, diffuse tenderness and swelling. Grade 3 is a severe sprain with functional disability, marked tenderness and swelling, significant bruising, and loss of motion. Often there is complete ligament rupture with a grade three sprain. Rehabilitation of an ankle sprain will understandably vary for each grade of injury, but must address range of motion, surrounding muscular strength, and balance training to help prevent re-injury.

Shin Splints

A catchall term for exercise induced shin pain, shin splints are associated with repetitive weight bearing activity, and are typically resolved with rest and avoidance of exacerbating activity. Generally there is inflammation of soft tissue, and there may be an underlying cause such as muscle imbalance, tendinitis, poor foot mechanics, or poor foot wear. It is important to address the underlying cause as well as reducing the inflammation, in order to prevent recurrence.

Plantar Fasciitis (Heel Spur)

The Plantar Fascia is a broad band of dense fibrous connective tissue which runs from the heel to all five toes. It helps to support the arch of the boot and to hold the parts of the foot together. This inflammatory condition of the fascia band is often mistakenly referred to as a heel spur. It is important to note that the pain arises from the inflammation, and not the spur that occurs in a large portion of the general population, Various methods can be used to help reduce the inflammation, such as heat, ultrasound, iontophoresis, and icing, while a flexibility program addresses common tightness through the calf and foot musculature.

References: Norkin, CC and Levangie, PK: Joint Structure and Function, A Comprehensive Analysis Magee, DJ: Orthopedic Physical Assessment Richardson, JK and Iglarsh ZA: Clinical Orthopaedic Physical Therapy