Northern Michigan Sports Medicine

 Ankle Sprains                                                Plantar Fasciitis

Ankle Sprains

• Ankle sprains are among the most common musculoskeletal injuries.
• Although both sides of the ankle can be sprained, the lateral (outside) ankle is the most commonly injured.
• The severity of an ankle sprain can be described as grades 1, 2, or 3, with a grade 3 sprain being the most severe.
• Grade 1 sprains are usually associated with mild overstretching of the supporting ligaments of the ankle.  Grade 3 sprains are characterized by complete tearing of the ligaments.
• Along with the supporting ligaments, tendons and bones can also be damaged, depending on how the injury occurs.
• The most common way to sustain a sprained ankle is by the foot rolling in while walking or running.

Symptoms

• After the foot has rolled in or out during activity, there will usually be pain on either side of the ankle, or across the front of the ankle joint. 
• This pain may be accompanied by swelling or bruising. 
• Putting weight through the involved lower extremity often causes discomfort.
• With severe sprains, a person may not be able to stand on the involved ankle, and walking may be very painful.

Treatment

• X-rays or other diagnostics may be necessary if a grade 2 or 3 sprain is suspected, or if a person is unable to put weight through the ankle. 
• Initial management of this injury should include rest, ice with compression, and elevation of the leg to decrease swelling.
• Early physical therapy can help speed recovery.  Treatment often consists of:
  • Modalities such as ice, electrical stimulation, and ultrasound to decrease pain and swelling
  • Walking and exercise in a pool
  • Range of motion exercises to decrease swelling and restore movement
  • Proprioceptive (balance) training to improve joint stability
  • Gradual return to activity drills such as single-leg balance and footwork drills

Plantar Fasciitis

• This condition is among the most common foot problems.  It is an inflammatory condition thought to be caused by irritation of the plantar fascia and its associated nerves and connective tissues
• The plantar fascia is a thick band of tissue along the arch and the bottom of the foot that is needed to support the arch.
• This band of fascia attaches the underside of the heel.
• People with flat feet often develop this condition, but it can also be present with other foot types.

Symptoms

• This condition is usually characterized by pain occurring at the heel on the underside of the foot and near the center of the arch of the foot.
• Pain can be especially severe during the first few minutes of walking in the morning.
• Prolonged walking or running also exacerbate symptoms.
• Pain is usually described as an intense burning on the bottom of the foot.

Treatment

• People commonly do not seek treatment for this condition until it has been present for many months.  Plantar fasciitis often becomes more  resistant to treatment over time.
• Custom-fit orthotics (shoe inserts) are often necessary to improve the biomechanics of the foot and lower extremity.  Doing so decreases the strain on the plantar fascia.
• Modalities such as massage, ultrasound, and iontophoresis (an anti-inflammatory treatment) can be effective.
• A comprehensive lower extremity stretching and strengthening program is very important.  Improving the strength and flexibility of the feet, ankles, knees, and hips help alleviate pressure on the plantar fascia.
• Activity modification is also necessary in the early treatment phase to allow healing to occur.