Ankle problems can be treated with conservative therapies, and people with a certain type of heel pain may benefit from plantar fasciitis exercises.
Various Ankle Problems
There are many causes of ankle pain, and the pain may be on the inside, outside, or around the Achilles tendon. The Achilles tendon connects the muscles between the heel bone and lower leg. If there is injury to the tendons, ligaments, or bones of the ankle, such as an ankle sprain, there could be significant pain. A sprain is caused by “forceful twisting or bending” of the joint. Walking on a surface that is uneven, a missed step, or sports could call lead to a sprained ankle. Other causes of ankle pain are Achilles tendinitis or Achilles tendinosis, ankle fracture, bones spurs, gout or pseudogout, bursitis, osteoarthritis or rheumatoid arthritis, strains, or tarsal tunnel syndrome. It is important to see a doctor if there is severe swelling or pain, an open wound or deformity, infections, or if the patient is unable to put weight on the foot.1 Achilles tendinitis is a condition that can be caused by “running or jumping workouts” and “repetitive activities…postural problems, or footwear and training issues”. Burning pain, aching, and a tender and warm tendon that becomes aggravated with activity are common symptoms with this disorder. Another name for this condition is paratenonitis. It is possible that a high-arched foot or being flatfooted could contribute to this condition, as can running on hard, uneven, or slanted ground. Aging is also related to this disorder.2 Achilles tendinosis, on the other hand, involves the inflammation and degeneration of the Achilles tendon. This could also be caused by running, and shoes can rub up against the bump that this condition causes. Calf tightness also occurs with this disorder. The “chronic wear and tear on the tendon” accumulates and leads to swelling and pain, or even “thickening of the tendon”. Patients may experience pain on the tendon or the back of their heel.3 An ankle fracture is a break in the bone. This leads to pain, swelling, possibly blisters, bruising, and difficulty walking.4
Treatment Options for Ankle Pain
Self-care options for ankle pain include RICE (rest, ice, compression, elevation) and pain medications such as NSAIDs (ibuprofen, naproxen).5 In the case of a fracture, elevation, ice, a splint, rest, possibly a cast or fracture boot, or even surgery could be required.6 There is another option to treat an unstable ankle that is not broken, and that is using special taping, such as Kinesio Tape or Rocktape. Kinesio Taping is a “rehabilitative taping technique that…(facilitates) the body’s natural healing process while providing support and stability…without restricting the body’s range of motion”.7 Rocktape is a taping product that can reduce swelling, stiffness and pain, improve posture, help performance, and “delay muscle fatigue”. Its glue is activated by heat and is also waterproof. The heat activation is provided by rubbing the tape upon application. It can be worn up to 5-7 days at a time.8 Chiropractors can help patients with Rocktape use, and Rocktape provides supplemental instructional videos for application, including methods of taping for the Achilles tendon, ankle sprains, and ankle swelling.9
About Plantar Fasciitis
Inflammation of the plantar fascia, a band of tissue that connects the heel to the toes, is called plantar fasciitis. The first morning steps might cause a stabbing pain. While exercise and movement throughout the day could provide relief, long periods of sitting or standing can make the pain resume. Runners, being overweight, and those who have poor support in the shoes are at risk of this disorder. Normally, the plantar fascia is “like a shock-absorbing bowstring” that supports the foot’s arch, but too much tension creates tears, along with irritation and inflammation.10 The most common heel pain is due to plantar fasciitis. It is found in people who are middle-aged, but it can also impact soldiers or athletes. One or both of the feet could be affected. People who roll their feet inward when walking (pronation), those with flat feet or high arches, people who run or stand too long on hard surfaces, those with tight calf muscles or Achilles tendons, and people wearing worn out or poorly-fitted shoes can develop plantar fasciitis.11 Generally, the condition starts with “mild pain at the heel bone…called a stone bruise”. Without treatment, the situation may become chronic, and knee, hip, and back problems can result due to compensating for the pain in the foot when walking.12
Treatments and Plantar Fasciitis Exercises
According to the American Orthopaedic Foot & Ankle Society, stretching is crucial for this disorder. Keeping weight off the foot until the inflammation reduces is also useful. Icing 3-4 times per day for 20 minutes could also provide symptom relief. NSAID medications and home stretches will often be recommended. If treatment for a couple of months does not resolve symptoms, a steroid injection in the heel may be prescribed. One exercise involves leaning forward on a wall with the heel on the ground and one knee straight while the other is bent. The arch and heel cord stretch during the leaning. Another stretch is squatting while leaning on a countertop. A plantar fascia-specific stretch involves having the patient sit and cross the affected leg over the other. Pulling the toes to the shin, the patient should hold the stretch for about 10 seconds, repeating 10 times, for three sets per day.13 Patients might try stretching the calves while in bed by pulling the balls of the feet forward with a towel. Others might want to massage the foot by rolling the foot over a tennis ball or even a frozen water bottle.14
Chiropractic and Devices
Chiropractors can provide advice on stretching and exercises and they offer therapy for this disorder. There are shoes that can help with plantar fasciitis.15 Some patients may find it useful to wear a special plantar fasciitis night splint to bed, orthotics (Foot Levelers) or a special foot sleeve (Feetures) at bedtime or throughout the day.16 Patients with pain tend to compensate and adjust their gait to deal with the problem. In fact, according to the American Chiropractic Association, “It’s possible to bring on plantar fasciitis as a result of compensating for conditions such as chronic Achilles tendonosis, calf strains, and tibialis posterior dysfunction.” There are many chiropractic treatment modalities that can be used to treat musculoskeletal conditions, such as plantar fasciitis, besides anti-inflammatory medications or injections. Taping, night splinting and manipulation (including instrument-assisted soft-tissue manipulation (IASTM)), are some of the treatment options. IASTM starts with heat and stretching, followed by the use of stainless-steel instruments. Other treatment options are low-level laser, electrical muscle stimulation, ultrasound, and foot taping. Obesity contributes to the plantar fasciitis symptoms, so patients may need to lose weight. Of course, rehabilitation requires “progressive resistance exercises”, such as toe curls and calf strengthening. Later, “proprioceptive exercises” are introduced, including single-leg stands, hopping, or jumping rope. Self-massage is important before any stretching or weight-bearing exercises. Before considering surgery, patients should know that secondary complications can result, such as lateral column syndrome. Most people (about 90%) recover from plantar fasciitis after “6 to 9 months” with “aggressive conservative therapy”. Multiple therapies and patient compliance are required, as “no single treatment has been shown to be effective”.17
Find out more about chiropractic and plantar fasciitis.