Ankle Sprain?

How many of you have had, or know someone who has had, an 'ankle sprain' that never seems to get better? If you have gone to see a health provider, chances are you have been told that you need to modify your activity level and rest in order for it to heal. The problem with this is that a lot of tendinopathies go undiagnosed in the foot/ankle, and deformities and chronic pain can be left as a result. A recent article by Simpson et al from American Academy of Family Physicians does a great job identifying common tendinopathies in the foot/ankle and how they should be treated. While this is not specific to physical therapy, below are general guidelines of the different pathologies and their associated treatment. The next time you have pain in your foot, don't assume it's 'just a sprain'!

Tibialis Posterior Tendinopathy
Symptoms:
-Pain and swelling posterior to the medial malleolus
-Pain worse with weightbearing and with inversion and plantar flexion against resistance
Treatment:
-Rest, Ice, Compression, and Elevation
-Decrease pronation through orthosis
-Immobilization in short-leg cast 2-3 weeks (if necessary)
-Tibialis Posterior strengthening

Peroneal Tendinopathy
Symptoms:
-Pain and swelling posterior to the lateral malleolus
-Pain with active eversion and dorsiflexion against resistance
Treatment:
-Rest, Ice, Compression, and Elevation
-Foot orthotic
-Lateral heel wedge
-Eversion strengthening

Achilles Tendinopathy
Symptoms:
-Pain, swelling, and/or crepitus at the tendon or 3-5cm above calcaneal attachment
-Recent change in intensity or duration of training
-Hamstring and gastrocnemius-soleus complex inflexibility
Treatment:
-Rest, Ice, Compression, and Elevation
-Gastrocnemius/Soleus stretching
-Eccentric Strengthening

Flexor Hallucis Longus Tendinopathy
Symptoms:
-Pain and swelling over the posteromedial aspect of ankle
-Pain with resistive flexion of great toe
-Seen in dancers or athletes who use a repetitive "push-off"
Treatment:
-Rest, Ice, Compression, and Elevation
-Shoe with firm sole
-Core strengthening

Tibialis Anterior Tendinopathy
Symptoms:
-Pain over the anterior ankle
-Weak dorsiflexion of foot
-Caused by forced dorsiflexion
Treatment:
-Rest, Ice, Compression, and Elevation
-Immobilization in short-leg cast 2-3 weeks (if necessary)
-Dorsiflexor strengthening

• Simpson MR, Howard TM. Tendinopathies of the foot and ankle. Am Fam Physician. Nov 15 2009;80(10):1107-1114.