At Walker and Hall we know through personal experience how any condition affecting the ankle can have an enormous effect on every aspect of your life e.g., from standing and walking, to commuting to sports and leisure activities.
The most common types of ankle pain we treat are
Sprained ankle
Achilles Tendonitis
Ruptured achilles tendon
Peroneal tendonitis
Referred pain
If your condition is not listed above please contact us
We have extensive experience in treating these conditions and managing your recovery.
To see how Walker and Hall can help you please see below
Sprained Ankle – Lateral Ligament Sprain (also known as Ankle Sprain, Rolled Ankle, Lateral Ligament Sprain of the Ankle, Twisted Ankle)
This is a condition characterized by damage and tearing to the soft tissue and ligaments of the ankle and most commonly affects the ligament on the outside of the ankle joint i.e., the lateral ligament.
It is a condition we often treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.
Anatomy
A ligament is a strong band of connective tissue which attaches bone to bone. The lateral ligament of the ankle comprises three bands of connective tissue and is responsible for joining the fibula to the talus and calcaneus. It acts to prevent the foot and ankle from turning inward excessively.
When this movement is excessive and beyond what the ligament can stand, tearing to the ligament occurs. This condition is known as a sprained ankle and may range from a small partial tear resulting in minimal pain, to a complete rupture resulting in significant pain and disability. As with all ligament sprains they range in severity from grade 1 to grade 3 and are classified as follows
- Grade 1 Sprain: a small number of ligament fibres are torn resulting in some pain, but allowing full function
- Grade 2 Sprain: a significant number of ligament fibres are torn with moderate loss of function and some degree of joint instability
- Grade 3 Sprain: all lateral ligament fibres are ruptured resulting in major loss of function and significant joint instability.
The majority of ankle sprains we treat at Walker and Hall are grade 2.
Causes of a sprained ankle
- Activities involving jumping and landing, or activities requiring rapid changes in direction, especially on uneven surfaces – such as basketball, football, volleyball and netball. The usual mechanism of injury is a combination of turning the foot inwards – inversion – and pointing the foot and ankle downwards – plantarflexion – during weight bearing. Sometimes you may land awkwardly from a high jump and roll the ankle, or more commonly you may land on an opposition player’s foot resulting in the foot and ankle turning inwards excessively with subsequent injury to the lateral ligament. In patients who experience recurrent ankle sprains there is often a loss of joint stability resulting in the patient rolling their ankle on flat surfaces or during trivial activities
There are a number of factors which can predispose you to a complete tear of the Achilles tendon and these include:
- poor proprioception or balance
- inadequate rehabilitation following a previous ankle sprain
- joint instability
- muscle weakness
- poor core stability or a lack of co-ordination
- joint stiffness
- poor muscle flexibility
- inadequate warm up
- inappropriate training
- inappropriate training surfaces
- poor biomechanics or foot posture
- decreased fitness or sport specific conditioning
- fatigue
- inappropriate footwear
Signs and symptoms of a sprained ankle
- Pain and swelling – felt at the time of injury and located over the outside of the ankle. In minor cases you may be able to continue activity only to experience an increase in pain, swelling and stiffness in the ankle after activity with rest, particularly on waking the following morning. In more severe cases the pain may be severe at the time of injury and a rapid onset of swelling may be present – often within the first few hours following the injury
- You will often experience tenderness on firm touch of the outer aspect of the ankle and an increase in pain when the ankle is moved inwards (inversion) and pointing the foot and ankle downwards (plantarflexion) thus placing the lateral ligament under strain.
- Walk with a limp or be unable to weight bear due to pain and you may develop bruising over the ankle which may spread into the foot
- Audible snap, click or tearing sound at the time of injury
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the extent of the ankle sprain. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for an ankle sprain are
- R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and Elevation (providing this is comfortable)
- Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, gentle ankle joint mobilising techniques and soft tissue massage to reduce pain and muscle spasm
- Advice with regards to the use of a heel wedge and crutches
- Ankle taping
- Home exercise programme – a graduated flexibility, strength and balance to ensure an optimal outcome
- Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
- Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Achilles tendonitis (also known as Achilles Tendinitis, Achilles Tendinopathy, Achilles Tendinosis)
This is a relatively common condition characterized by tissue damage and pain in the Achilles tendon.
It is one of the most common conditions we treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.
Anatomy
The muscle group at the back of the lower leg is called the calf and comprises two major muscles, one of which originates from above the knee joint and is called the gastrocnemius muscle and the other from below the knee joint and is called the soleus muscle. Both of these muscles insert into the heel bone via the Achilles tendon.
During contraction of the calf, tension is placed through the Achilles tendon. When this tension is excessive due to too much repetition or high force, damage to the tendon occurs. Achilles tendonitis is a condition in which there is damage to the tendon with subsequent degeneration and inflammation. This may occur traumatically due to a high force going through the tendon beyond what it can stand or more commonly, due to gradual wear and tear associated with overuse
Causes of Achilles tendonitis
- Repetitive or prolonged activities – these include activities such as excessive walking, running e.g., marathon and triathlon, football and athletics
- Trauma – occasionally it may occur suddenly due to a high force going through the achilles tendon beyond what it can stand e.g., sudden acceleration or forceful jump
- Following a calf or Achilles tear, poorly rehabilitated ankle sprain and or poor foot biomechanics – any of these conditions if left too long can lead to Achilles tendonitis
There are a number of factors which can predispose you to Achilles tendonitis and these include
- joint stiffness – particularly the ankle
- muscle tightness – particularly the calf
- inappropriate or excessive training
- poor biomechanics
- poor foot posture – flat feet or high arches
- inappropriate footwear
- inadequate warm up
- muscle weakness
- poor proprioception or core stability
- being overweight
Signs and symptoms of Achilles tendonitis
- Pain – usually felt in the region of the heel and back of the ankle. In less severe cases, following activities which place stress on the Achilles tendon, you may only experience an ache or stiffness in the Achilles area that increases with rest – typically at night or on waking first thing in the morning. These may include walking and running excessively – especially uphill or on uneven surfaces, jumping, hopping, performing heel raises or performing calf stretches. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses you may experience symptoms that increase during sport or activity. The pain may also increase when performing a calf stretch or heel raise i.e., rising up onto your toes.
- Swelling, tenderness on firmly touching the Achilles tendon and occasionally a palpable thickening of the affected Achilles tendon
- Muscular weakness of the affected calf
- Walking with a limp
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the extent of the Achilles tendonitis. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for Achilles tendonitis are
- R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and Elevation (providing this is comfortable)
- Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, gentle ankle joint mobilising techniques and soft tissue massage to reduce pain and muscle spasm
- Advice with regards to the use of a heel wedge and crutches
- Biomechanical assessment, correction and the use of the appropriate orthotics
- Home exercise programme – a graduated flexibility (especially of the calf muscles), balance, strength and core stability programme to ensure an optimal outcome
- Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
- Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Achilles Tendon Rupture (Complete Tear) (also known as a Ruptured Achilles Tendon, Completely Torn Achilles Tendon)
This is characterized by a complete rupture (snapping) of the Achilles tendon.
Although not very common it is a condition we see at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.
Anatomy
The muscle group at the back of the lower leg is called the calf and it comprises two major muscles, one of which originates from above the knee joint and is called the gastrocnemius muscle and the other from below the knee joint and is called the soleus muscle. Both of these muscles insert into the heel bone via the Achilles tendon.
During contraction of the calf, tension is placed through the Achilles tendon. When this tension is excessive due to too much force, the Achilles tendon can be torn. Tears of the Achilles tendon can range from a small partial tear where there is minimal pain and minimal loss of function, to a complete rupture which may require surgical reconstruction.
Cause of an Achilles tendon rupture
- Achilles tendon ruptures most commonly occur in patients in their 30s or 40s and typically occur when a patient attempts to accelerate from a stationary position or when lunging forwards such as while playing tennis or squash
There are a number of factors which can predispose you to a complete tear of the Achilles tendon and these include:
- poor flexibility
- inappropriate training
- poor biomechanics
- poor foot posture
- inadequate warm up
- muscle weakness
- inadequate rehabilitation following a previous ankle, calf or Achilles tendon injury
Signs and symptoms of an Achilles tendon rupture
- Pain – a severe sudden pain in the Achilles region accompanied by an inability to bear weight on the injured leg
- Patients often describe an audible ‘snap’ or ‘tearing’ sound, or the sensation of being kicked or hit in the back of the leg at the time of injury
How Walker and Hall can help you
The treatment for a complete rupture of the Achilles tendon is either surgery or conservative management, often depending upon the age and requirements of the patient:
Surgery – often considered to be the most appropriate form of management for active patients who are seeking the highest level of function. It involves a period of immobilization in a plaster cast for one to two months following surgery and a rehabilitation period of three to six months involving extensive physiotherapy
Conservative management – this tends to be for older individuals and involves immobilizing the Achilles tendon in a shortened position in a cast for approximately four weeks. The Achilles tendon is then gradually stretched and strengthened over time.
The types of physiotherapy treatment used at Walker and Hall for the rehabilitation of a complete rupture of the Achilles tendon are
- Ice and heat to reduce swelling and muscle spasm
- Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, gentle ankle joint mobilising techniques and soft tissue massage to reduce pain and muscle spasm
- Advice with regards to the use of a heel wedge and crutches
- Home exercise programme – a graduated flexibility (especially of the calf muscles), balance, strength and core stability programme to ensure an optimal outcome
- Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
- Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Peroneal Tendonitis (also known as Peroneal Tendinopathy, Peroneal Tendinitis, Peroneal Tendinosis)
This is a condition characterized by pain and inflammation of the peroneal tendons as they pass over the outer aspect of the ankle and foot.
It is a condition we often treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.
Anatomy
There are two muscles which lie on the outside of the lower leg and are together known as the peroneal muscles. They originate from the outer lower leg bone (fibula) and travel down the outside of the leg where they insert into various bones in the foot via the peroneal tendons. They are responsible for moving the foot and ankle away from the midline of the body – eversion.
Whenever these muscles contract or are placed under stretch, tension occurs through the tendons. If this tension is excessive due to too much repetition or high force, damage to the tendons may occur. Peroneal tendonitis is a condition involving damage to one of the peroneal tendons with subsequent degeneration and inflammation.
Causes of peroneal tendonitis
- Excessive walking or running – especially on slopes or uneven surfaces, or during sporting activities requiring frequent change of direction and or jumping such as dancing, basketball, football or volleyball.
There are a number of factors which can predispose you to peroneal tendonitis and these may include:
- muscle tightness – particularly the calf or peroneal muscles
- muscle weakness
- joint stiffness – particularly of the foot and ankle
- inappropriate or excessive training or activity
- inadequate recovery periods from sport or activity
- poor foot biomechanics
- inappropriate running technique
- inappropriate footwear
- inadequate warm up
- inadequate rehabilitation following a previous ankle or lower limb injury
- neural tightness
- muscle imbalances
- being overweight
Signs and symptoms of peroneal tendonitis
- Pain – felt over the outer aspect of the ankle, foot or lower leg during activities which place large amounts of stress on the peroneal tendons or after these activities with rest, especially on waking the following morning. These activities may include walking or running excessively – especially on slopes or on hard or uneven surfaces, and sporting activities requiring frequent change of direction and or jumping. The pain tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities. You may also experience pain on firmly touching the affected peroneal tendon
- Swelling – seen over the ankle and foot.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the extent of the peroneal tendonitis. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for peroneal tendonitis are
- R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and Elevation (providing this is comfortable)
- Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, gentle ankle joint mobilising techniques and soft tissue massage to reduce pain and muscle spasm
- Advice with regards to the use of a heel wedge and crutches
- Ankle taping
- Home exercise programme – a graduated flexibility, strength and balance to ensure an optimal outcome
- Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
- Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Referred Pain
Not all ankle pain is necessarily coming from the ankle. Occasionally, pain felt in the ankle can be referred or caused by a problem in another area of the body such as the back or spine. This is called referred pain.
What is Referred Pain?
Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.
What structures can refer pain into the ankle?
The following structures have the ability to refer pain into the ankle
- The lumbar and sacral spines (from the 4th lumbar spine to the 2nd sacral vertebra – L4 to S2). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic an ankle problem.
- The hip joint
- The knee joint
- The muscles of the hip and pelvis area
- The muscles of the thigh
- The muscles of the lower leg
How can Walker and Hall help you distinguish between an ankle problem and referred pain
At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for the ankle symptoms.
It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.
You will be involved in all stages of your treatment given every opportunity to ask questions.
