5 1/2 Tips to Beat Bad Ankle Pain

bad ankle
Source: Pixabay

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.

Foot Orthotics – Are They Worth the $?

I’m often asked about orthotics and the questions usually involve two basic issues:

     1.  Do orthotics really work?

     2. Why are orthotics so expensive?

I find it ironic that most people asking these questions own orthotics.  If they are wearing orthotics and they have to ask if they work, it must mean the orthotics are not doing their job.  No one seems to ask such questions about contact lenses or glasses.  If they’re wearing contacts and they question their effectiveness, the contacts probably aren’t the right lenses for that person.

Orthotics are no different.

As for the price, in many cases I think orthotics are grossly over-priced.  Sure there is tons of science and detail installed into a properly fitted pair of orthotics but there is little reason why someone needs to charged $600 for any shoe insert that isn’t covered in gold and diamonds!

I’m a fan of orthotics if fitted properly….for the right reasons and for the right price.  Approximately 40% of my athletes presently wear orthotics.  I owe a great deal of my knowledge about the lower kinetic chain and orthotics to David Tiberio, professor and friend from one of my alma maters, the University of Connecticut.  He’s a brilliant physical therapist and I appreciate him sharing his amazing insight with me over the past 25+ years.

What is an orthotic?

An orthotic is a specifically designed shoe insert which is custom-made to correct a biomechanical abnormality by correcting the poor alignment and enhancing the body’s ability to move.

How Do Orthotics Work?

As I tell my pro football players: “Orthotics bring the ground up to the foot.”  The foot is the base of support of the entire body and it starts the movement pattern when the foot is in contact with the ground during standing, walking or running.

If you were to put a smaller wheel on the front left side of your car, the car will still be driveable and get you to where you want to go.  It will be slower, it will be harder to drive, other parts of the car will be stressed more, the other tires will wear-out faster and the appearance of your car will change.  Poor foot alignment is no different.

To get that car alignment corrected without changing the tire, it can be done two ways.  1.  The car can be driven without the front left tire ever touching the road – not likely to happen or  2. The road can be brought up to the tire as if that tire was now riding on the curb.  This is a simple example of how an orthotic functions.

The Benefits of Orthotics

There are many reasons why orthotics are used.  Those reasons include leg length discrepancy, plantar fasciitis, heel pain, ankle sprains, tendonitis, arch pain, shin splints, foot pain, stress fractures, low back pain, muscle pain/injury, neuromas, bursitis, and sciatica. The influence of an orthotic, as with the base of support of any structure, can reach from the bottom to the top of that structure.

There is much discussion related to the best manner to create the orthotic and it goes well beyond the scope of this sports medicine blog posting.  Weight bearing status, casting, laser, standing, sitting, laying prone, hard orthotics, half-length, orthotic material, where to stabilize the arch,…etc. are just some of the factors related to orthotics.

The Truth About “Perfect Alignment”

The mechanics of the human body are amazing and a big reason why I love doing what I do as an athletic trainer and physical therapist in the NFL.  Every joint in the body has a three-dimensional movement pattern.  Unlike the hinges on your door that moves in only one plane of motion, the human body joints have what is called accessory movements.  These are subtle movements of a joint are necessary for full range of motions to occur.

I like to restore “proper alignment” because there is no such thing as “perfect alignment”.  This normal three-dimensional movement means that an orthotic must bring the ground up to the foot to allow for this normal movement pattern to happen naturally.  In other words, orthotics allow the body to do its job by moving naturally without pain.

I tell my players that the only time they will have bilateral symmetry on the football field is during the National Anthem.  It’s true.  Think about it: the field is never level and they are always changing direction throughout the game.

The A Factor

As for the athletes (A) themselves, one leg is usually longer than the other, injuries change joint motions over the years, flexibilities vary from side to side, the wear pattern of the shoe alters the mechanics of the foot, muscle weakness alters the running sequence and their joint laxity/arthritis changes how that athlete moves.

In other words, the athlete himself isn’t moving the same on both sides of the body.  With this being said, the theory of an orthotic is to help balance the manner in which an athlete moves on both sides of their body.

Back to Orthotics….

Now that we got all the kinesiology and body mechanics out-of-the-way, let’s get back to the orthotics themselves.  I emphasize to my athletes that a properly fitted pair of orthotics should fit like your favorite pair of blue jeans.  They “just fit right”.  No two pair of favorite jeans are the same.  The same is true for orthotics.  A well-fitted orthotic should have no hot spots, no pressure points, no uneasy feeling when they are worn and the athlete should almost forget that they are there.

Think about it this way:  if your orthotics are doing their job properly, the foot and the entire body above it is positioned to do its job.  Those previously noted movements can now happen with ease.  It’s like tucking that napkin under the leg of the wobbly table.  Now the table is both level and stable to do its job of being a table.

Getting the proper orthotic to meet your needs is the key.  The most important factor related to the orthotic is what YOU, the athlete, feel and think.  Speak up and give your medical team the necessary feedback to adjust your orthotics so they “just fit right”.  Don’t forget that it’s your feet and your money!

 

Metatarsalgia: Foot Pain’s Evil Brother

Metatarsalgia is a general term relating to forefoot pain secondary to inflammation in the area of the distal foot and toes.

Metatarsalgia: Foot Pain’s Evil Brother

Metatarsalgia is a general term relating to forefoot pain, secondary to inflammation in the distal foot and toe area.  Joints that connect metatarsal foot and toe bones become swollen, and the second, third, and fourth MTP joints are most often affected.  Additionally, Metatarsalgia is commonly found within the second, third, and fourth joints between the toes.

Morton’s Neuroma is a similar condition that presents with forefoot pain.  Unlike Metatarsalgia, Morton’s Neuroma pain is located between the distal metatarsal bones as opposed to within the forefoot and toe joints themselves.

Morton’s Neuroma is caused by pinched nerves located between the second, third, and fourth metatarsal bones, resulting in nerve inflammation.

Pain in the ball of the foot is not typically linked to either of these conditions, although it is not surprising to develop this symptom by compensating for lower extremity dysfunction.

Signs and Symptoms of Metatarsalgia

  • Forefoot and toe pain that increases with weight-bearing activities
  • Symptoms that worsen when wearing tight-fitting shoes or high heels
  • Point tenderness pain in the distal foot area and proximal toes
  • An excessive pattern of blisters, calluses and wear and tear in the forefoot and toes
  • Increased pain from passive toe bending and rotating
  • Pain in the ball of the foot (related to compensation mechanics that sometimes present with chronic foot pain)
  • A contributing factor of long-term abnormal toe alignment, such as claw toes or bunions 
  • Excessive skin or calluses underneath the foot due to excess pressure

Signs and Symptoms of Morton’s Neuroma

  • Localized pain between the third and fourth distal metatarsal bones and toes
  • An increase in weight-bearing symptoms, such as feeling as if you are  “standing on pebbles”
  • Increased pain with weight-bearing activities
  • Sharp pain, burning, numbness and/or tingling in the distal foot and toes
  • Increased symptoms between the metatarsal bones when squeezing the forefoot
  • Excessive callus and wear patterns under the distal forefoot and great toe
  • Pain in the ball of the foot (related to compensation mechanics that sometimes present with chronic foot pain)

Treatment for Metatarsalgia and Morton’s Neuroma

  • Aggressively ice the arch, foot and toes with ice bags, ice massage or (ideally) an ice bucket, for 10 to 15 minutes.
  • Wear the proper footwear for specific activities.
  • Minimize weight-bearing activities.
  • Massage and apply soft-tissue treatments to the arch, great toe, ankle joint and calf.
  • Perform a biomechanical evaluation to assess contributing factors such as a leg length discrepancy, hyper pronation/supination, tight ankles, restricted toe extensor tendons, hypomobile toes, or knee, hip or low back conditions.
  • Stretch your calves on a consistent basis.
  • Wear orthotics, ideally with a rigid steel insert, when experiencing pain in the ball of the foot.

Questions a Pro Athlete Would Ask

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to their beloved game or sport:

1. Are you concerned that I may have a stress fracture in my foot or toes?

2. Could my foot symptoms be related to nerves in my back or leg?

3. Will orthotics help, and if so, where can I find them at a reasonable price?

4. If faced with this same problem, where would you go for therapy?

Sports Medicine Tips

If the Shoe Doesn’t Fit, Don’t Wear It – It’s a fact that women’s shoe designs help keep foot doctors in business.  They may look sexy and stylish but are absolute killers for the health of your feet.  Ladies (and gentlemen) – rid your closet of any ill-fitting shoes ASAP!

Do Some Sole Searching – Assess the overall health of your shoes in addition to your feet. Wearing old, “expired” shoes with worn soles is a common factor that leads to foot and arch pain.

(Yet Another) Test with a #2 Pencil – Using the eraser end, apply pressure between the metatarsal bones of the foot to help pinpoint the location of the pain and lead to a diagnosis.

Ice is Your Friend – I’m sorry, but it’s true – the bitter chill of ice is necessary to treat this injury.  The pros will tell you that ice is their best teammate.  Stop complaining and stock your freezer accordingly!

Turf Toe Management

Turf toe is an injury with a short name but a long history of pain in the NFL. With large men rapidly changing directions on varying surfaces, the forces originating at the ground level are extremely high. Simply stated, every football player move that you see on your plasma screen during Sunday’s game start at the foot and big toe.

Turf Toe Caused By Hyperextension

Turf toe is an injury with a short name but a long history of pain in the NFL.  With large men rapidly changing directions on varying surfaces, the forces originating at the ground level are extremely high.  Simply stated, every football player move that you see on your plasma screen during Sunday’s game start at the foot and big toe.

Turf toe is the medical term related to a sprain of that 1st metatarsophalangeal (MTP) joint or, as it is commonly referred to as, the “big toe”. The name turf toe originated in the mid-1970’s when certified athletic trainers and physicians reported an increase in 1st MTP joint injuries with a large number of games being played on artificial turf.  The combination of harder playing surfaces, increased shoe traction and lighter less rigid shoes proved to be the main contributing factors to injuries related to the big toe.

Big toe pain originates at the 1st metatarsophalangeal (MTP) joint and usually includes surrounding soft tissue.  The most common mechanism of injury is joint compression with hyperextension of the 1st MTP joint.  In reality, turf toe can occur with any combination of compression with excessive extension, flexion, rotation, adduction (moving away from the 2nd toe) or abduction (moving towards from the 2nd toe) of the 1st MTP joint.

An example of this injury in football is when a player lands on the back of another player’s ankle while athlete’s big toe is planted in the ground and extended.  With the extra weight applying pressure into the arch and the player’s inability to unload the front of the foot, the 1st MTP joint is forcefully hyperextended and the joint surfaces are compressed.  It’s easy to see how this mechanism of injury can create considerable damage to the joint itself and all the structures on the plantar (undersurface) of the distal arch and big toe.

With the example noted above, the muscles that flex or bend the 1st MTP joint can be stretched or torn.  The capsule that surrounds the joint is vulnerable along with the ligaments and plantar plate complex, which is the stabilizing structure on the underside of the big toe.

Lastly, the two small sesamoid bones that rest under the 1st MTP joint, or “ball of the foot”, are potential sources of pain with turf toe and any injury that affect this area of the distal arch.  With direct trauma or hyperextension of the big toe, the sesamoids can become inflamed or fracture.

Signs & Symptoms of Big Toe Pain

  • A sudden or slow onset of pain anywhere encompassing the base of the big toe.
  • With an abnormal motion of the 1st MTP joint, a “pop” or a “shifting” sensation is noted.
  • Point tenderness and swelling at the base of the big toe.
  • Passive and active movements of the toe upward (extension) are painful and the amount of motion is significantly limited when compared to the other foot.
  • When moving the big toe into the direction of the injury, the symptoms increase and the strength in that position is significantly reduced.
  • Pressure while weight bearing, twisting and pushing off the front of the foot will increase symptoms in the big toe.

Treating Turf Toe Pain

  • Icing, elevate and rest the foot is the best start to controlling the swelling and pain.
  • Icing techniques include a 15 minute ice bag (good), a 10 minute ice massage (better) or the Granddaddy of them all, the 12 minute ice bucket (the best).
  • Walking boots are valuable tools in the NFL and a wonderful ways to protect the toes, forefoot and ankles while allowing an athlete to walk.
  • When you’re able to comfortably wear a shoe, utilizing a steel shoe insert or rigid orthotic in all of your shoes will stabilize the forefoot and minimize extension at the big toe.
  • Avoid barefoot walking or any activities in flimsy and unsupported shoes.
  • Massage of the arch, gentle painfree range of motion (ROM) of the toes, stretching of the ankles and calves will enable better blood flow to the injured tissue while maximizing the drainage from the areas with excess swelling.
  • When the warmth in the joint has subsided and at least 75% of your painfree motion had returned, picking up marbles/rocks/peanuts with your toes will increase the strength and mobility of your toes.
  • Towel curls, to be started with the same criteria as the marbles, will effectively strengthen your arches and intrinsic muscles of your forefoot.

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. Do I have turf toe and exactly what structures did I damage with my injury?
  2. Do I need an x-ray, MRI or CT Scan to determine the extent of my injury?
  3. Will orthotics help me and if so, where do you suggest that I purchase them at a reasonable price?
  4. Did my shoe wear contribute to my injury and if so, what changes do you suggest?
  5. Are my non-athletic shoes contributing to my problem?
  6. Do you think that I need surgery on this injury now or in the future?

Elite Sports Medicine Tips from Mike Ryan

  • Swelling Control – Your toes are located at the end of very long network of blood vessels, which are assisted by both contracting blood vessels and gravity.  Help control your swelling by minimizing your standing time, maximizing your elevation time, aggressive icing, wearing stiff shoes and being consistent with your physical therapy.
  • Gout? – I have pro football players fight me on this every year.  Sometimes Gout really is the source of the pain if the mechanism “just doesn’t fit”.  If your unsure, check with your doctor because Gout is more common than you think.  “If the Gout shoe fits, wear it.”
  • Joint Surface Status – Degenerative joint disease (DJD) in the big toe is common with high level “stop and go” athletes as are…(are you ready for this?)….women who commonly wear crowded, pointed-toed high heeled shoes. If your toe angles are changing and your toe ROM is decreasing, your joint surface is probably less then ideal.
  • Don’t Forget About Your Calves – Ankle ROM is an important factor related to toe pain.  Keeping your calves loose and limber will help.  Massage and stretching of the calves will immediately increase ankle ROM and decrease the need for excessive 1st MTP extension.  Flexible calves and loose ankle can reduce your turf toe pain by 25%!
  • Little Piggy’s #2, 3, 4 & 5 – Don’t forget about the little guys in the neighborhood.  Your other toes need to be stretched and cared for as well.  I see many bad looking toes and toenails in my business and I can tell you that your foot will function allot better with all five Little Piggy’s doing their part.

How To Eliminate Heel Pain

How To Eliminate Heel Pain

In order to eliminate heel pain, it is important to understand its underlying cause(s). Although the term “heel pain” is somewhat generic, you can testify to its significance if you suffer from this condition.  Sources of the pain, which is located in the arch area on the underside of the foot, can vary.

Heel pain may be caused by trauma such as a forceful strike of the heel against a hard surface, but an overuse injury such as plantar fasciitis is also a potential culprit.

The underside of the heel, or calcaneus, bone has a thick layer of fat and protective fascia that provides padding as the heel makes contact with the ground.  Excessive forces or repetitive pounding can cause this fat pad to move or become inflamed.  When the protective layer under the heel bone loses efficiency in this manner, heel pain and burning feet are painful side effects.

Common Sources of Heel Pain

  • Plantar Fasciitis – A common source of arch pain, this inflammatory condition involves the plantar fascia in the back of the arch.
  • Heel Bone Spur – This problem occurs when excessive bone forms underneath the calcaneus (heel).
  • Heel Contusion – Simply put, this is a bruised heel bone.
  • Calcaneal Stress Fracture – This represents either a preliminary or significant fracture of the calcaneus bone.
  • Tarsal Tunnel Syndrome – This painful condition occurs when nerves encroach upon the back of the foot and arch.
  • Calcaneal Bursitis – This manifests itself as inflammation that occurs within the sack of fluid that sits under the heel.

Heel Pain Signs & Symptoms

  • Tenderness associated with the surface of the heel bone
  • Increased warmth and potential swelling of the underside of the heel bone
  • Arch pain that originates on the heel and can extend into the underside of the foot, towards the toes
  • Posterior heel pain trigged by bearing weight on the foot, which may worsen with active toe flexion

Professional Treatment for Heel Pain

  • Ice the entire heel bone with an ice bag, ice massage or, ideally, with an ice bucket.
  • Rest the area to minimize pressure on the calcaneus.
  • Gently massage the arch and toes.
  • Wear appropriate shoes that bolster padding for the heel bone and help absorb shocks.
  • Stretch the calf to foster pain-free movement of the ankle joint.
  • Consider utilizing orthotics or arch supports, depending on the anatomical alignment and biomechanics of your lower extremities.

The treatments noted above may improve heel bone spur symptoms and help avoid surgery.

Ask The Best Questions to Receive the Best Care

To ensure you receive the best possible care for your injured foot, ask questions like smart professional athletes would as they seek a quick, safe return to the sport they love. Specifically, here’s what a pro athlete would ask his or her sports medicine specialist:

1. Are you 100% certain of the diagnosis provided?

2. Do I need an X-ray to determine the extent of this injury?

3. What are my injury treatment options?

4. What can I expect when dealing with this injury over the next 2-6 weeks?

5. Can you recommend any expert heel pain rehab specialists in this area?

6. Will you provide me and my therapist with a detailed protocol to direct my rehab regimen?

Tips for a Speedy Recovery

  • Act Fast – Arch pain and heel pain are not injuries to ignore.  By prioritizing treatment, it is possible to resolve this injury quickly with minimal downtime.
  • Do Some Sole Searching – Shoes are typically the source of the problem.  Old, improper shoes and worn shoe soles are common factors that lead to arch pain and burning feet.
  • Remember That Ice is Your Friend – Yes, it’s a reality check:  Ice hurts, but it’s exactly what you need for this injury.  Professional athletes will tell you that ice is their best teammate.  Stop complaining and do what is needed….ICE, and lots of it.
  • Know What to Expect – Heel pain typically dictates minimal recovery time.  Provided there is no stress fracture, large bone spur or significant plantar fasciitis, the downtime required for this injury can range from a couple of days to a few weeks.  Quickly determine the source(s) of the problem and seek the appropriate treatment, and you’ll be back in the game before anyone even knew you were cooling your heels!