5 1/2 Tips to Beat Bad Ankle Pain

bad ankle
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Too many of us live with daily ankle pain. Usually the factors creating ankle pain are often quite controllable and manageable with the right sports medicine advice.

Both athletes and non-athletes are susceptible to sore ankles, ankle sprains and chronic ankle pain. Controlling the pain and maintaining healthy ankles, feet, toes and calves is not difficult. I’m often asked for tips and suggestions on these body parts by individuals both young and old. Let me share with you the same tips I use on NFL players to help you live a fun and active lifestyle.

1.  Strengthen your Base of Support

Strong arches and toes are key to stabilizing everything above the feet. Any base of support, be it a building or a human body is vital to both stability and function. Simple exercises such as picking up marbles with your toes, barefoot walking/running, toe towel curls and  barefoot balance drills should be done on a daily Basis.

2.  The Right Shoes for Sprained Ankle

Wearing the proper shoe and, more importantly, not wearing the wrong shoe is vital if you want happy “dogs”. Women’s shoes are the best things to happen to pediatrics (foot doctors) because they consistently create ankle, feet and toe pain for women. Spending a little more money on the right shoe is money well spent if an active lifestyle is a priority of you.

3.  Warm-up/Cool Down for Running Ankle Pain

If there’s one thing I’ve learned about my body since I’ve turned 40 is that warming up and cooling down is important. In saying this, I realize it doesn’t require a lot of time to do so. The use of a roller, flexibility exercises, compression sleeves and ice has help me do this quickly and consistently.  Too often ice is not considered an important option for chronic ankle injuries.  That’s a mistake…ice therapy rocks and it should be considered to be one of your best friends!

4.  Embrace your Downward Dog

This could be your most important stretch. Last week I was doing a downward dog stretch in my living room at 4:15 AM when I was startled by the sight of my dog Marshall right next to me also doing a downward dog with me!

My Loyal Dog Marshall

It’s a great stretch that addresses muscle, tendons, joints and fascia from your toes through your arches, over your heels, through your calves, into the back of your knees, throughout your hamstrings, behind your hips and all though your low back…..just to name some of the locations.

5.  Self Traction and Mobilizations

These require more skill or may require the assistance of a friend although they are priceless for maintaining normal ankle mechanics. With the sore ankle at approximately 90° or a “neutral position”, gently pulling on both the heel and the top of the foot together.  This will create a gaping of the ankle from the lower shin. This can be accomplished with the help of an assistant or by placing the foot under a bed or couch to stabilize the foot and ankle.

Another mobilization move which is helpful to maintain the mechanics of a sprained ankle is to gently move or mobilize the lateral ankle bone both directly forward and more importantly directly backwards. This lateral ankle bone or lateral malleolus is a common source of a sore ankle.  Increasing its mobility is one of my favorite tricks to decreasing pain in a chronically sore ankle.

Bonus Tip –  Aggressively Directed Massage

If you really want to loosen up chronically stiff ligaments and muscle, aggressive massage should be included. Once a sore ankle, shin and arch are warmed up, apply a moderately aggressive massage with your thumbs to the locations around your ankle locations noted below.

Focus on the areas on both sides of the Achilles tendon that forms the backside of the ankle joint, the entire edge surfaces of the lateral ankle bone and the front of the ankle joint.  Including the arch and the great toe is always an added bonus. After these areas have been loosened up, it’s important to get all those moving parts active and functional to both normalize range of motion and to re-program the entire leg how to move pain-free.

Taming the Fire of a Painful Heel From Plantar Fasciitis

Understanding a Plantar Fascia Strain

Plantar fasciitis is a painful condition with localized pain in the backside of the arch where it attaches to the underside of the heel bone or calcaneus.  It is often the result of overstretching, overloading or tearing of the origin of the arch, which runs from the heel to the front of the foot under the toes.

This band of tissue stretches every time weight is applied to the foot with standing and walking.  It helps to stabilize and propel the foot forward in movement. Plantar fascia strains can result excessive trauma to the band or the result of culminated effect of repetitive stress placed on arch over time. A plantar fascia strain usually gives rise to sustained inflammation of the front of the heel and back of the arch.  This results in excessive pain in this location, especially after prolonged non-weight bearing inactivity such as sleeping and sitting.  This is based on the simple fact that the band tightens when you don’t move it. If left untreated, a plantar fascia strain can become a chronic and troubling ailment.

Causes: The most common cause of plantar fasciitis is doing too much running, walking and/or jumping in poor footwear. Also, beginners attempting to go overboard in their chosen physical activities are likely to stretch the band too much the first time.   Additional predisposing factors include obesity, rapid weight gain, flat feet, and excessive exercise with insufficient progression.  With some chronic arch pain conditions, as the band of tissue continues to pull on the heel bone, it can result in a heel bone spur.

Signs & Symptoms of Heel Pain From Plantar Fasciitis

  • Perception of burning, stabbing, or dull aching pain at the front of the heel and along the band of tissue in the backside of the arch.
  • Difficulty bearing weight on the foot without shoes.
  • Arch pain with heel raises and with flat foot squatting.
  • Localized swelling and tenderness under the heel and arch.

Professional Treatment for Plantar Fasciitis

Plantar fascia strains usually respond well to conservative treatment methods. However, recovery times do vary from individual to individual.

  • Rest in the form of avoiding weight-bearing will help improve heel pain.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Repetitive icing with the arch and toe flexor tendons in a stretched position will reduce inflammation and pain while helping to elongate the sore plantar fascia tendon.
  • Proper footwear for your sports.
  • Taping the foot will assist in supporting of the arch, to reduce inflammation and decrease the risk of further injury.
  • Progressively aggressive transverse friction massage to the posterior arch along with a moderate massage for the ankle and lower shin.
  • Strengthening and stretching exercises for the arch and calf muscles will help a painful heel.
  • Arch support inserts can be helpful.
  • Arch taping, if done properly, can effectively support the arch and reduce the amount of heel pain with weight-bearing.
  • Minimize weight-bearing activities.
  • Weight loss, if overweight or obese.

Asking the Right Questions like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

1)   Does this heel pain have anything to do with my pelvis, lower extremity or foot alignment?

2)   What forms of physical therapy do I need to do to quickly resolve this injury so I can get back to my sport(s) pain-free?

3)   What are my options besides surgery?

4)   Are there any long-term complications from a sprain?

5)   Will I benefit from the use of anti-inflammatory medicine?

6)   Is this painful heel a result of some other biomechanical abnormality that needs to be addressed?

Elite Sports Medicine Tips from Mike Ryan

  • Fast Treatment/Fast Recovery: The sooner you address plantar fascia sprains the quicker they resolve.  Don’t let it become chronic.
  • Minimize Newton’s Laws: Aggressive weight-bearing activities will prolong the time for recovery and increase the risk of long-term complications.
  • Template for Post-Workout Therapy:Immediately after all of your workouts or treatments do the following:
    • Elevate your foot for 3 minutes.
    • Stretch for 5 minutes
    • Ice the arch and heel for 7 minutes.
  • Stretch: Aggressive stretches for the calves, arches, big toe and toe flexor tendons will go a long way in maintaining healthy tissue involving the entire foot.
  • Eat and Drink Right: It’s easier and safer to control inflammation and promote healing by being well hydrated and with a healthy diet compared to taking all sorts of pain pills.

How To Eliminate Heel Pain

In order to eliminate heel pain, we have to know what causes heel pain? Although the term heel pain is somewhat general, if you suffer from the condition you can testify to the significance of the injury.  The source of the pain in the arch area on the underside of the foot can vary.

Heel pain can be due to a trauma such as forcefully striking the heel on a hard surface or it may be an overuse injury, such as plantar fasciitis.

The calcaneus bone, or heel bone, has a thick layer of fat and protective fascia on its underside to provide padding as it makes contact with the ground.  Excessive forces or repetitive pounding of the heel can cause the fat pad to move or become inflamed.  When the protective layer under the heel bone decreases in efficiency like this, heel pain and burning feet can result.

Common Sources of Heel Pain:

  • Plantar Fasciitis – A common source of arch pain, this inflammatory process involves the plantar fascia, which enters into the back of the arch.
  • Heel Bone Spur – This occurs when excessive bone forms under the calcaneus(heel).
  • Heel Contusion – Known as a bruising of the heel bone.
  • Calcaneal Stress Fracture – This is a preliminary or significant fracture of the calcaneus bone.
  • Tarsal tunnel syndrome – This happens when the nerves encroach the back of the foot and arch.
  • Calcaneal bursitis – Is inflammation of the sack of fluid which sits under the heel
  • An increased warmth and possible swelling of the underside of the heel bone.
  • Arch pain originating on the heel and possibly extending into the underside of the foot towards the toes.
  • Posterior heel pain with weight bearing on the foot, which may worsen with active toe flexion.

Signs & Symptoms

  • Tenderness anywhere associated with the surface of the heel bone.
  • An increased warmth and possible swelling of the underside of the heel bone.
  • Arch pain originating on the heel and possibly extending into the underside of the foot towards the toes.
  • Posterior heel pain with weight bearing on the foot, which may worsen with active toe flexion.

Professional Treatment for Heel Pain

  • Icing the entire heel bone with an ice bag, ice massage or, ideally, with an ice bucket.
  • Rest the area to minimize the pressure on the calcaneus.
  • Easy massage of the arch and toes.
  • Modify the shoes to increase the padding encompassing the heel bone to provide greater shock absorption.
  • Increased calf stretching to allow greater pain-free movement of the ankle joint.
  • Consider utilizing orthotics or arch supports, depending upon your lower extremity anatomical alignment and biomechanics.
  • Heel bone spur symptoms can be improved with treatment noted above and it may require surgery.

 

Receive The Best Care By Asking The Best Questions

To ensure you receive the best possible care for your injured foot, ask questions like a smart professional athlete who wants to safely return to his/her sport as quickly as possible.  Here’s what a pro athlete would ask his sports medicine specialist:

  1. Are you certain of the diagnosis?
  2. Do I need an x-ray to determine the extent of this injury?
  3. What are my options with treating this injury?
  4. What can I expect with this injury for the next 2, 4 and 6 weeks?
  5. Who do you consider to be the expert heel pain rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Tips to Quickly Recover from Heel Pain

  • Start Treatment Fast – Arch pain and heel pain are not injuries to ignore.  Start the treatment fast and this injury can usually be resolved quickly with minimal downtime.
  • Sole Searching – The shoes are typically the source of your problem.  Old shoes, improper shoes and worn shoe soles are common factors that lead to arch pain and burning feet.
  • Ice is Your Friend – It’s a reality check:  Ice hurts but it’s exactly what you need for this injury.  The Pro’s will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.
  • What to Expect – The recovery time for heel pain is typically minimal.  As long as there is no stress fracture, large bone spur or significant plantar fasciitis, the downtime for this injury can range from a couple of days to a few weeks.  Treat it early to determine the source(s) of the problem, correct it and you’ll be back in the game before anyone knew that you were icing your heel!