Talking about management
now for ankle sprains in particular,
one of the keys, and I think this could
come up on your examination,
would be early mobilization with
range of motion exercises.
Of course, ice is important.
We know that a more serious brace,
either an Air-Stirrup or a lace-up brace
provides superior results to just wearing
an elastic compression sleeve alone.
So, that’s something to consider.
For ankle sprains in particular,
acetaminophen is about as effective
as NSAIDs and probably safer.
And then, certainly think about physiotherapy,
particularly for that patient with a
second or even third ankle sprain.
They definitely need to start working on
preventing the next episode of ankle
sprain because it’s most likely to come.
Therefore, some muscle
strengthening and stretching as well.
In those other conditions, talking about management,
workouts that involve
hills – so going up hills,
using stairs or interval workouts where
they take a rest and they go again
makes that tendinitis worse.
So, those should be avoided.
For physical therapy,
strengthening of the calf musculature is important to
help strengthen and protect that Achilles tendon.
For peroneal tendinitis,
which also produces something of
a more lateral type of ankle pain,
there’s evidence that lateral heel wedges and
ankle taping don't necessarily help healing.
But a strong commitment to physical therapy,
with range of motion and strengthening,
can help these patients.
And then eventually, some of these patients
might actually need surgical repair as well.
And so, let's look at plantar fasciitis.
The good news is, as common as it is,
most patients do fine with
just conservative treatment only.
So, that includes stretching on a routine basis.
I recommend it at least twice a day.
Deep myofascial massage to work
out that stretching and inflammation.
Analgesics can be effective for the short term.
And then using an ice massage is helpful as well.
In terms of next steps of therapy for plantar fasciitis,
I often will recommend just simple orthotics
to try to take some of the pressure off the plantar fascia.
Doesn't have to be something custom,
at least at first for straightforward cases.
I recommend over-the-counter
because they are so much cheaper.
And still highly effective.
For those patients who break through,
that 10% who don't do well in conservative therapy,
it’s time to consider injection therapy.
It’s usually fanned out over three
anatomical sites in the plantar fascia.
It is superior in research to be better than
dry needling or just lidocaine by itself.
There is some risk, though, with these injections of
plantar fascia rupture, which is a devastating condition.
And I should mention here as well that
you never inject the Achilles tendinitis
because of the risk of
rupture of the Achilles tendon.
And then finally, for severe cases of plantar fasciitis,
think about extracorporeal shockwave therapy
and some of these patients
need to go to surgery as well.
So, with that, I’d say that we have a bunch of
different conditions that can affect the foot and ankle.
A good examination and a history as
to where the location of that pain is
and how much it affects our function is key.
Ottawa ankle rules for avoiding
unnecessary use of x-ray also key.
And therapy tends to involve conservative
treatment for the majority of these conditions at first.
But think about getting physical therapy involved
probably sooner rather later
for these conditions as well,
particularly if there's a chance for recurrence.
Thanks very much.