FOOT AND ANKLE
Plantarfascitis
What Is It?
From an osteopathic perspective, this condition involves inflammation and degeneration of the plantar fascia, a strong band of connective tissue that runs along the sole of the foot from the heel to the toes. The plantar fascia plays a crucial role in supporting the arch of the foot and absorbing impact when walking. When overstrained or subject to repetitive stress, it can become irritated, leading to pain and stiffness, particularly in the heel.
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How Does It Present?
Plantar fascia issues often manifest as pain in the foot, especially around the inner heel. A common sign is sharp, intense pain when stepping out of bed in the morning, as the tissue tightens overnight and is suddenly stretched when weight is applied. As the day progresses, the pain may ease slightly but can become aggravated again with activity or prolonged standing. Patients often describe the foot as feeling tired, achy, or sore after extended periods of use.
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Why Has It Happened?
A number of factors may predispose someone to developing plantar fasciitis. Tightness in the calf muscles, improper foot mechanics, or a lack of support in footwear can all contribute to excessive stress on the plantar fascia. In osteopathic terms, these mechanical imbalances in the foot and ankle can often be linked to dysfunctions further up the kinetic chain, particularly in the hips, knees, or lower back. Misalignments or restricted movement in these areas can alter gait and posture, putting increased strain on the plantar fascia.
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How Can We Help?
Osteopathic treatment for plantar fasciitis focuses on addressing the underlying mechanical imbalances contributing to the condition. Techniques to release tension in the calf muscles, Achilles tendon, and plantar fascia can help alleviate pain and improve flexibility. Additionally, osteopaths may assess the function of the hip, knee, and ankle joints to identify any compensatory patterns or restrictions that may be affecting foot mechanics.
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Homecare advice, such as stretches for the calf muscles and plantar fascia, the use of a night splint to keep the foot in a dorsiflexed position while sleeping, and footwear adjustments, will support recovery. By improving overall movement patterns and addressing structural imbalances, osteopathic treatment aims to not only relieve symptoms but also prevent recurrence.
Inversion sprain
What Is It?
This injury, commonly referred to as "rolling your ankle," is something most people have experienced at some point. It typically involves a sprain of the ligaments on the lateral (outer) side of the ankle. From an osteopathic perspective, this type of injury disrupts the intricate balance between the structures of the foot and ankle, leading to instability and difficulty in regaining proper function. During the healing process, it’s not uncommon to re-sprain the ankle, as the body works to restore proprioception (the body's awareness of joint position) and the muscles strive to recover movement control and stability in the affected area.
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How Does It Present?
The key signs of a lateral ankle sprain include swelling around the lateral malleolus (the bony prominence on the outer ankle), tenderness when pressing on the area, and pain when attempting to invert the foot (moving the foot inward, similar to how the injury occurred). This may also be accompanied by bruising and limited range of motion in the ankle joint. The discomfort typically worsens when placing weight on the foot or attempting to perform everyday movements.
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Why Has It Happened?
From an osteopathic viewpoint, the structure of the ankle is designed to provide more mobility in inversion (rolling the foot inward) than in eversion (rolling the foot outward). While this allows for effective movement during walking and running, it also creates a greater susceptibility to sprains when the foot rolls too far inward. Though eversion sprains (where the foot rolls outward) can occur, they are much rarer due to the stability provided by the structure of the inner ankle.
Factors such as previous ankle injuries, poor footwear, or uneven surfaces can increase the likelihood of "rolling" the ankle again, especially if proper rehabilitation has not been undertaken after the initial injury.
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How Can We Help?
As osteopaths, we focus on a holistic approach to healing and recovery. Treatment may include manual therapy techniques, such as soft tissue massage to reduce swelling and improve circulation, as well as joint mobilisation to enhance mobility and function. Taping can provide additional support to the ankle during the recovery phase, while proprioceptive training will help retrain the body’s balance and coordination, improving joint awareness to prevent re-injury. Strengthening exercises aimed at restoring muscle function and stability are also crucial for long-term recovery.
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By addressing the overall mechanics of the foot, ankle, and related structures, osteopathic treatment can assist in speeding up recovery, promoting proper healing, and ensuring better long-term stability of the ankle.
Tarsal tunnel syndrome
What Is It?
From an osteopathic perspective, this condition, commonly known as Tarsal Tunnel Syndrome, occurs when the posterior tibial nerve becomes compressed as it passes through the tarsal tunnel, a narrow space located on the inside of the ankle near the heel. This tunnel is formed by bones and ligaments, and any alteration in the surrounding structures can lead to increased pressure on the nerve, resulting in pain and discomfort.
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How Does It Present?
Because the posterior tibial nerve is being compressed, typical symptoms include pins and needles, numbness, and sometimes weakness that radiates into the foot and toes. These sensations may worsen with activity or standing for prolonged periods and may improve with rest. The affected area may also feel tender to the touch, particularly around the inside of the ankle, and in more severe cases, there may be noticeable muscle weakness in the foot.
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Why Has It Happened?
From an osteopathic viewpoint, the root cause is often linked to dysfunctional biomechanics in the foot and ankle. Poor alignment or mechanics, such as fallen arches (flat feet), can place additional strain on the structures surrounding the tarsal tunnel, increasing pressure on the tibial nerve. Conditions like bone spurs or cysts may also encroach on the tunnel, irritating the nerve. Inflammation, swelling from other injuries, or direct trauma to the ankle can further compress the nerve. Osteopathic practitioners would also consider how these foot and ankle mechanics relate to the overall posture and gait of the patient, as dysfunction in these areas can affect the body as a whole.
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How Can We Help?
Osteopaths take a holistic approach to diagnosing and treating Tarsal Tunnel Syndrome. A thorough physical assessment would first be conducted, focusing on the foot and ankle’s biomechanics, alongside specific tests to elicit symptoms and confirm compression of the tibial nerve. Treatment would aim to decompress the nerve and restore proper function to the foot and ankle. This could involve soft tissue manipulation, stretching of the surrounding muscles, joint mobilisation, and addressing any postural imbalances contributing to the issue.
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Additionally, we may provide lifestyle and ergonomic advice, including exercises to strengthen the muscles that support the arch and improve foot mechanics. This holistic approach not only aims to relieve symptoms but also to prevent reoccurrence by addressing the underlying causes of the nerve compression, ensuring long-term relief and improved mobility.
Medial tibial stress syndrome (Shin Splints)
What Is It?
Shin splints, medically referred to as medial tibial stress syndrome, is a broad term used to describe exercise-induced pain in the lower leg. The pain is typically localised to the inner surface of the tibia (shin bone), about halfway between the knee and ankle. This condition can arise from a variety of causes, but in many cases, it is linked to tendinopathy of the tibialis posterior, flexor digitorum longus, or soleus muscles. These muscles play a key role in stabilising the foot and ankle during activity, and overuse can lead to inflammation and discomfort along the shin.
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How Does It Present?
Shin splints usually present as pain or discomfort along the inner side of the tibia, halfway down the leg. Initially, the pain is often triggered by exercise and may subside during periods of rest, only to return after activity or during cool-down. In more severe cases, the pain can persist during everyday activities such as walking up stairs or engaging in general movements. The discomfort is often described as a dull ache but can become sharp if the condition worsens.
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Why Has It Happened?
The root cause of shin splints is often overuse of the lower leg muscles, particularly the tibialis posterior, flexor digitorum longus, and soleus. These muscles work hard to support the arch of the foot and absorb shock during activities like running, jumping, or intense exercise. When these muscles are overworked due to excessive training, improper footwear, or sudden changes in exercise intensity, the repetitive strain can lead to inflammation and micro-tears in the muscle tendons, resulting in pain. Other contributing factors include poor biomechanics, such as flat feet or improper gait, and inadequate recovery between training sessions.
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How Can We Help?
As osteopaths, our approach to treating shin splints focuses on understanding how your body moves and functions as a whole. We assess your posture, gait, and movement patterns to identify any underlying issues contributing to the problem, such as muscle imbalances or joint restrictions. Once the root causes are identified, we use a range of hands-on techniques, including soft tissue manipulation, joint mobilisation, and myofascial release, to alleviate tension and restore proper function in the affected areas.
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In addition to manual therapy, we work with you to develop a tailored exercise and rehabilitation plan that addresses both the pain and its underlying causes. This may include stretches to improve flexibility in the calf and foot muscles, as well as strengthening exercises to support better foot and leg mechanics during activity. We also provide advice on improving biomechanics, footwear, and training techniques to help prevent recurrence and get you back to your activities as quickly and safely as possible.
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By taking a holistic approach, we aim to not only relieve your immediate symptoms but also to enhance your overall movement patterns, helping you remain active and pain-free in the long term.