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Ankle Mobility – Significance in Injury Prevention

Ankle mobility and its significance in injury prevention

Let it be walking, running, jumping or landing, ankle is the first major joint, from where the forces are transferred up in the body. So it makes the ankle joint a lot more important than what people think of it. Ankle joint is often overlooked while dealing with conditions occurring at knee joint, hip joint or lower back. Primarily ankle joint movements include dorsiflexion (toes coming closer to shin) and plantar flexion (tip toeing) (Fig 1 & 2). Limited dorsiflexion at ankle joint affects shock absorption and many functional movements such as squats and going downstairs.

Every time our foot lands on the ground while walking, running or landing, there is ‘Ground Reaction Force’ produced. To keep the forces acting on the body within limits, it is important for the body’s musculature to absorb the forces.  Under impact activities every joint involved should work in their optimal range. If any joint’s range of motion is affected, it will increase stress on the other joints. This will also influence the muscle function and shock absorption around the affected joint.This is why ankle mobility is important to prevent injuries at foot, knee, hip and Lower back.

dorsiflexion

Fig 1 – Dorsiflexion

plantar-flexion

Fig 2 – Plantarflexion


 



A simple example to better understand it is to do a small jump, landing with stiff joints and another landing while bending at different joints. Landing with stiff joints will feel heavier and impart high forces on the joints. On the other hand, same landing done while allowing ankle knee and hip joints to bend, will feel much lighter. A good range of motion in joints allows the muscle to stretch more and absorb the forces optimally. Therefore limited/restricted joint range at ankle joint will increase the share of Ground reaction force more on knee and hip joint. In addition, a stiff ankle not only lacks in absorbing shock but it also reduces your overall agility and control.


 



Factors leading to reduce ankle mobility – Click here


 


Are your feet normal??

There’s no such thing as normal: variety in healthy feet

Article by Timothy Maiden

Tim photo

Senior Podiatrist at The Foot Practice (Singapore)


“Is it normal?” must be one of the most commonly asked questions in medical history.

There’s actually been surprisingly little research done on ‘normal’ feet in adults.  Because feet are hidden away in shoes most of the time, we don’t see the natural variation the way we do with facial features or body shape.  People only seek medical help if they’re in pain, so there’s lots of research done about conditions like bunions or hammer toes, but very little done about the range of different shapes which characterise healthy feet.

The rough estimate is that around 11% of adults have flat feet (https://www.researchgate.net/publication/266142136_Prevalence_of_flat_foot_among_18_-25_years_old_physiotherapy_students_cross_sectional_study), while high arches affect around 10-15% (http://www.acnr.co.uk/2013/01/pes-cavus-not-just-a-clinical-sign-diagnosis-aetiology-and-management/), and everyone else is ‘normal’.  The statistics indicate that children have higher rates of foot deformities – but perhaps this is just because attentive parents take their children to the doctor for fairly mild problems, whereas adults are less keen to seek help for themselves. (http://www2.cmu.edu.tw/~mtjm/full-text/14%281%29p1-9.PDF)




Feet are often divided into categories according to their appearance.  “Peasant” feet are square-looking with stubby toes all a similar length; “Greek” feet have a peaked appearance, with the second toe longer than the big toe; and “Egyptian” feet look tapered, with the big toe the longest and the others of decreasing sizes.  But these aren’t medical descriptions, just loose descriptions used by shoe manufacturers. (http://www.pointeshoesonline.com/foot-shape/)

The official description of a normal foot, as found in medical textbooks, is a list of features written by a long-dead podiatrist and never really tested by science (http://www.podiatrytoday.com/what-%E2%80%98normal%E2%80%99-foot).  Sydney University is currently conducting a “1000 Norms” project, collecting and analysing data on the anatomy of healthy people (http://sydney.edu.au/health-sciences/research/1000-norms.shtml), but it will be years until the project is completed and we have a clearer picture.




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Tarsal tunnel Syndrome

 

Tarsal Tunnel Syndrome

 

Tarsal tunnel syndrome is a similar condition like carpal tunnel syndrome, where the symptoms are caused from compression of the nerve. The location of tarsal tunnel is inner side of the ankle and the nerve getting compressed is posterior tibial nerve. It is covered with a thick ligament known as flexor retinaculum and base is formed by ankle bones.

Symptoms usually start gradually and get worse overtime. Common symptoms are pain, numbness, tingling and burning sensation over inner side of ankle and sole of the foot. It might result in loss of sensation overtime. Symptoms are constant, i.e. present all the time and are aggravated with activity like walking and running.



People suffering from tarsal tunnel syndrome find it difficult to stand or walk for prolonged time. Movements like eversion (moving foot outwards) and dorsiflexion (moving foot upwards) gets limited as they provoke the symptoms. Same as carpal tunnel symptoms may become worse in the night.




Read causes and treatment options of Tarsal Tunnel Syndrome on Page 2




Plantar Fasciitis : Most common cause of heel pain

Plantar Fasciitis

Plantar fasciitis is one of the most common conditions leading to heel pain. It is commonly seen in people who spend long hours standing. Plantar fascia is a thick fibrous tissue which runs from heel to toes and is responsible in maintaining the arch and overall shape of the foot. Excessive forces on plantar fascia causes micro tears and degeneration which leads to inflammation and pain. Pain is worse early in the morning and after prolonged hours of sitting or standing. Location of pain is usually at the heel but in some cases it can be present at the arch of the foot.

Causes:

  • Jobs involving prolonged standing
  • Weak and tight foot and ankle musculature
  • Stiff ankle joint
  • History of ankle sprain
  • Overweight
  • High arch or flat foot type
  • Improper footwear with reduced support

Treatment options:

Get a proper diagnosis done by a physiotherapist or an orthopedic

  • Conservative treatment
  • Injection treatment (cortisone shot)
  • Shock-wave therapy

Conservative treatment:

  • Stretching exercises for plantar fascia and calf muscles (see pics 1,2,3 below)
  • Ball roll on plantar fascia (see pic 4)
  • Foam rolling on calf and hamstrings to improve flexibility
  • Strengthening exercises of foot and leg to improve shock absorption
  • Icing over the inflamed area
  • Ankle joint mobilization
  • Soft tissue mobilization
  • Wearing proper footwear with good arch support
  • Avoid walking barefoot
  • Use of night splints to keep muscles and fascia in stretched position
  • Tapping helps supporting the foot and reduce strain on Fascia
  • Custom Insoles or orthotic devices to correct foot biomechanics if required

Plantar Fascia stretch

_20151122_131956

Pic 1

Calf Stretch

calf-1

Pic 2 – Bend Knee calf (Soleus) stretch

calf-2

Pic 3 -Straight Knee (Gastrocnemius) Stretch

plantar fasciitis

Pic 4 – Ball roll on plantar fascia

 

Rehab Mantra
Stay Fit. Love Life

READ OTHER ARTICLES

Ankle Mobility – Significance in Injury Prevention

Ankle mobility and its significance in injury prevention

Let it be walking, running, jumping or landing, ankle is the first major joint, from where the forces are transferred up in the body. So it makes the ankle joint a lot more important than what people think of it. Ankle joint is often overlooked while dealing with conditions occurring at knee joint, hip joint or lower back. Primarily ankle joint movements include dorsiflexion (toes coming closer to shin) and plantar flexion (tip toeing) (Fig 1 & 2). Limited dorsiflexion at ankle joint affects shock absorption and many functional movements such as squats and going downstairs.

Every time our foot lands on the ground while walking, running or landing, there is ‘Ground Reaction Force’ produced. To keep the forces acting on the body within limits, it is important for the body’s musculature to absorb the forces.  Under impact activities every joint involved should work in their optimal range. If any joint’s range of motion is affected, it will increase stress on the other joints. This will also influence the muscle function and shock absorption around the affected joint.This is why ankle mobility is important to prevent injuries at foot, knee, hip and Lower back.

dorsiflexion

Fig 1 – Dorsiflexion

plantar-flexion

Fig 2 – Plantarflexion


 



A simple example to better understand it is to do a small jump, landing with stiff joints and another landing while bending at different joints. Landing with stiff joints will feel heavier and impart high forces on the joints. On the other hand, same landing done while allowing ankle knee and hip joints to bend, will feel much lighter. A good range of motion in joints allows the muscle to stretch more and absorb the forces optimally. Therefore limited/restricted joint range at ankle joint will increase the share of Ground reaction force more on knee and hip joint. In addition, a stiff ankle not only lacks in absorbing shock but it also reduces your overall agility and control.


 



Factors leading to reduce ankle mobility – Click here


 


Are your feet normal??

There’s no such thing as normal: variety in healthy feet

Article by Timothy Maiden

Tim photo

Senior Podiatrist at The Foot Practice (Singapore)


“Is it normal?” must be one of the most commonly asked questions in medical history.

There’s actually been surprisingly little research done on ‘normal’ feet in adults.  Because feet are hidden away in shoes most of the time, we don’t see the natural variation the way we do with facial features or body shape.  People only seek medical help if they’re in pain, so there’s lots of research done about conditions like bunions or hammer toes, but very little done about the range of different shapes which characterise healthy feet.

The rough estimate is that around 11% of adults have flat feet (https://www.researchgate.net/publication/266142136_Prevalence_of_flat_foot_among_18_-25_years_old_physiotherapy_students_cross_sectional_study), while high arches affect around 10-15% (http://www.acnr.co.uk/2013/01/pes-cavus-not-just-a-clinical-sign-diagnosis-aetiology-and-management/), and everyone else is ‘normal’.  The statistics indicate that children have higher rates of foot deformities – but perhaps this is just because attentive parents take their children to the doctor for fairly mild problems, whereas adults are less keen to seek help for themselves. (http://www2.cmu.edu.tw/~mtjm/full-text/14%281%29p1-9.PDF)




Feet are often divided into categories according to their appearance.  “Peasant” feet are square-looking with stubby toes all a similar length; “Greek” feet have a peaked appearance, with the second toe longer than the big toe; and “Egyptian” feet look tapered, with the big toe the longest and the others of decreasing sizes.  But these aren’t medical descriptions, just loose descriptions used by shoe manufacturers. (http://www.pointeshoesonline.com/foot-shape/)

The official description of a normal foot, as found in medical textbooks, is a list of features written by a long-dead podiatrist and never really tested by science (http://www.podiatrytoday.com/what-%E2%80%98normal%E2%80%99-foot).  Sydney University is currently conducting a “1000 Norms” project, collecting and analysing data on the anatomy of healthy people (http://sydney.edu.au/health-sciences/research/1000-norms.shtml), but it will be years until the project is completed and we have a clearer picture.




Continue readingNext page



Tarsal tunnel Syndrome

 

Tarsal Tunnel Syndrome

 

Tarsal tunnel syndrome is a similar condition like carpal tunnel syndrome, where the symptoms are caused from compression of the nerve. The location of tarsal tunnel is inner side of the ankle and the nerve getting compressed is posterior tibial nerve. It is covered with a thick ligament known as flexor retinaculum and base is formed by ankle bones.

Symptoms usually start gradually and get worse overtime. Common symptoms are pain, numbness, tingling and burning sensation over inner side of ankle and sole of the foot. It might result in loss of sensation overtime. Symptoms are constant, i.e. present all the time and are aggravated with activity like walking and running.



People suffering from tarsal tunnel syndrome find it difficult to stand or walk for prolonged time. Movements like eversion (moving foot outwards) and dorsiflexion (moving foot upwards) gets limited as they provoke the symptoms. Same as carpal tunnel symptoms may become worse in the night.




Read causes and treatment options of Tarsal Tunnel Syndrome on Page 2




Plantar Fasciitis : Most common cause of heel pain

Plantar Fasciitis

Plantar fasciitis is one of the most common conditions leading to heel pain. It is commonly seen in people who spend long hours standing. Plantar fascia is a thick fibrous tissue which runs from heel to toes and is responsible in maintaining the arch and overall shape of the foot. Excessive forces on plantar fascia causes micro tears and degeneration which leads to inflammation and pain. Pain is worse early in the morning and after prolonged hours of sitting or standing. Location of pain is usually at the heel but in some cases it can be present at the arch of the foot.

Causes:

  • Jobs involving prolonged standing
  • Weak and tight foot and ankle musculature
  • Stiff ankle joint
  • History of ankle sprain
  • Overweight
  • High arch or flat foot type
  • Improper footwear with reduced support

Treatment options:

Get a proper diagnosis done by a physiotherapist or an orthopedic

  • Conservative treatment
  • Injection treatment (cortisone shot)
  • Shock-wave therapy

Conservative treatment:

  • Stretching exercises for plantar fascia and calf muscles (see pics 1,2,3 below)
  • Ball roll on plantar fascia (see pic 4)
  • Foam rolling on calf and hamstrings to improve flexibility
  • Strengthening exercises of foot and leg to improve shock absorption
  • Icing over the inflamed area
  • Ankle joint mobilization
  • Soft tissue mobilization
  • Wearing proper footwear with good arch support
  • Avoid walking barefoot
  • Use of night splints to keep muscles and fascia in stretched position
  • Tapping helps supporting the foot and reduce strain on Fascia
  • Custom Insoles or orthotic devices to correct foot biomechanics if required

Plantar Fascia stretch

_20151122_131956

Pic 1

Calf Stretch

calf-1

Pic 2 – Bend Knee calf (Soleus) stretch

calf-2

Pic 3 -Straight Knee (Gastrocnemius) Stretch

plantar fasciitis

Pic 4 – Ball roll on plantar fascia

 

Rehab Mantra
Stay Fit. Love Life

READ OTHER ARTICLES