Foot and Ankle Pain
Considering its size, the foot has an astonishing 28 bones, 38 muscles, 25 joint complexes and 214 ligaments to its structure, making it a highly complex body part. It has one of the most demanding jobs of the body in terms of providing functional capability, given that it enables individuals to stand, walk and run throughout their lifetime, therefore it is not surprising therefore that problems with the ankle and the foot affect 75% of people at some stage in their lives.
These may be sustained when a person suddenly twists or turns on the ankle in a way that the soft tissues are unable to stabilise, which causes tearing of these structures to occur. Strictly speaking, sprains occur mainly to ligaments, but the mechanism of an ankle sprain can be such that other soft tissue structures are injured, including muscle, nerve and joint capsule. As they occur so commonly, ankle sprains are often not considered to be important injuries. However, the velocity at which they can occur, usually during weight bearing, means significant soft tissue injury can result. If this soft tissue injury is not addressed correctly, scar tissue and joint adaptations can follow causing long term 'chronic' ankle problems including pain, stiffness and instability. It is interesting that 80% of all ankle sprains are estimated to become chronic / recurrent. This gives some idea as to how many of these injuries are mis-managed, often through the assumption that they are only minor injuries and therefore do not require medical attention. The most common ankle sprain is that of the lateral complex – which can include the lateral ligaments, peroneal muscle group, ankle joint capsule, and sometimes the peroneal nerve. It is sustained when an inversion injury occurs, causing the foot to suddenly turn under (over onto the outer part of the ankle). Pain, swelling, reduced motion at the foot and ankle and difficulty weight-bearing are common signs and symptoms associated with this injury. In the longer term, if normal movement is not restored quickly, scarring occurs within the injured soft tissues, affecting the foot and ankle joints and the associated muscles and ligaments. This can alter foot and ankle movement dynamics and overall position sense / balance (proprioception). In some cases, the injured ligaments become effectively 'longer' as they have been overstretched and they do not possess the elastic / contractile properties that muscles do. Overstretched and therefore incompetent ligaments provide poor support around the ankle joint, predisposing the individual to problems with ankle stability and recurrent strains and sprains. It is important therefore that a physiotherapist is consulted following an ankle sprain. If the sprain is minor, recovery with appropriate guidance and rehabilitation exercises should be relatively speedy. More complex and higher velocity ankle sprains (involving multiple soft tissues) will take longer to recover, although with the correct supervision and appropriate rehabilitation, a full recovery is usually made.