There are many conditions that can affect the ankle or hindfoot. Sometimes these are tendon problems but can also include ligaments, joints and other soft tissue structures.
ANKLE SPRAINS
Sprains of the foot can be the result of direct injuries or from the shape or posture of the foot and lower leg. These injuries can, if not correctly assessed and managed, lead to chronic problems such as arthritis to the ankle joint.
Classification of Ankle Sprains
- Grade 1: Mild sprain with full healing.
- Grade 2: Partial tear; may result in ankle looseness.
- Grade 3: Complete tear, often with additional damage to cartilage, tendons, or secondary ligaments.
Management of Chronic Ankle Instability
For persistent issues with ankle instability after Grade 2 or 3 sprains, physiotherapy is usually prescribed. This includes:
- Reducing inflammation
- Strengthening the peroneal muscles
- Performing wobble-board exercises to improve proprioception
If physiotherapy is ineffective, further investigation, including stress X-rays or MRI scans, may be necessary to confirm instability and rule out other issues. Treatment options include using a lightweight brace or undergoing surgery.
Achilles Tendonitis
Achilles tendon injuries are a common foot problem. It usually causes pain, stiffness and swelling near where the tendon inserts into the heel. It can start slowly, and develop over a period of time.
Non-Surgical Management
Achilles tendon injuries are common and cause pain, stiffness, and swelling near the heel. The condition can develop gradually due to various factors, including:
- Overuse, especially in runners
- Inappropriate footwear
- Poor running technique
- Lower limb biomechanics
- Genetics
It is also more common in patients with high blood pressure, high cholesterol, or diabetes. Rarely, it can be triggered by antibiotics like ciprofloxacin and ofloxacin.
Four common causes of pain near the back of the heel are:
- Paratenosynovitis: Inflammation of the sheath around the tendon.
- Non-insertional Achilles tendonitis: Pathology located 2-6cm above the heel bone.
- Insertional Achilles tendonitis: Pathology at the insertion point of the tendon, sometimes involving bursitis.
- Achilles tendon rupture: Often 2-6cm from the heel, can be mistaken for tendonitis.
Achilles tendonitis is often linked to increased activity levels, improper footwear, and microtearing of the tendon. Despite the pain, the tendon usually remains intact.
Treatment Options
Most cases are treated non-surgically, involving:
- Activity Modification: Avoid high-impact activities until symptoms resolve.
- Shoe Wear Modification: Use well-fitted comfort shoes, possibly with a heel lift to reduce tendon load. Avoid “negative heel” shoes.
- Medications: Short-term use of anti-inflammatories to reduce pain and discomfort.
- Calf and Achilles Stretching: Regular stretching to reduce tendon strain.
- Double Leg Heel Rises: Strengthening exercises done on the edge of stairs to improve tendon strength and flexibility.
- Eccentric Achilles Tendon Exercises: Heel drops performed slowly to strengthen and stretch the tendon. Start with both legs, progressing to one leg, and vary knee position.
Advanced Treatments
- PRP Injections: Plasma-rich protein injections from the patient’s blood may stimulate healing, though evidence of their effectiveness is limited.
By adhering to these treatment strategies, most patients can manage their Achilles tendonitis effectively without surgery.
