Before we go for a dive, I would like to point out two important notes, first of all, I’ve chose to look at the foot and the ankle combined due to the mutual muscles they share, and the pain factors that are tangled with one another.
Second, the foot and and ankle are the base of our body and one of the more complex systems in it. It withholds many joints, ligaments, muscles and tendons, and it is engaged in most of our daily movements. Baring this fact in mind, it is easier to understand that the tiniest of change in either the location or the structure of that system would create a chain reaction of “dislocated” joints and muscles, in order for the body to bring itself back to an almost neutralized position. Why ‘almost’ you wonder? Well, it can’t be neutral if the base is not set properly, and maintaining this position takes a lot of effort.
Throughout this article, we would go over some of the common injuries relating to the foot and ankle, which would follow by an anatomical examination of the structure supplying another point of view for the injury and offering a solution.
Sprained Ankle
One of the more common injuries people might experience in their life time is an ankle sprain. Can be caused due to high velocity trauma while misplacing a leg, or through slipping a slippery road and having a sharp movement within the ankle. While it is not easily ‘achieved’, having a Sprained Ankle once, raises the risk for having another one in the future.
Let’s go over the structure of the ankle, built out of 2 joints and 4 bones, the Tibia and Fibula support the Talus bone and together they create the true ankle joint that allows the ankle to form a planter and dorsal flexion, underneath that joint you would find the Subtalar joint which consists of the Calcaneus and the lower part of the Talus. To better understand the locations of all the bones, if you look at your ankle you’d see two parts of your bones pointing to and from the body, those are called Malleoli (singular = Malleolus), one pointing toward the other ankle is part of the Tibia, and the other one is part of the Fibula. The Calcaneus is your heel bone, and the Talus is the bone residing between the inner and outer Malleoli and above the Calcaneus.
Bare in mind, just like placing a few branches together would not hold the same position for a long period, bones alone, would not create a steady structure. Along side those bones you can find ligaments connecting the bones together in all direction. These ligaments will allow the joints the movement they require, set the limit of the motion, and ‘glue’ the ankle along so that the joints would remain in a neutral non-harmful position.
A Sprained Ankle can either mean a ligament has a tear in it, or is completely teared in 2, depending on the damage done to the ligament. Sprained Ankles are graded by a certified MD to asses the damage and build up a future plan, since I’m not a certified to do the grading, I would not dig into the matter to avoid confusion. Symptoms for this injury would include swelling, bruising and tenderness while touching the area.
Now, since I bring things from my perspective as both a trainer and a senior massage therapist, I’m letting you know I’ve encountered another case that may be caused the same way a Sprained Ankle is caused, but does not fit the symptoms, for it’s lacking one or two of them. Sometimes when you misplace your step, before the ligaments can receive the damage, the body engages in a strong muscle pull to place the step as it should have been placed and correct the ankle, now this pull of the muscle can cause soreness and initiate a chain reaction that would mimic a pain that can be caused due to lower grade sprain but is non related to the ligaments, and does not have the symptoms, there are quite a few muscles going through the ankle to allow it’s motion and stability, and depending on the motion that caused the pain, the correct muscle can be figured, that in itself is an article and testing required, so I would not examine relating muscles for the Sprained Ankle, but you can ask a certified therapist dealing with those conditions for his/her opinion of the matter.
One other thing, that I’ve personally experienced and encountered with some of my clients, after the pain is gone, and no special treatment was taken, just rest and wait for the pain to leave, there may be some lack in the range of motion of the ankle when comparing left to right, that usually indicates muscle trauma and not necessarily structural change of the joints, so don’t panic that you’ve lost your motion for good, it may be solvable.
Heel Spurs
As was mentioned in the previous section regarding the Sprained Ankle, the heel is a bone called Calcaneus. The heel connects with the rest of the foot through a thick fascia named Plantar Fascia, which originates at the Calcaneus, and goes all the way to each of our toes.
Just like any other organ in our body, bones can either grow and change shape to match a situation or an ongoing state, or they can degenerate and lose their form from lack of use and tension. When inspecting heel spurs, we can see the first example, due to excessive tension of the Plantar Fascia, there is a constant ‘pull’ on the Calcaneus bone, as a reaction, the body would grow a bone spur from the insertion of the fascia to shorten the length it over goes, and try to reduce the tension and pull on the bone. This process takes some time, and does not always relate with pain, but people may describe their heel as if they have a needle, pin or a knife stuck underneath their heel.
It is important to note, undergoing a surgical procedure for this case is not necessarily the only solution, usually it would be a waste of your time and money, and stretching or going to a physical therapy treatment may help in reducing the pain or making it disappear for good. If you payed attention, a heel spur does not relate to pain on most occasions. Relieving the tension from the fascia, would reduce the ‘pull’ on the bone, relax the muscles involved in the stabilization of the foot and reduce the pain.
Now, after understanding the bases of this pathological condition, it’s time to look at another condition that are often referred to as a Heel Spurs but is actually non related and is actually an inflammation caused due to overuse or over tension of the fascia. This condition is Plantar Fasciitis.
Why would Plantar Fasciitis be confused with a Heel Spur? Well, one of the symptoms, is a stabbing feeling near the heel when starting a walk after a period of rest, can be either laying down, standing or sitting. This feeling is a confusing symptom, the pin and knife description of the spur mentioned earlier suits as well. In my experience, the best solution for Plantar Fasciitis is to understand the original cause for the tension on the Plantar Fascia, and perform stretches to reduce the tension and enable the fascia a healing period. The most common reasons, I’ve seen, are:
Continuous tension on the Achilles Tendon, causing the foot to ‘engage’ into a plantar flexion without actually having the muscle perform the motion, which would create a chain reaction of the rest of the muscles to put the foot back into a neutral position, causing them to perform a dorsi flexion of the foot at all times, raising the tension within the foot, causing the Plantar Fascia to overload.
Inspecting the other direction for that matter, we’d look over the Tibialis Anterior muscle which helps in stabilizing the foot and allowing it to lock on certain motions. As with the Achilles Tendon, constant pull from the muscle, would create a counter chain reaction to neutralize the position of the foot.
Also relating to the front chain, we would be able to find the Tibialis Posterior muscle, which has an important role in preserving the arch of our foot, could trigger a chain reaction as well as the Tibialis Anterior muscle.
Understanding the main muscle pulling on the foot, would help better understand the cause, and would supply stretches and strengthening exercises to ease the pain of the Plantar Fasciitis and prevent it from re-occurring in the future.
Achilles Tendinitis
The Achilles tendon is the connection between the calf muscles (Gastrocnemius and Soleus) to the heel, and is the lever used to create a planter flexion. This tendon is the strongest tendon in the body, and can withstand a big amount of force applied on it, however, as any tissue in our body, it has it’s limits and an overuse can cause inflammation or a tear.
This section would discuss an inflammatory condition, the Achilles Tendonitis. Like any other tendonitis, this condition occurs from excessive use of the tendon, without proper stretching or resting periods. The pain would usually be felt at the back of the leg, just above the heel, it would be more sensitive in the morning or after a long rest, and would ease with movements.
Now, the Achilles Tendonitis is not a very complex condition, and would usually require rest and stretching to heal. So why is it included in this article? That’s right, because of the reason I would handle as a manual therapist, the muscles connecting to the tendon, the Gastrocnemius and the Soleus, prior to an inflammation, those muscles might be shortened, or sore, in which state they can mimic the tendonitis pain and symptoms, but on a more upscale anatomical view, when those muscles pull, they create a planter flexion motion of the foot, which would require the body to use strength and activate different muscles to pull the foot back into neutral position.
Pain might not be felt at the back of the leg, where the muscles are pulling but at the front of the leg where the body is using extra strength to pull the foot back. This state of push pull in the body would irritate the tendon and would lead to an overuse and as a result an inflammation. An opposite view of the chart described would suggest that the Achilles Tendonitis could infect be triggered due to a pulling muscle at the front part of the leg, that would create a chain reaction of Achilles pull through the Gastrocnemius and the Soleus.
In cases of which the pain is not a result of tendonitis, a manual therapy to either the Soleus or the Gastrocnemius could ease the pain. Note in the example given that if the pain persists after treatment, it could be a result of a bigger chain of operating muscles, so try a different method of pain reduction in the therapy.
To sum it up, our feet and ankles are a complex part of the body. Always pay attention to when the pain starts, which action was done when it first begun, remembering those details would help in understanding the condition you are in. Also, an important notice, the name of the condition supplied after inspection, is not always as terrifying as it may sound, sometimes the pain is a result of muscle ache that mimic the ache of the condition given. Stay Safe.
The described above, are suggestions for muscles that I think should be examined as well, there are other conditions not discussed in this article, and other chains that can be examined for the conditions discussed. Should you have any questions, feel free to ask