Ankle and foot pain can be as obvious as the injury may appear to be or it can be quite complex with overlapping injuries in the same region. Common ankle injuries include common inversion sprains, “high ankle sprains” which need to be managed much differently, Achilles tendinitis or tears, posterior tibialis tendinitis, posterior tibial neuropathy, peroneal neuropathy, plantar fasciitis, heel spurs, stress fractures, and injuries in the low back or knee that refer pain to the ankle and foot.
Many people suffer from “twisting” their ankle. This twisting can stretch, partially tear, or completely tear the ligaments on the outer side of the ankle. A clinical exam and appropriate imaging will determine the best management. Some patients never managed their torn ligaments from ankle sprains years ago and have developed new injuries and perhaps ankle tendon tears or arthritis.
A “high ankle sprain” or a “tib-fib ankle sprain” is a much different type of sprain and needs to be managed immediately or the patient is likely to suffer from an early onset of ankle arthritis.
The Achilles tendon can become sore with overuse. It is commonly seen in tennis players, track athletes, joggers and weekend athletes. Achilles tendinitis becomes more common seen in the 30’s and 40’s. Achilles tendinitis responds exceptionally well to soft tissue mobilization. Some patients have partially torn the Achilles tendon and have several options of managing this injury. A few cases have who present to our office have not responded to any form of previous care may have an atypical case of radiating pain from a nerve and disc injury in the low back. An examination of the low back and ankle can clinically determine the pain generator.
Plantar fascia is a thick band of connective tissue on the bottom of the foot that functions somewhat like the bowstring on a bow. This connective tissue can become inflamed and infrequently, it can tear. The inflammation is often triggered by increasing a load on the tissue that it is unaccustomed to such as increasing running distance too much and/or too soon. It is also associated with running in shoes that have too many miles logged on them and no longer provide proper support. Some cases of plantar fasciitis resolve by simply having the patient buy a new pair of shoes. There are also nerve entrapments in the ankle, knee or low back that can produce pain and/or tingling in the bottom of the foot.
Neuropathies and Radiculopathies
Peripheral nerves can be compressed by the ankle or the knee and can produce symptoms that mimic plantar fasciitis or problems from the low back. A careful examination is required to differentiate these neuropathies. Special nerve tests may then be ordered to further quantify this problem.
Spinal nerve root inflammation or compression from the lumbar spine (low back) does not always display all of the classic symptoms. These spinal nerve root problems (radiculopathies) are often called “sciatica” by patients. The pain can present atypically and can sometimes present in the heel only or the bottom of the foot only, which can mimic Achilles tendinitis or plantar fasciitis. Some of these patients have had months, or in some cases years of treatment without any significant improvement because the pathology has not been identified.
The doctors of the Soft Tissue Center are board certified in chiropractic sports medicine and have extensive experience with elite track and field athletes who often have the problems noted above. Our doctors are an excellent choice for patients to begin the diagnostic process and for appropriate case management and treatment.