Foot and Ankle Pain

Our feet and ankles are subject to a lot of loading on a daily basis. Treatment needs to attempt to recover both the stability and flexibility after an injury.

By far the most common injury which patients have to contend with is when they roll their ankle and foot in an inwards direction and sprain one or more of the main three ankle ligaments on the outer side. The image below shows these three. They are easily tested in the practice with a few simple movements. In cases where we are not sure as to the extent of the damage or it seems to be severe - we will send you for an ultrasound scan which will show us in detail which areas have been affected. This will cause varying degrees of ankle pain.

Treatment will of course be individualised for your particular injury, but would involve (in less severe cases) mobilising the bones in your foot, relaxing some of the muscles in your foot, lower leg and possibly all the way up to your hip in order to reduce your ankle pain. It just depends on how long ago the sprain took place and how badly it influenced your foot and leg movements. In most cases you will be shown a few stretches to do on your own and a simple strapping technique which - when possible - would allow you to continue your activities. Also, if appropriate, we may recommend a variety of pain relieving or anti-inflammatory creams which you could choose to purchase at your own discretion at any pharmacy.

Like any part of the body, the foot can experience pain which is coming from a completely different place. The most common dysfunctions to refer pain to the foot are the lower back, hip and the lower leg. From the lower back there can be a nerve irritation from a variety of causes which will send pain to the foot. The nature of the pain will generally be worst when you are standing for a period of time and it will stretch as a line of pain from the hip or lower back area into the foot. For this we will usually do a series of clinical tests.

From the hip, where a muscle can simply be tight we can get referral all the way down to the foot, or just to the foot itself - there doesn't necessarily have to be a line of pain all the way down along the leg. Also this sort of referred pain will generally be very spread out and you may have trouble actually being able point out exactly where in the foot it is. Similarly, in the lower leg there are a number of muscles which can shoot pain into the foot. The most common muscles to do this are the ones along the front of your lower leg, along the shin bone. These will usually refer into the top side of the foot. Less commonly your calf muscles can refer into the sole of your foot.

It's most annoying when every step you take causes you heel pain. Your heels are actually made up of two bones 'stacked' on top of each other. Due to a variety of reasons these two bones can develop a tilt and put your entire walking pattern at risk. In some patients this may have far reaching knock-on effects such as lower back pain or even headaches. In others it will simply cause just local foot or heel pain. This is usually easily remedied with osteopathic manipulation and some muscle work. You would also be shown stretches which you can do on your own to speed up the process.

Heel pain can also happen because the muscular attachments to the underside of your heel become inflamed and cause pain whenever you try to use them to walk. In these instances the pain will often be worst after a period of rest - such as when you get up first thing in the morning, or after you have been sitting watching TV for a while and go to get up. This condition is often called Plantarfascitis. Its treatment involves a mix of modalities dependant on its severity. In mild cases (which can still be quite painful) osteopathic treatment and stretching on your part can be enough to actually fix the heel pain over the period of a few months. In other cases where the inflammation is more severe we would need to order an X-ray and ultrasound in order to assess the severity. In some of the most severe cases we may need to refer you for a cortisone injection in order to give you long standing relief. As always we will discuss these options together, you will receive our professional advice, but you will always make the final decision on what you would like to do.

The arches in our feet act as springs for the rest of the body with every step we take. The arch most people think of is called the medial arch - the one that runs along the inner aspect of your foot. There are however other foot arches too which can be just as important to foot function. With osteopathic treatment we ensure that we balance the forces which pass through the foot by mobilising any restricted joints in the feet and releasing any tight muscles or fascia. We will often work together with a podiatrist on your behalf if arch supports / insoles are needed in order to get the best result.

It is important to note that the foot itself might not be the problem when it comes to arch issues, but that other parts of the body can also affect the foot arches quite heavily. For example patients with lower back pain will often walk on the outer edge of the feet and wear out the outside edges of their shoes. In such a case the foot is stiffening to increase its shock absorptive capacity and decrease the degree of force that goes up to the lower back.

In certain cases where constraining shoes are worn for many hours a day, or if you have to walk great distances on hard surfaces you may develop a nerve compression or entrapment in your foot. The nerve (which can vary between patients) becomes squashed between your foot bones can lead to a great deal of pain every time you try and put weight on the foot.

These painful nerve entrapments often need to be differentiated from fractures which can occur under the same conditions - either by means of X-ray of ultrasound. In some cases we can help with osteopathic treatment, whilst in others we will suggest an appropriate podiatrist, specialist or other professional who would be most helpful to you in order to achieve the fastest results.

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