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Ankle manipulation

Ankle sprains

This is an injury to one or more of the ligaments around the ankle joint. Ligaments are strong elastic band-like tissues which hold bones together. Often a sprain occurs on the outside of the ankle or lateral side. Most people sprain their ankle by ‘rolling’ over onto the outside of their foot, this is known as an inversion injury.

Signs and symptoms

A sprained ankle is usually painful especially around the area of damaged ligament; you may see swelling find your ankle difficult to move or to walk on. You may also see some bruising. In more severe sprains you may find that you struggle to walk and limp when weight bearing.

How physiotherapy can help

A Physiotherapist can help advise on immediate treatment, such as PRICE – Protect, Rest, Ice, Compression and Elevation, as well as rehabilitation options for your ankle once the initial symptoms have settled. Should you experience walking difficulties your Physiotherapist can provide a crutch to help support you when walking should this be necessary. Remember it is important to encourage normal movement to the ankle rather than walk badly so try to avoid this.

Physiotherapy can work to return your ankle movement to normal, improve the strength of the surrounding tissues, including muscles and advise on any ankle braces (if required) in order that you may return to the sports / hobbies you enjoy.

It is important not to ignore an ankle sprain or a sprain that is not improving.

Plantar fascitis

Plantar fascitis is a painful overuse condition originating in the plantar fascia. The plantar fascia is a strong ligamentous structure on the sole of your foot, it originates from your heel bone(calcaneus) and spans across the bottom of your foot (the plantar surface) inserting into the bones of your forefoot (metatarsal heads). Its role is to help give structure and support to the foot.

Signs and symptoms

Typically activities that involve putting force on this structure can prove to be painful, such as running, walking or dancing. Usually pain is reported beneath the heel and is particularly worse when first waking in the morning. Initially putting the foot down after getting out of bed is often reported as very painful, or descending the stairs first thing.

Pain is usually focussed to one point on the heel bone but there is usually tenderness along the inside border (medial) of the plantar fascia, due to tightening of the ligamentous structure. If the big toe is pulled back stretching the fascia, it is usually painful.

How physiotherapy can help

Often there is a biomechanical cause behind this problem, such as excessive pronation (flat foot) or tightness of the calf. A physiotherapist will be able to assess your gait (walking) pattern and foot posture. If they feel orthotics may help improve this problem, they will be able to arrange for an orthotic assessment, if required they will provide orthotics (insoles) to correct your foot posture and foot biomechanics.

Physiotherapists are able to provide treatments which will help with pain relief. These include interventions such as soft tissue massage, stretching of the fascia, acupuncture, ultrasound, taping, or a heel cup. Plantar fasciitis can often be associated with weight gain and obesity; if you think this may be contributing to your problem seek appropriate medical advice on starting a weight loss programme as part of your treatment regime.

Applying an ice pack to the sole of the foot can prove to be helpful after activity, and can help reduce the symptoms of the condition. It is important to wrap an ice pack in a damp cloth and apply for 20 minutes checking the foot regularly. Speak to your physiotherapist about using ice to help with your condition.

It is important to treat this condition early on, the longer it is left the more difficult it becomes to treat and resolve, so please don’t ignore it.

If you think you are struggling with plantar fasciitis please contact us, using one of the options under 'To contact us' below, to see if we can help you.

Achilles tendinopathy

Achilles tendinopathy is a painful and often disabling condition associated with pain around the Achilles tendon. More often than not patients complain of pain around the tendon itself, usually localised to one point. However pain can also present at the insertion of the tendon into the heel bone, the calcaneum, which is otherwise known as insertional achilles tendinopathy, or behind the tendon in the bursa, which is otherwise known as retro calcaneal bursitis.

Presentation is usually reported as a gradual onset of pain; this is due to tendon degeneration and its inability to cope with load from the lower limb. As the tendon tissue begins to degenerate minute tears with the tendon body develop. These changes in the health and vascularity of the tendon then become pain generating.

Conversely patients who have suffered a rupture of the achilles will have unknowingly experienced the same degeneration of tendon health, although not painfully. These changes in tendon health and minute tears weaken the tendon ultimately causing its rupture. Typically this group of patient does not usually report achilles pain prior to a rupture.

Achilles tendinopathy is typically due to an overuse condition often associated with prolonged episodes of exercise such as running or walking, although it is not exclusive to this group.

Signs and symptoms

  • Mild ache in the tendon and tenderness around the tendon itself
  • Pain and stiffness in the tendon on rising in the morning, however these symptoms diminish with walking around or after applying heat, such as a hot shower
  • Pain during exercise training which diminishes but then returns several hours afterwards
  • Thickening around the tendon body, although often mistaken for swelling
  • Episodes of more intense pain with activities such as ascending the stairs, brisk walking, sprinting or  running; high demand activities that require lengthening or a stretch to the tendon.

How physiotherapy can help

Tendon healing usually occurs over a twelve week period, however dependent on the severity and chronicity of the problem, your physiotherapist will be able to determine your length of recovery, following a comprehensive assessment.

For acute, newly diagnosed tendon problems of six weeks or less, rest and moderation of activities is paramount to allow tendon healing. Your physiotherapist will discuss this with you.

For more chronic tendon pain sustained prior to the 6 week period, physiotherapy can help promote tissue healing, reduce pain and begin to strengthen surrounding muscles, employing treatment techniques which promote stretch and flexibility to the tendon.

Achillies tendon pain can also be attributed to the biomechanics of the foot. Should your therapist feel this is a causative factor they will be able to refer you to an orthotist who will undertake a more comprehensive assessment of your foot and gait pattern. Should it be required they can provide custom made insoles (orthotics) to help improve foot posture, reducing force through the tendon.

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Call the Physiotherapy team on 0118 955 3413 or

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