Common injuries of the lower leg, foot and ankle
Ankle sprains are by far one of the most common injuries in sport. They are usually caused by rolling the ankle on uneven ground, or changing direction suddenly. The injury is sudden, painful and typically playing on is not possible. Pain and swelling is localised and easy to pinpoint, the ankle is tender to touch and often cannot be walked on.
Physiotherapy treatment immediately involves reducing and controlling pain and swelling through rest and ice, strapping and reducing weight-bearing through the foot. Medium to long term, it is essential to rehabilitate the lower leg and ankle for balance, strength, coordination and good mobility. Once an ankle is weakened, it is very common to re-injury the ankle.
Calf muscle strain
The calf muscle is at the back of the lower leg and gives you power to push off when walking and running. A strain of this muscle feels like a sudden sharp pain followed by difficulty using it. Most commonly, the calf suffers injury midway between the knee and ankle. Common causes of this injury are failing to warm up sufficiently or a sudden change of direction.
Physiotherapy treatment involves initially settling and controlling the pain and amount of swelling through ice, rest and gentle massage. As the pain decreases, a calf muscle strengthening and lengthening program of exercises, followed by sport and activity-specific exercises are essential to prevent re-injury. Never return to sport or activity until the pain is completely diminished.
The Achilles tendon is the largest and thickest in the body, it connects the calf muscle of the lower leg to the heel of the foot. Tendonitis or inflammation of the tendon can be sudden or chronic due to overuse. Common causes are sudden straining while landing suddenly or jumping, many years of running, poor footwear or foot biomechanics, tight and weakened calf muscle or a sudden increase in activity levels.
Pain associated with Achilles tendonitis is moderate to severe, can feel like it is "burning", is typically worse in the morning when first out of bed, and is often accompanied by localised swelling at the tendon above the heel.
As with all other foot and ankle injuries, immediate rest and controlling of pain and swelling is then followed by an exercise program. This exercise program aims to both strengthen and lengthen the calf muscle and Achilles tendon. There may also be the need to address the strength and coordination of the knee and hip above if there is poor stability and control of these joints.
Heel spurs and plantar fasciitis
The plantar fascia is a thin layer of tough tissue that spans the arch of the foot. It acts to support the inside arch of the foot, however, with over-stretching, it can become microscopically injured and cause pain at the heel. Over-stretching is caused by poor foot biomechanics such as over-pronation, poor unsupportive footwear, tight Achilles tendon or hyper-mobility of the joints.
Common complaints when suffering from this injury include pain on the sole of the foot, commonly at the heel and pain when getting out of bed and first steps if the morning. Pain can feel like a "burn".
Physiotherapy treatment involves thorough assessment of the lower leg alignment and mechanics. Deep massage of the calf and lower leg muscles, strapping, orthotics and heel raises are all possible management strategies.
Osteoarthritis (Hallux valgus)
Osteoarthritis is the slow erosion or wear and tear of the joint surface made of cartilage. It is common in joints that work a lot in the human body. This can be said of the big toe and arthritis and the often accompanying deformity is called hallux valgus or bunions.
Physiotherapy managements aims to control the pain of the big toe joint by providing education about appropriate footwear, prescription of orthotics, bunion pads or toe spacers to improve arch support, bone alignment and therefore forces on the big toe. Referral may be made on to podiatrists or even orthopaedic surgeons to discuss surgical options for management of toe deformities that impact too greatly on the quality of life.
Shin splints is the term commonly used to describe pain of the front of the lower leg. This can include stress fractures of the shin bone (tibia), muscular imbalance causing tendonitis or compartment syndrome which is caused by blood flow problems through exercising muscles of the lower leg.
Pain of this sort is often worse with activity and exercise, decreases with rest and worse with impact. Night tine pain and aches is typical also. It is caused by a sudden increase in activity, poor unsupportive footwear and over exercising.
Physiotherapy treatment must include an excellent diagnosis and referral on to the correct medical practitioner if stress fractures or compartment syndrome is suspected. Shin splints due to poor muscular balance is managed well by a physiotherapist, with rest, deep massage and exercise programs to target lower limb and pelvic stability the usual paths to take.