Foot injuries are common among athletes during their career and can cause a lot of pain, discomfort and in some cases can sideline them for some time. Overuse, overtraining, weak muscles and tendons, trauma, poor technique and incorrect footwear can all lead to foot injuries. In this article we will look at some of the most common foot injuries and how physical therapy can help.
A tendon is a band of tissue that connects muscle to bone. The Achilles tendon connects your calf muscles to your heel, allowing you to walk, run and jump. Achilles tendinopathy, strain of the Achilles tendon, is a common injury that may affect runners, or people with over-pronated (flat) feet or those with high arches or tight calf muscles as well as those who wear runners that are not an appropriate biomechanical fit for them. Some people may have a protruding heel bone (calcaneus) which pulls the Achilles tendon into a position where it is more likely to be strained.
The Achilles tendon is already under strain when the foot pushes off the ground in walking, running or jumping, so when there is extra stress on the tendon due to the above reasons then it is easy to understand why Achilles tendinopathy is common.
Achilles tendinopathy is a painful and quite often a chronic condition that is difficult to treat. If the strain is higher up in the tendon towards the calf, then physical therapy management of ice, ultrasound, deep tissue massage, stretching, corrective exercises, strapping and advice on footwear is often very successful. If the strain is closer to the insertion at the heel, you may need to see a specialist who may recommend an anti-inflammatory steroid injection at the site or perhaps surgery.
Podiatry is also highly recommended for Achilles tendinopathy and heel inserts can be of great benefit in reducing symptoms.
The primary symptom of an Achilles tendon injury is pain at the back of the heel, which increases with exercise and lessens when exercise stops. Achilles tendinopathy may also manifest itself with warmth, swelling and tenderness at the site. Range of motion may be limited.
Achilles tendinopathy can lead to small tears in the tendon, making it susceptible to rupture. However rupture may also take place without any previous Achilles tendon problems.
Symptoms of Achilles tendon rupture are:
- Sudden pain in the back of the ankle which feels like a kick or a stab. Sometimes a loud snap is heard. It may turn into a dull ache.
- Swelling between the heel and the calf. You may have a ball of swelling where the ruptured tendon has bunched up.
- Difficulty walking or rising up on the toes.
A rupture may be treated surgically or non-surgically, depending on the extent of the damage and your condition. Until you can get professional help, the RICE formula should be applied:
- Rest. This is important as walking may cause further problems.
- Ice. Use an ice pack wrapped in a wet tea towel. Never apply directly to the skin and leave on for twenty minutes. Repeat every two hours.
- Compression. Bandage the foot to prevent further swelling. Take the bandage off at night when you go to bed.
- Elevate the leg at or above the level of the heart to decrease swelling.
For non-surgical intervention, we will either strap the Achilles tendon or we will recommend a brace, as well as physical therapy treatment used for Achilles tendinopathy. We will work with you to manage your pain and we will also help you modify your training schedule to match your recovery and advise you on how to prevent further injury.
Athletes who run and jump a lot may be susceptible to metatarsalgia, a type of foot injury that manifests itself in pain and inflammation in the ball of the foot. Causes of metatarsalgia can include wearing unsupportive footwear, overpronation of the feet (flat feet), clawing or hammertoes or a tight, high arch.
Symptoms of metatarsalgia are:
- Pain in the forefoot is most pronounced when the person tries to bear weight or push off, especially if they are in high heels.
- Pain is usually gradual in its onset.
- Passive range of motion (when the therapist tries to bend the foot downwards) may be difficult or painful.
- Pain and tenderness when the area is pressed on.
- Excessive skin or calluses may be seen under the foot because of pressure.
Physical therapy involvement in this type of foot injury may involve the following:
- Assess gait and help correct uneven distribution of pressure on the metatarsals (bones of the foot).
- Recommend properly fitting shoes.
- Recommend you to a podiatrist for fitting of orthoses to correct foot posture.
- Train you in stretching and strengthening exercises to correct tightness in the tendons.
- Massage to relieve pain and tightness in the metatarsal area.
The plantar fascia is a fibrous tissue that provides support for the arch of the foot and acts as a shock absorber for the foot. It inserts into the heel bone (calcaneus) and runs along the length of the arch of the foot. Plantar fasciitis is an overuse condition of the plantar fascia near its insertion at the calcaneus.
This type of foot injury causes pain at the bottom of the heel and is mostly felt after waking in the morning but as it worsens the heel becomes painful during any weight bearing activity such as walking.
Plantar fasciitis is experienced by walkers and those who are on their feet a lot. Women, the obese, those who overpronate or have very high arches and the elderly may also experience this type of foot pain.
Rest and ice are very useful in relieving pain caused by plantar fasciitis.
Rehabilitation with a physical therapist is necessary to reduce pain and provide stretching exercises to strengthen the calf muscles and the intrinsic muscles of the foot. Your physical therapist may also recommend orthotics or taping to take pressure off the plantar fascia.
If you are suffering from this or other type of foot injury, your first step should be to call us at Axis Physical Therapy. We are here to help you and by contacting us early, you can avoid further injury and be on the road to recovery sooner.
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