Ankle & Leg Pain

Ankle & Leg Pain

Ankle Sprains

Ankle sprains can involve both the medial (inside) and the lateral (outside) ligaments of the ankle. A sprain occurs when ligaments are overstretched, partially torn or ruptured and your physiotherapist diagnoses a sprain’s severity clinically.

In the initial stages (0-72 hours), ankle sprains are painful, may be swollen or bruised and affect your ability to weight bear. It is important to ice, compress and elevate your ankle during the first 48-72 hours and have your injury assessed by your local physiotherapist.

A full recovery requires rigorous rehabilitation including strengthening, joint mobilisations, soft tissue work, proprioceptive exercises (to retrain balance and awareness) and a graduated return to activity. Taping or temporary bracing may be used to aid a safe progression and return to full activity and your physiotherapist will guide you.

 

Posterior ankle impingement

Impingement is caused by structures such as bursas, fat pads or tendons being compressed in an area where movement may decrease the space for these structures (such as near a joint).

Posterior ankle impingement (PIS) occurs at the back of the ankle on actions such as pointing, jumping and rising and may involve irritation of the bursa, fat pads or the tendons and, in some cases, it may be associated with FHL tenosynovitis.   Ice is useful in reducing the pain, swelling and irritation behind the ankle.  Treatment includes soft tissue work to unload the muscles of the lower leg, ankle mobilisations, strengthening and biomechanical assessment and improvements.

 

Tibial Stress Fractures

The tibia is the largest bone of the lower leg. A stress fracture is a small, but significant crack in a bone most commonly caused by overuse from high impact sports or activities. Torsion forces on the tibia from excessive turning and unmanaged medial tibial stress syndrome (or a stress reaction in the tibia) are common causes of tibial stress fractures.  Signs and symptoms of a stress fracture often include localised pain over the area, increased pain with weight bearing and a gradual onset of pain.  Stress fractures are often difficult to see via plain X-ray therefore diagnosis may be through clinical assessment by your physiotherapist or doctor, an MRI or bone scan.

Relative rest (avoiding the aggravating activity) and unloading the tibia is a key component to recovering from a stress fracture, accompanied with soft tissue therapy, joint mobilisation (to maintain foot and ankle mobility) and strengthening.

Flexor Hallucis Longus (FHL) Tenosynovitis

The FHL is a muscle of the lower leg whose primary function is to pointe the big toe. The FHL muscle also contributes to plantarflexion (or pointing) of the ankle. The FHL tendon courses to the toe via a bony groove behind the inner part of the ankle and is surrounded by a sheath that assists the tendon to glide smoothly. Tenosynovitis is the inflammation of this sheath that surrounds a tendon, rather than the tendon itself.

Particularly in ballet dancers, this muscle is susceptible to high loads with jumping, pointing and dancing en pointe. When overload occurs in this muscle, the tendon rubs excessively in the bony groove which causes an inflammatory response in the tendon sheath (i.e. tenosynovitis).

Signs and symptoms include pain anywhere along the FHL tendon, weakness in pointing/jumping/pointe work; reduce range of pointe and pinching at the back of the ankle. Physiotherapy treatment is key and includes soft tissue work, ankle mobilisation and strengthening.

Medial Tibial Stress Syndrome (MTSS) (sometimes referred to as “shin splints”)

MTSS is a stress response to the connective tissue surrounding the muscles in the lower leg resulting from overuse or a sudden onset of increased load. Overuse is commonly secondary to repertoire changes, increases in training load or type and changing footwear.  Muscles of the lower leg are arranged into compartments bound by fascia (connective tissue) that attach to the tibia and fibula.   When muscles are not coping with their load and fatigue there is increased force transmitted through the connective tissue and thus increased force to the tissue’s attachments to the bone. This increase in force can cause pain and tenderness along the tibia. Ice, soft tissue techniques, strengthening, footwear modifications and taping are treatment strategies that your sports physiotherapist may prescribe to manage this condition.

Stress Fractures

A stress fracture is a small crack in a bone most commonly caused by overuse from high impact sports or activities. Weight bearing bones of the foot and lower leg, lumbar spine and pelvis are common areas where stress fractures may occur.

Signs and symptoms of a stress fracture often include localised pain over the area, increased pain with weight bearing and a gradual onset of pain.

Stress fractures are often difficult to see via plain X-ray therefore diagnosis may be through clinical assessment by your physiotherapist or doctor, an MRI or bone scan.

Relative rest (avoiding the aggravating activity) and unloading the region is a key component to recovering from a stress fracture, accompanied with soft tissue therapy, joint mobilisation and strengthening the surrounding muscle groups.