Ankle/Foot

Achilles tendinopathy and rupture

The Achilles tendon connects the calf muscle to the heel bone. Tendinopathy involves microtearing of the tissue in and around the tendon. Inflammation is not usually found. Causes of tendinopathy are many: sudden, unusual, repetitive or high loading; footwear; age etc. Risks such as obesity, gout, Rheumatoid Arthritis, smoking have been implicated. Symptoms include swelling and pain. Onset may be gradual or activity-related. Ruptures are sudden and painful. There is an audible pop, then an inability to point the toes.
Treatment of tendinopathy involves modifying or discontinuing the offending activity. Decreasing the stress on the tendon with a heel lift in the shoe may be helpful. Footwear modification or an orthotic may be indicated. Analyzing technique for flaws is critical. The earlier the treatment is begun, the better. Icing regularly is encouraged. A physical therapist will teach proper stretches and especially eccentric strengthening exercises. Though tendon repairing is lengthy, it often does heal.
Ruptures take many weeks to heal. Serial casting or surgery will be suggested by the surgeon. Physical therapists will guide the rehab over the months. Immobilization, gradually decreasing shoe/heel raises and eccentrics are progressed.

Bunion or Hallux Valgus

A bunion is an enlargement of the tissue and bone around the joint at the base of the big toe. As this progresses over time, it forces the big toe toward the second toe. Some causes are: inefficient foot biomechanics like excessive pronation, "bad" shoes, etc. There may be an inherited tendency. (A Tailor's Bunion is similar, but at the base of the little toe.) It is often quite painful, with redness and swelling. Other medical conditions need to be ruled out, such as gout, rheumatoid arthritis, infection, among others. Treatment is always conservative initially: supportive shoes, pads, orthotics, etc. Physical therapy may be of help. The last resort is always surgery, done by an orthopedic surgeon or a podiatrist (DPM).

Plantar Fasciitis

The plantar fascia is a thick band of connective tissue deep in the arch of the foot, between the big toe and the heel. Stressful biomechanics are often present, though it is often instigated by overuse. This a common pathology of the foot. Its treatment involves analyzing any predisposing abnormal biomechanical factors in the lower kinetic chain of the leg, as well as identifying any causative activities. Taping or orthotics(off-the-shelf or custom) may be helpful. Regular icing and specific stretches for the ankle/foot are critical. If recalcitrant to conservative care, a Physical Therapist may provide soft tissue and joint mobilization and/or modalities. One must be persistent with caring for this problem.

Ligaments hold bones together, while muscles move those bones. Lateral (outer) ankle sprains are the most common athletic injury. Either traumatically or due to predisposing biomechanical/soft tissue factors, the ankle may twist, thus stretching or tearing the outer ligaments of the ankle. If the sprain is minimal, a short period of rest and ice should heal the ligaments well. If a more significant sprain occurs, swelling and sometimes bruising occurs. A short period of immobilization may be necessary to allow healing. This should be followed by rehabilitation to ensure optimal strength, flexibility and balance gains. Seek the help of a physical therapist. If rehab is insufficient, sprains can be quite recurrent. A brace or orthotics may be indicated. In severe cases, an orthopedic susrgeon may suggest ankle ligament reconstruction as a last resort.