Ligaments And Tendons Of The Foot
The soft tissues surrounding the joint help stabilize the bones so they do not move too much in the wrong directions. Sprains usually occur during athletic activities but sometimes we step down or trip on a rug and put abnormal pressures on our ankle. Most often, a sprain occurs when the foot gets tilted inward or inverted. These abnormal forces causes stretching or tears to the ligaments that stabilize the joint. The injured ligaments will lead to swelling, inflammation, and pain. If the injury is severe, there may be a fracture present. It is standard for doctors to order x-rays and do multiple different maneuvers to the foot and ankle to asses which ligaments are damaged and if any of the bones are broken. When no bones are involved, rest, ice, compression, elevation, and anti-inflammatory medication usually does the trick.
Unfortunately, it is nearly impossible to tell the difference between ankle instability and subtalar joint instability by physical evaluation. To evaluate the damage, radiographs have to be carefully evaluated and some non-traditional evaluations should be utilized. Placing the foot in specific forced positions is necessary to open up the joint spaces to assess the damage. These can be very painful and a local anesthetic may be necessary in order to complete the exam. Ultrasound has shown to be a great way to evaluate injuries, but not all medical care centers have this modality available. If this injury is caught early , the treatment is mostly non-surgical. Different immobilization devices and physical therapy can usually strengthen the ligaments. Occasionally the injury will become a chronic problem that requires surgery. Since this injury is hard to assess and difficult to differentiate from ankle joint injuries, your doctor may have a difficult time recognizing the issue. It is important to communicate your symptoms and pain as thorough as possible. Knowing how the injury occurred and the position your foot was in when the injury occurred can be very useful information for your doctor to determine what ligaments were injured. If you had an ankle sprain that doesn't seem to be getting better, it may be an unstable subtalar joint that is the root of your problems.
Although an ankle sprain is a common injury and many people would consider it of minor concern, without adequate care, it can result in chronic joint instability. That is why it is important that the early treatment of ankle sprains be followed by proper rehabilitation.Many people who have had an ankle sprain injury still have symptoms even after going through the treatment. Most often this happens because of incomplete rehabilitation. If that is your case, you might find the exercises suggestions below useful. But before beginning any rehabilitation program, it is important to see a doctor and make sure that there is no more serious injury, such as a fracture, for example.Even if rest is recommended after ankle sprain, prolonged immobilization is a treatment error. It is true that patients will feel better if placed in cast or a walking boot, but this can lead to delayed rehabilitation and a stiff ankle, which is prone to re-injury. The ligaments will heal with tissue that is of better quality and the appropriate length when ankle movement is initiated earlier. So, it is very important to do some specific types of exercise for the ligaments to heal properly.
I think just about everyone has experienced the pain of a sprained ankle at sometime in their lives, most of us more than once. Most people that are active or athletic will experience the pain of a sprained ankle at some point. When I was a medic with a rifle company in the Army National Guard it was a common injury. When I played football or basketball or even baseball in high school I suffered a few sprain ankles also.
“Flat Feet” is a widely used generic medical term that describes some type of decrease in the height of the arch that is located on the inside of the foot. In some cases, a person with flat feet has a slight decrease in arch height, while in other cases, there is no arch visualized. Flat feet are considered normal in infancy and in young children until 8-10 years of age. Around this time, an arch should be identified. However; most people with flat feet never develop pain.
There are many different terms that are used to describe a person with flat feet. Some of these include pes planus, pes valgus, equino valgus, collapsing pes valgo planus, and talipes calcaneovalgus. Although flat feet is a broad term, it is a very complex disorder that not only affects the arch but also other parts of the foot and/or ankle. The most commonly associated disorders with flat feet are bunions, hammertoes, heel pain, midfoot collapses and dislocations, and an everted or valgus position of the heel and/ or ankle as well as equinus. Since there are so many associated disorders that can cause symptoms with flat feet, the associated disorders should also be treated concurrently when treating flat feet.
In general, there are two very common presentations of flat feet which are termed “flexible” and “rigid”. A “flexible” flat foot means that the arch collapses upon weight bearing of the foot while the arch of the foot is visible when the foot is not touching the ground. Flexible flat feet commonly occur in the pediatric or adolescence and can continue into adulthood. If symptomatic and not properly treated, a flexible flatfoot can become stiff or rigid and potentially develop in a more severe condition. The second common presentation of flat foot is termed “rigid” which means that the height of the arch is the same whether or not the foot is touching the ground during weight-bearing. Rigid flat feet can be caused by many factors including arthritis, tarsal coalitions, and congenital vertical talus.
The severity of symptoms that occur with flat feet varies from person to person as well as the location on the lower leg and foot. The symptoms are not defined by how low the height of the arch is but rather the adaptive changes in bone, tendons, and ligaments. At times, there are patients that have no visible arch height, who are asymptomatic, while patients with a very slight decrease in their arch height have severe symptoms.
After diagnosing flat feet by a physical examination and radiographs as well as other imaging modalities, the treatment regiment should begin promptly. There are non-surgical and surgical treatment protocols to help treat the pediatric as well as the adult acquired flat foot. The conservative treatments are based on controlling the pathological movements of the bones, ligaments, and tendons. This is done by custom molded foot orthotics, and/ or foot and ankle braces. Rest, ice, compression, elevation and an organized physical therapy regiment helps decrease the tenderness, inflammation, and swelling that occurs.
When considerable effort of conservative treatment has failed to relieve symptoms, surgical intervention is indicated. The type of procedure that is performed is highly variable because each flat foot is unique to each other. The principles behind the vast array of surgical procedures available are based on to correct each area of soft tissue, ligament, and bone that is contributing to the pathologic symptoms. The surgical procedures can range from implants, soft tissue releases, and tendon transfers to osteotomies and fusions of bones with or without bone grafts. The recovery period is dependent on the surgical procedure performed which can range from 8- 12 weeks followed by physical therapy.
