By Brian Hoke

 

Injuries and conditions that cause pain in the foot and ankle often have a profound effect on our desire to enjoy an active lifestyle.  Understanding the causes of these issues can significantly lower our risk of experiencing these problems. We will outline a few of the most common foot and ankle injuries and provide some tips for avoiding these problems.

 

Ankle Sprains

The ankle is supported by strong bands of tissue to support the joint in our daily activities.  When we walk or run the natural direction of motion for the ankle is inward, and our foot structures are designed for this path of loading.  Your big toe is big because that is the area that is designed to take the weight of our body.  In keeping with this principle, the inner ankle ligaments are incredibly strong and are rarely damaged.  Unfortunately, our weight sometimes falls to the outside, often because we land on an uneven surface or object.  The outer ankle ligaments are smaller and are easily damaged.  Once this injury has occurred, it frequently becomes a recurrent problem.  A key to preventing ankle sprains is to train the body to react and protect the area by improving our balance reactions. 

 

Try following these steps to work on improving the ankle’s ability to react and protect us: stand in a doorway on one leg.  

• See how long you can stand without losing your balance. Your goal is 30 seconds.  
• Do this first with your eyes open, and when you can do it for 30 seconds, try again with your eyes closed.  
• Try doing this for 5 times on each leg.  
• If you do this three times a week, you will find that within a few weeks your ankle can react and protect you automatically when it senses the joint going into a dangerous position

 

Plantar Fasciitis

The plantar fascia is a strong band of tissue that helps to support our foot when we walk and stand.  If the arch area has excessive flexibility, this can cause the plantar fascia to become stretched beyond its normal length and can cause it to tear at its attachment to our heel bone.  One of the issues that can cause the arch to flatten too much is tightness in the calf muscle and Achilles’ tendon in the back of the leg.  The extra motion in the arch area compensates for the calf tightness. 

 

To avoid this problem, we need to maintain optimal flexibility in the calf muscle.  We can do this by actively pulling the ankle up with our muscles, or we can superimpose more stretch by pulling with a strap or leaning into a wall while keeping our heel down.

 

Another useful principle in avoiding unwanted stress to the plantar fascia is to support the arch area with footwear that is designed with an “anatomical footbed” that matches the natural shape of the foot.  There are many choices of fashion-conscious footwear that have been designed to also support the natural curves of your foot.

 

Achilles’ Tendonitis

The Achilles’ tendon is the strong strap-like tissue that connects the calf muscle to the heel bone.  It is a very strong structure and has the ability to store and release elastic energy when we run and jump.  A key to keeping this tendon healthy is to include eccentric (negative) training for the calf muscle. 

 

To train this muscle group, begin by standing on the edge of a step.  Let your heels drop down past the edge of the step.  Now rise up onto the balls of both feet.  When you have gone as high as possible, shift all your weight to one foot and take the other foot off the ground.  Slowly and carefully lower your weight down on one leg.  This lowering is known as an eccentric muscle contraction, and research has shown that this can build and strengthen the Achilles’ tendon, making it less likely to sustain an injury. We suggest doing this 10 times per set and doing 2-3 sets.  Because this is working on strength, you should take a rest day and only do every other day (3-4 times a week).

 

Let’s Stay Healthy 

Doing these simple activities can significantly lower your risk of having to deal with these common injuries. Set some time aside each week for a little preventive maintenance and you will greatly increase your odds of staying injury free even with an active lifestyle. Let yourself keep doing you!

 

 

About the Author:

 

Specializing in orthopedic and sports physical therapy, Brian Hoke, DPT, SCS has a particular interest in the biomechanical factors influencing lower limb rehabilitation. He is co-owner and director of Atlantic Physical Therapy, a private practice in Virginia Beach, VA.

Brian is a board certified Clinical Specialist in Sports Physical Therapy, a distinction achieved by fewer than 600 physical therapists in the U.S. He works with athletes of all levels—from recreational runners to elite professional and Olympic athletes. He has contributed chapters to two textbooks on the treatment of running injuries.

Brian is an avid educator, lecturing extensively in the U.S. and internationally. Since 1985, he has been a faculty member of the popular continuing medical education seminar, “When the Feet Hit the Ground, Everything Changes.” He co-developed and has taught the “Take the Next Step” course since 1990. In addition, he has been an adjunct faculty member of physical therapy programs at Old Dominion University and Touro College on Long Island, NY.

Brian’s expertise in sports physical therapy is a particular asset to Vionic’s athletic line of footwear. He and Phillip Vasyli have also collaborated to create a foot orthotic designed for problems with supination—when feet roll outward too much.