LOWER LEG & ANKLE
Sardelli Orthopaedics provides top-of-the-line orthopedic care for all kinds of muscle, bone, and joint conditions, including those of the lower leg and ankle. With specialized expertise and leading-edge technology, Sardelli Orthopaedics can help you return to your active lifestyle after an injury or surgery.
Sardelli Orthopaedics provides orthopedic services to the southeast Michigan area including Burton, Clarkston, Davisburg, Davison, Fenton, Flint, Grand Blanc, Independence Twp., Lake Orion, Lapeer, Oxford, Waterford, White Lake, and other communities. Contact us to schedule an appointment.
Achilles Tendon Injuries
The Achilles tendons are thick and powerful bands of fibrous tissue. They connect your calf muscles to your heel bones. The tendons help you walk, run and jump. And that means they are under a lot of stress, making injuries to the Achilles tendons common.
Ligaments are fibrous, elastic bands of tissue that connect and stabilize the bones. An ankle sprain is a common, painful injury that occurs when one or more of the ankle ligaments is stretched beyond the normal range of motion. Sprains can occur as a result of sudden twisting, turning or rolling movements.
What Is an Ankle Sprain?
A sprain is a stretch injury of the ligaments that support the ankle. About 25,000 ankle sprains occur in the United States every day. The ligaments on the outside of the ankle are the most commonly injured when the foot is turned inward (inverted).
What Are the Symptoms of an Ankle Sprain?
The ankle is tender and swollen on the outside, below, and just in front of the ankle bone. Typically, the bone is not as tender at the area above and in front of it. A sprain may be mild, causing only modest pain, or severe enough to prevent weightbearing.
What Should I Do If I Sprain My Ankle?
Initial care is the same as for all other acute injuries: RICE (Rest, Ice, Compression, and Elevation). Use ice for 20 to 30 minutes each hour. Do not put the ice directly on the skin because it can cause frostbite. Wrap the ice in a wet towel or cloth to protect the skin. See a physician if you are unable to bear weight or if the ankle fails to improve within several days.
How Should I Rehabilitate My Ankle?
Rehabilitation can begin a few days after the injury, when the swelling starts to go down. There are three goals to aim for in rehabilitation
Restore motion and flexibility. Gently move the ankle up and down. After 5 to 7 days, start restoring motion to the hindfoot by turning the heel in and out. You should also begin to restore flexibility to the calf muscles. One way to do this is to face a wall with one foot in front of the other and lean forward with your hands on the wall, bend the front leg while keeping the back leg straight and both heels on the floor. Lean forward until you feel a gentle stretch, and hold for 10 seconds. Switch legs and repeat.
Restore strength. After 60 to 70 percent of the ankle’s normal motion has returned, you can begin strengthening exercises using a rubber tube for resistance. Fix one end of the tube to an immovable object like a table leg, and loop the other end around the forefoot. Sit with your knees bent and heels on the floor. Pull your foot inward against the tubing, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot. You can also sit on the floor with your knees bent and the tube looped around both feet. Slowly pull outward against the tube, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot.
Restore balance. As the ankle recovers and strength returns, balance is restored by standing on the injured leg, with the other foot in the air and your hands out to the side.
After the first week you may want to warm the ankle before doing these exercises by soaking it in warm water. Warmed tissue is more flexible and less prone to injury. Use ice when finished with the exercises to minimize any irritation to the tissue caused by the exercise.
When Can I Return to Sports?
Return to sports only after you have met these goals:
You have full range of motion in all directions (up and down, side to side, and in and out).
You have near-normal strength in all muscles around the ankle.
You have good balance.
You have no pain or swelling with exercise or activity.
Should I Use a Brace When I Play Sports?
Taping the ankle or using a brace for support can help prevent re-injury. There are many different types of braces: some made of neoprene, some made of elastic material, and some that have extra straps or ties for support. Select a brace that feels like it gives you the best support for the activity you want to do. Braces with straps or ties generally provide greater support. Never use a brace that is too tight.
Remember, a brace helps support strong muscles but should never be used as a substitute for a strengthening program. Continue to do strengthening exercises as you return to sports.
High Ankle Sprain (Syndesmosis Ligament Injury)
This condition is a sprain of one or more of the ligaments that hold the tibia and fibula together at the ankle. This joint, called the ankle syndesmosis, is made up of ligaments on the front and rear of the ankle, and in the space between the tibia and fibula.
Plantar fasciitis is an irritation of the plantar fascia. This thick band of connective tissue travels across the bottom of the foot between the toes and the heel. It supports the foot’s natural arch. It stretches and becomes taut whenever the foot bears weight.
What Is Plantar Fasciitis?
Plantar fasciitis is pain felt at the bottom of the heel. It is usually felt on the first step out of bed in the morning or when walking again after resting from a walking or running activity. However, plantar fasciitis pain can, if it persists, soon be felt any time you are walking, running or jumping.
Although the pain is mostly felt at the bottom of the heel, it can also radiate down the entire bottom of the foot toward the toes. Plantar fasciitis is not usually associated with numbness or tingling.
Anatomy of the Plantar Fascia
The plantar fascia consists of dense bands of tissue deep below the skin that extend out in a fan-like fashion from the heel bone to the toes. If you pull your toes and foot toward your head, you will feel this tissue tighten.
What Causes Plantar Fasciitis?
Plantar fasciitis is thought to be caused by repetitive stretching of the tight bands of the plantar fascia which result in micro tears in these bands as they extend from the heel. Because these tears usually do not occur from a single traumatic event, an immediate healing reaction is not triggered. A chronic irritation or inflammation process thereby begins which increases with activity. A sudden weight gain may also increase stress to an otherwise normal plantar fascia.
Pulling of the tight plantar fascia on the heel bone during activity can result in the formation of a bone spur off the tip of the heel bone, at the origin of the plantar fascia tissue. This bone spur itself is not the cause of pain, but rather the mechanical result of the chronic inflammatory process on the bone caused by the stretching of the tight tissue.
Surgery is rarely necessary to treat plantar fasciitis. To decrease your pain and symptoms, you may want to:
Tape the heel and arch. Custom shoe inserts may be needed to support the arch and the heel.
Increase the flexibility of the plantar fascia and calf muscles by doing stretching exercises. Tight calf muscles increase he stress on the plantar fascia and predispose you to plantar fasciitis.
Massage the plantar fascia by rolling your foot over a round tubelike object with a diameter of 3 to 4 inches. A rolling pin works nicely for this.
Strengthen the muscles of the foot and ankle that support the arch. One way to do this is to scrunch up a hand towel with your toes or use your toes to pull a towel weighted with a food can across the floor.
Warm up well before stretching. Cold tissues cannot stretch as effectively. After stretching, ice your heel for 20 to 30 minutes at the point of maximum tenderness to decrease any inflammation that may result from too vigorous a workout.
Consider the use of oral anti-inflammatory medications such as aspirin or ibuprofen. These medications can decrease the inflammation of the plantar fascia and thus decrease your symptoms so that you can stretch and improve your flexibility. In some cases, your physician may recommend a prescription antiinflammatory for you.
Try a night splint. These devices, prescribed by your physician, keep the foot flexed at 90 degrees instead of the typical relaxed foot position of toes pointed down that occurs during sleep. Wearing a splint may lessen the pain of the first step in the morning.
Massage the heel with a sports cream, which may lessen symptoms. A variety of “hands on” therapeutic treatments can also be administered by a physical therapist.
How to Prevent Plantar Fasciitis
Always warm up well and stretch before participating in sports.
Wear good, supportive shoes for your athletic activities.
Keep the muscles of your feet and ankles strong to support your arch.
Don’t try running to lose weight after a rapid weight gain. Walk first, and stretch the muscles of the foot and calf to help condition your body before running.
Avoid activities that cause pain in your heel.
See your physician if pain persists despite these measures.