Curezone Physiotherapy, Mississauga is a team of providers providing treatments in various musculoskeletal Injuries, Spinal Injuries, Vestibular, Concussion, Post operative Rehabilitation, Pelvic health conditions and Sport injuries including Foot and ankle Physiotherapy.
Each foot has 26 bones, 30 joints and many muscles, ligaments and tendons that work to provide stability, reinforcement, mobility, balance and weight bearing properties. The bones of the foot include the Talus which forms a joint with the two bones of the lower leg; Fibula and Tibia. The Calcaneus the largest bone of the foot or better known as the heel of the foot which lies just beneath the talus bone. The Tarsals are 5 irregularly shaped bones the for the arch of the foot these bones include; the Cuboid, Navicular and Medial, Intermediate, Lateral Cuneiforms. The Metatarsals are 5 bones labelled numerically starting from the big toe. The Phalanges are 14 bones that make up the toes the big toe or the 1st metatarsal only has two phalanges the distal (further from body) and proximal (closer to body). The others all have three Phalanges with the inclusion of the Intermediate Phalange which is in between the distal and proximal phalange. The last bones are the Sesamoids these are two small bones on the plantar surface of the foot that lie beneath the head of the 1st metatarsal or the ball of the foot.
Joints Muscles
The main muscles of the foot are the Tibialis Posterior which helps support the arch of the foot, the Tibialis Anterior which allows for dorsiflexion of the foot. The Peroneal Muscles which are located on the lateral side of the ankle that allow for movement on the outside ankle. Extensor muscles which help raise the toes so we can move forward. Finally, the Flexors which help stabilize the toes.
Tendons and Ligaments
The tendons attach the muscles to bones and the ligaments hold the bones together to maintain the foots arch. The Achilles tendon which runs from the Gastrocnemius to the Calcaneus. This tendon allows us to run, jump, stand on toes and climb up stairs. There are three other important ligaments of the foot these are the Plantar Fascia which runs from the sole of the foot at the heel to the toes by stretching and contracting this ligament it helps us balance and gives strength to walk. The Plantar Calcaneonavicular Ligament is found in the sole of the foot that connects the calcaneus to the navicular bone that supports the head of the talus. This is otherwise known as the “Spring” Ligament of the foot because it restrains the medial longitudinal arch from falling or collapsing into a flat foot. The Calcaneocuboid Ligament connects the calcaneus and the cuboid bones together and helps the plantar fascia to support the arch of the foot.
Common Injuries of the Foot
Achilles Tendon Tears
This is commonly known as Achilles Tendonitis and it is inflammation due to the overuse and repetitious movements of the foot. If you are diagnosed with Achilles Tendonitis it is possible that you can suffer from a tear or a full rupture. This injury could also occur from sudden trauma to the tendon. If you report to the physiotherapist that you heard a snapping or popping sound after landing from a jump or taking off to begin sprinting or running the Achilles tendon may have ruptured. To successfully diagnose if there is an Achilles tendon rupture or tear an MRI can be ordered. The symptoms a patient would normally feel with this type of tear is redness, severe pain, swelling, tissue damage, altered muscle function possibility of chronic symptoms and pain interfering with your active daily living activities like walking.
Ankle Sprains
High Ankle Sprain – The ligaments effected are just above the ankle joint which is the distal tibiofibular joint and this forms the syndesmosis. This syndesmosis is meant to absorb shock when we take steps, bear weight, run or change direction when running.
– Causes – Inversion of the Ankle coupled with Dorsiflexion to the syndesmosis structure usually from sudden twisting, cutting or turning motions while jumping, running or sprinting and commonly occurs in athletes that play soccer, football and basketball. There isn’t a brace to prevent a high ankle sprain from occurring however to avoid this sprain training for flexibility and strength as well as incorporating stretching exercises can reduce the risk of high ankle sprains.
– Symptoms – Pain radiating from ankle up the leg, pain while stepping, depending on how you injured the ankle movements that shorten the ligaments or lengthen the ligaments will cause pain and there are no signs of bruising or swelling and sometimes it is possible that you may not know how severely you injured yourself.
– Treatment – Pressure, Ice Elevate, Rest (PIER Principle).
Ankle Sprains (Lateral and Medial) – A lateral ankle sprain occurs when you invert the ankle coupled with plantarflexion. The ligaments that are affected are the Anterior Talofibular ligament, Posterior Talofibular ligament and Calcaneofibular ligament. A medial ankle sprain is when you evert the ankle coupled with dorsiflexion the ligament affected is the Deltoid ligament.
– Signs and Symptoms – Instability, Pain with walking, Swelling, and Discolouration
– Treatment – Keep ankle joint in a neutral position to shorten ligaments, P.I.E.R Principle, Crutches and strengthen Peroneal Muscles.
Shin Splints
Any pain to the anterior shin this is clinically known as Medial Tibial Stress Syndrome can be diagnosed as Periostitis, Tendonitis or a stress fracture as Shin Splints is a very common and broad term to describe this pain. It occurs in athletes that are running, jumping or marching on hard surfaces, even changes in training and wearing different footwear.
– Signs and Symptoms – Anterior pain, pain when palpating the tibial crest, pain with resisted dorsiflexion and inversion
– Treatment/Prevention – PIER, Rest, Warmup increasing the extensibility of area, Support medial longitudinal arch, wear proper footwear, strengthen the tibialis anterior and posterior.
Anterior Compartment Syndrome
– Symptoms – Tightness in the anterior compartment of the lower leg due to swelling, infection or hypertrophy. It can compress the tibial artery which can lead to necrosis. There is a pain that is not going away, red, hot, shiny skin.
– Treatment – Acute: Medical Emergency, Chronic: Manage is Ice, Elevation and Rest and gastrocnemius and soleus stretching. Do not put pressure because the tibial artery is already under a lot of pressure and it will lead to necrosis which is cell death. Further treatment includes surgical removal of the anterior fascia to release pressure only in acute cases.
Turf Toe
Sprain of the plantar capsule of the 1st Metatarsal Phalangeal Joint. The way this occurs is coming to an abrupt stop and the toe is forced against the shoe which hyperextends the ligament and joint spraining it.
– Signs and Symptoms – Swelling of the metatarsal phalangeal joint and distal phalanx on the plantar aspect, pain with running and decreased ROM
– Treatment – PIER, out of play for 1-3 weeks and healing time is 3-6 months
Plantar fasciitis
Plantar fasciitis is an inflammation in the connective tissue on the bottom of your foot. This can occur from aggravated overuse, such as constant standing, improper posture, or footwear that lacks proper arch support.
