Ankle and Achilles Tendon Pain
Calf strain / tear
The calf has 2 muscle groups, the gastrocnemius which gives the calf its shape, and the soleus which sits underneath. Calf tears can happen in either of the two muscles but are more common in the gastrocnemius. Tears to the calf are quite painful and restrictive, giving difficulty with walking. Treatment focuses on decreasing muscle tightness and accelerating muscle healing. Following this scar management and a graded stretching and strengthening program.
Shin splints / Tibialis posterior tendinopathy
Shin splints occur when the connective tissue surrounding the shin bone become irritated. These lining shares an attachment with the muscle called tibialis posterior which runs deep and behind the shin bone. Shin splints often begin due to an increase in running or sports participation. Symptoms begin initially with exercises then improve mildly throughout the session, following exercise the shin will often ache for an extended period. If left untreated this can lead to stress fractures in the shin bone. The tibialis posterior tendon assists in supporting the arch on the inside of the foot and is usually the starting force for aggravation of the shin bone. Treatment focuses on decreasing tensional forces on the lining of the bone and correcting mechanics of the ankle. Initial ice use and relative rest will ease symptoms followed by a graded return to activity program.
This condition affects the strongest tendon in the body, the Achilles tendon which attaches to the back of the heel from the gastrocnemius and soleus muscles. This condition often affects the middle to later ages population, however, can occur in instances of chronic overload of the tendon. Chronic overload leads to swelling and microtears within the tendon which causes pain and weakness with activity. Treatment focuses on a loading program to strengthen the tendon and biomechanic corrections. If left untreated the Achilles tendon can rupture which results in surgery. Following surgery, you will mobilise in a moonboot for an extended period, with long term rehabilitation to restore strength and normal mechanics of the tendon and muscles.
Fat pad impingement / Posterior impingement
This condition refers to pain localised to the back of the heel under the Achilles tendon. This can be due to muscle tightness, stiffness or even bony spurs. Behind the achilles near the bone, the Achilles fat pad lies to help cushion the achilles tendon against the bones. Due to either compressing the fat pad or bony contusion when your toes point towards the ground, swelling begins which can lead to pain with ankle movements. Treatment focuses on decreasing muscular tightness on the lower leg, restoring normal mechanics and decreasing inflammation. Alterations to footwear or taping may be used to assist with return to sport to prevent further damage to these structures.
Ankle sprain and Ligament Tears
This is the most common injury to the ankle and can range from mild, to severe or even fractures. Generally, the outside of the ankle is more commonly affected due to the nature and structure of the ankle allowing more range of motion. The ligaments on the inside of the ankle are much harder to damage due to its structure and lack of range of motion that stresses these ligaments. Treatment of most ligament strains and tears is non-surgical unless chronic instability arises or there is large amounts of damage to ligaments (these often occur in hand with a fracture). Restricted loading (crutches), bracing or taping and swelling management is initial priority. Following this restoration of range of motion then restoring mechanics. An extensive program is used to correct balance, strength and other contributing factors to the injury. Following this, taping through return to sport can be effective with the goal of reducing support as you grow stronger. This condition responds extremely well to physiotherapy.
Between the 2 bones of the shin is a band of connective tissue called the syndesmosis. This band of tissue can be damaged and is done so when the foot in planted and injured or with a rotational force. When this ligament is injured, instability arises between the bones in the shin leading to pain extending up the leg. This condition, if severe will result in surgery to repair the connective tissue to provide stability to the ankle. Treatment for this injury begins with a moon boot and restricted loading through crutches. Once you are able to walk pain free and without a limp you are able to come out of the moonboot. Following this treatment follows that f an ankle sprain with extra emphasis on load bearing and plyometric strengthening.