The foot is made of many small bones that are separated into talus, calcaneous, tarsals, metatarsals and phalangeal bones. It is then categorised into forefoot, mid foot and hindfoot. Whereas your ankle joint is made of talus, tibia and fibula.
This allows you to move the foot and ankle in multiple directions and it be so adaptable to uneven surfaces and transferring weight from one part of the foot to another.
The foot and ankle has ligaments, tendons, and intrinsic (within the foot) and extrinsic (passes from outside foot into foot) muscles that help stabilise it and help provide gross and fine movements.
The foot and ankle can be injured by high impact, repetitive movements or impact, or become painful due to changes in the joint.¬† This can have an impact on the rest of body due to adaptations to pain, such as lower back pain. Therefore it is an important area of the body to keep working effectively or treat properly when you have injured it or have a problem.
Ankle arthroscopy is also know as key hole surgery where small cuts are made either at the front or back of the ankle depending on the type of surgery your surgeon is performing. Surgery regularly performed arthroscopically are for ankle arthritis, anterior ankle impingement, ankle instability, lateral ligament reconstruction, osteochondral defects of the talus, diseases of the synovium, ankle pain following a fracture and undiagnosed ankle pain.
After all ankle arthroscopic surgery your consultant will recommend Physiotherapy who will be provided with a post operative protocol depending on the type of surgery that has been performed. The surgeon will inform you and your Physiotherapist of weight bearing status and duration, and any restrictions on particular movements of the ankles. Your physiotherapist will assist you initially to regain full range of movement and swelling management, which will then progress to gait re-education, muscle strengthening and proprioception exercises by liaising with your consultant at each stage of your recovery. This will ensure that you are able to return to normal or sporting activities post-operatively.
Many people have bunion surgery when their big toe has started to angle inwards (technically describe as hallux valgus deformity) which affects their walking and/or is painful. It can also affect your second toe if your big toe moves across into it. Common bunion surgeries are scarf osteotomy and chevron osteotomy.
After the surgery your surgeon will recommend you have Physiotherapy input to help with managing swelling, regaining full range of movement in your big toe and re-educating your gait. You will initially be mobilising in a hospital shoe for 6 weeks before returning to normal shoes, and then start sporting activities at 6 months.
This surgery like the bunion surgery is performed on your big toe, but is carried out to remove excessive bone on top of the first joint due to arthritis (technically known as hallux rigidus). This can cause reduced range of movement in the big toe resulting in pain. You can also experience pain with direct pressure to the area from footwear.
Physiotherapy is required after surgery to regain range of movement in your big toe, assist with reducing post-operative swelling, muscle tightness and re-educate your gait as you would have adapted an abnormal gait pattern prior to surgery due to the pain in the joint. They will also look at any muscle tightness in the lower limb which could be contributing to stiffness in toe and altered gait pattern.
Flat foot also known as Pes Planus can be due to a large number of issues affecting the structures around the foot and ankle. Inherent bone deformities can be the reason behind flat feet in children, but the adult-acquired flat foot is strongly correlated to muscle some calf muscle weakness. A tear or weakness in one of the muscles responsible for medial stability can cause the ankle to roll inwards and causes this appearance of a flat foot. Over-activity in some calf muscles can also cause the same issues as chronic tightness in this area can position the heel to cause the arch of the foot to tighten, and be dragged down into this flat-footed position.
This is often treated by physiotherapist with manual treatment, a strict stretching and flexibility program, as well as exercises to strengthen the muscles at the front of the shin. Shoes orthotics can also be highly beneficial too as they can decrease the load on the medial (middle) portion of the foot, and place the foot into a more anatomically correct position.
If this conservative treatment fails then your consultant may recommend Flat Foot reconstruction surgery, which is a combination of tibias posterior tendon reconstruction and calcaneal osteotomy.
After surgery you will be in a plaster cast or aircast boot for 6 weeks non weight bearing. At 6 weeks you will mobilise full weight bearing with a brace or insole and you can start physiotherapist. You will be brace and insole free after 12 weeks post-operation, but it maybe advisable to wear an insole for sporting activity.
Your Physiotherapy will be a bespoke programme that will be formulated by your Physiotherapist after continuous assessment of your restricts and improvements over your recovery period. It will consist of managing post-operative swelling and muscle tightness, gait re-education and exercise programme including stretching, strengthening and proprioceptive exercises. Your exercise programme will be altered as your ability improves so that you are able to return to normal level of activity for you and sports at 6 months.
When you have your ankle fused, the bones that are involved are your tibia, fibula and talus. You may have this performed due to pain and stiffness caused by severe arthritis or previous injury or fracture in the area. This results in damage to the cartilage at the end of the bone causing the bones rub against each other as space is narrowed.
For 6 weeks you will be non weightbearing with a plaster cast or aircast boot, but at the end of this period your consultant will encourage you to start weight bearing through the foot in the aircast boot. This is when you will start your Physiotherapy, this will not be on the joint that is fused (as we do not what this joint to start moving). Your Physiotherapist will be able to assist with swelling reduction, muscle tension around mobile joints in foot, muscle strengthen and proprioception and help with gait re-education with the fused joint. By 6-12 months you should be able to return to your sporting activity, and your Physiotherapist can help mediate your exercise programme to achieve this.
Your peroneal muscles are made up of three muscles, peroneus brevius, longus, and tertius that help stabilise the ankle and assist turning the foot outwards. The tendons of the muscles can be made problematic due to acute injury, acute inflammation, chronic degeneration or premorbid factors such as high arched feet, RA, Psoriasis or diabetes.
Symptoms that you can experience is pain, swelling localised to the area, weakness and/or instability on the lateral aspect of the ankle, and popping or clicking sensation on movement on the ankle. These can be made worse during exercise or sporting activity.
Depending on the condition in the tendon your surgeon will advise you on the best course of treatment, this could be conservative or surgical. With both types of intervention you will require Physiotherapy intervention to help with swelling management, reduction of pain, gait re-education and provide a specific exercise programme. They will also address the cause of peroneal tendon problem to reduce the likelihood of you suffer with condition again.
It is common injury to sustain but it has different degrees of severity, which are classified from grade 1-3. These can be from inflammation around the ligament to complete rupture of the ligament. Symptoms after a grade 1 sprain that you can suffer are swelling, bruising, localised pain, and difficulty weight bearing and mobilising on that foot. Whereas with grade 3 sprain you will also have symptoms are instability around the ankle and other structural damage to the area such as fractures and tendon injury.
Initially with this type of injury you are recommended to rest, ice, use compression and elevation, and gently range of movement exercises which will show within a few days a significant improvement. If you are still finding it difficult to mobilising normally due to pain or feeling of instability around the ankle it could be that more damage that to the area has been sustained.
With all degrees of sprain Physiotherapy is a vital to regained a fully functioning ankle. Physiotherapy will assist with swelling reduction, exercise programme to address weakness around the ankle with strengthening and proprioceptive exercises, and gait re-education. Even with severe sprains Physiotherapy can be enough regain normal function of ankle and to avoid surgical intervention.
If you are still have a painful ankle or it is not functioning normally after a few months we would strongly advise further investigations with an ankle specialists who could perform ligament reconstruction to repair the damage.
Achilles tendon is the largest tendon in your body and runs at the back of your ankle which attaches your calf muscle to your heel bone. It is normally injured during a sporting activity due to training too hard and/or tendon weakness, but ageing, long term use of cortiscosteriods, steroid injections near the tendon and certain antibiotics can also contribute to increase the risk of a tear.
There are two options for treating an achilles tear (which could be partial or complete) is conservatively or surgically. Conservative treatment consists of being placed in a plaster cast or brace for several weeks. This is a normally an option if the two ends of the achilles are close together, but the overall rehabilitation period will be longer than surgical intervention.
Surgery is the other option where your surgeon will reattach the tendon ends with strong stitches and then you will be placed in plaster cast with your foot in a pointed position. At 2 weeks post-operatively your surgeon will then transfer you into an aircast boot and this is when you will begin to see your Physiotherapist.
During Physiotherapist sessions they will initially help with swelling management and gentle stretching and strengthening exercises for pointing your toes and turning the foot side to side, and exercises for the rest of your body to maintain flexibility, strength and cardiovascular fitness. The movement of pulling your foot up will be restricted until you no longer need the aircast boot as your consultant will want you gradually to regain this movement to avoid excessive stress on the repair.
At this point your Physiotherapist will slowly increase the intensity of your rehabilitation programme as you are able with short and long term goals to assist you returning to your chosen sporting activities at 6-9 months.
You may be suffering with pain and stiffness in the morning or worsen with activity along your achilles tendon that will be more severe the day after exercising. Other symptoms will be swelling and thickening around the tendon. This is caused when the collagen in the tendon becomes weak and less flexible resulting in microscopic tears. These tears cause the weakness, pain and swelling.
Tendinopathy can be non-insertional or insertional which will determine how your Physiotherapist will treat your problem. This will be diagnosed by your consultant assessing your foot and ankle and backing it up with MRI scan.
They will normally advise you to have Physiotherapy to treat your symptoms alongside reducing activity levels, anti-inflammatories, pain killers and shockwave therapy. Physiotherapy treatment will be a combination of swelling management, releasing muscle tension, gait analysis and re-education, and exercise programme including strengthening and stretching exercises that are specific to non-insertional or insertional achilles tendinopathy. Once the symptoms have subsided your Physiotherapist will provide you with a graduated return to sport programme to ensure you do not irritate your achilles again.
Plantar Fasciitis is the inflammation of the lining of the sole of the foot that is attached to the heel, which supports the foot arch, and it is the most common cause of heel pain. Typical injuries that can some times result in plantar fasciitis include stress fractures of the heel bone, osteoarthritis in the sub-talar joint, thinning of soft tissue over the heel, and irritation of small nerves around the heel. Most of the time, plantar fasciitis can occur as a pathology on its own and be seen with tight calf muscles.
Physiotherapy is the most effective way of treating this condition with a combination of stretching and strengthening exercises, gait re-education during walking and/or running to ensure that there is no recurrence of symptoms.¬† Your Physiotherapist will also advise rest and ice of the affected area, and temporary full length soft insoles to offload plantar fascia if appropriate.