Hi, this is Dr. Steve Gangemi. And in this video, I want to discuss some ankle and foot injury issues. We are going to talk about assessment and treatment of the foot and ankle starting here in part one with the ankle, and then in part two with the foot. So the ankle is one of the most commonly injured areas of our bodies. Runners injure them, people jumping and climbing, you land, you step down wrong. Ankles roll really easy, especially if your ligaments have been weakened over a period of time which we’ll discuss about a little bit later. But ankles sprains and strains are kind of the same thing. You can really never just sprain or strain an area. You kind of sprain the ligaments and strain the tendons.
And what I want you to think about when you actually injure these areas is not to worry so much about addressing the actual area that feels inflamed or the area where you have actually perhaps torn some of the ligaments. Because these areas will heal up really well if you deal with and treat the areas that are more powerful of your lower leg. In other words, for this the calf muscles and an important muscle called tibialis posterior that helps with the function of your foot and lower leg when you’re walking, when you’re running, when you’re jumping. So we learned earlier in or actually in another video what to do when you get injured and why you shouldn’t ice and why you shouldn’t necessarily stretch out these areas. But you actually use compression when you injure an area. And the same concept goes for any area especially the ankle. So let’s get into that.
So when you injure your ankle, you obviously pretty quickly know it. You know you rolled wrong or you rolled your ankle, you landed in a hole, you stepped in a ditch, that sort of thing. And next thing you know your ankle is black and blue. And one of the first things you can do is just to compress that area. You can wrap it, it’s good to elevate it like we talked about earlier. And use, try and keep your ankle as mobile as you can without causing too much excruciating pain. Obviously, as with any injury in your body, if you’re not quite sure of the extent of the damage that’s done there, have it checked out by your doctor to make sure that you didn’t break something. You don’t want to trying to treat this and assess it on your own and realize several days or weeks later that it’s been broken the whole time or there’s been a bad tear in the ankle if it’s not healing up.
So again, as always, be smart with checking yourself out with these things. But rather than poke around where there’s lots of ligaments on the inside of the ankle here or the outside, typically where it swells up a lot, I want you to think about the calf muscles that support and control a lot of the foot and lower leg ankle stability. And therefore, if they’re working really well, if they’re not fatigued, then the ligaments can heal up a lot faster. Obviously, the ligaments connect the bones together. So your ligaments is sprained or your tendon is strained will heal faster than it might not if otherwise. So we’re gonna use some compression starting about halfway down the lower leg here on the back of the calf with our thumbs in a squeezing like motion. Look for any tender spots here, especially where the meaty part of the calf starts to get a little bit narrow. And basically rub out those tender areas, squeeze the calf, and poke around for any tender areas that you feel in there. Hold them or rub them out for anywhere from 10 to 30 seconds.
And just like I’ve shown in some other videos, if you hold them and move your ankle maybe where it’s been hurting, so if I…if the inside of my ankle hurt when I was turning my foot in like this and I hold here and I move my ankle again like that and it feels a whole lot better, then I know I can really get in here and work out some of these trigger point area where my ankle…to help support my ankle where those muscles have actually been injured even way up here where I’m actually trying to work harder to help support my foot and lower leg ankle type injury. And again, so when you typically injure ligaments and tendons and muscles, the connective tissue spreads apart, the fascia tears a little bit. They separate and we want to try and put those back together so they can heal up quickly and help our body get rid of that injury as quick as possible with compression trigger type therapy.
So the next thing I want to address is more of a chronic type injury that many people experience, especially runners, people who are jumping and moving a lot. Hopefully, you are. And that’s Achilles tendinitis, one of the most common running movement type injuries we see in the lower leg foot area. Or ankle area, I should say in this case. Most people know that their Achilles tendon is the extension of their calf muscles, the tendon attaching to the bone, attaching to the back of your heel bone, also known as your calcaneus. And this tendon becomes very inflamed or chronically weakened over time. And then you’re given the diagnosis Achilles tendinitis meaning inflammation of that tendon, or tendinosis which is sort of like a chronic injury, inflammation, weakening of that joint. Sorry, of that tendon. So Achilles tendinitis or Achilles tendinosis.
So the trigger points and the muscle compression points to work for the Achilles tendon here are going to be the same for the ankle sprain and strain issues that we just discussed, with the exception that they’re probably just a little bit lower, more on the narrower part of your lower calf also known as your soleus muscle. So you’re gonna look for those points way down here and not where it’s tender in your Achilles tendon. I rarely have to work somebody’s Achilles tendon to help them recover from Achilles tendinitis or any Achilles issue, with the exception sometimes maybe on the inside of the tendon right in here, right where there’s a little bit of a groove. Or on the outside of the tendon here but not directly on the tendon. So even if your Achilles tendinitis…obviously if it hurts and you’ve been given that diagnosis, that’s where the issue is. But stay off the actual tendon here and come up about maybe two inches, and work your way up right in mid-line with that tendon. And typically there’s a really hot spot in there that you are going to want to hold and put some pressure on to help heal up that Achilles tendinitis issue.
So a common conventional therapy for Achilles tendinitis is to put a heel lift in the foot because when you…in the back of your shoe. Because when you elevate the heel a little bit, you tend to take some of the stress off the Achilles tendon. And actually many people today getting into the barefoot minimalistic type movement are actually injuring their Achilles tendon because they’re going too fast and too quickly from a thick heeled show into a thinner shoe or even walking around barefoot. Which is absolutely great and I personally believe the best thing to do, to walk naturally and move naturally with absolutely nothing between your foot and the ground. However if you do that too quickly then you’re basically taking a shortened tendon and you’re trying to naturally elongate it as you go more towards barefoot. So you can end up creating an injury that way whether it be ankle instability or Achilles tendinitis type issues.
And therefore, people use the opposite to raise the heel a little bit of the ground or have someone wear a shoe or a type of footwear with a little bit of heel in it to take some of the tension off the Achilles tendon. This is definitely fine to do if you notice that your Achilles tendon hurts more when you’re walking barefoot, or in a flat type shoe where there’s no differentiation between the heel and the ball of your foot. In other words, the shoe is completely flat. That’s fine to use it to get you out of pain and get your Achilles healing faster. But eventually as it heals up and you’re feeling better you should work your way back down into the most minimalist type shoe you can use so the Achilles tendon is in a naturally strong position and it’s functioning as normal as possible and you’re not unnaturally shortening the tendon.
One final quick thing I want to mention on tendon issues, Achilles tendinitis issues, and ankles sprains and strain, when you’re injuring the…or if you’ve injured the ligaments of your ankle and they tend not to be healing up as quickly as you’d like, obviously everyone wants them to heal quicker. But if they’re healing up really slowly and someone can’t figure out why, it has a lot to do with hormonal balance in your body. And when your stress levels are too high, and I’ve talked about this in some other videos, then cortisol levels actually tend to…high cortisol levels from too much stress in your body, this is an hormone that your body makes, tends to weaken ligaments and cause, they causes like a ligament laxity over time where the ligaments aren’t responding properly to the normal amount of stress even if it’s just walking and of course, jumping and even more powerful type movements. And the foot can’t respond properly, so the ligaments don’t heal if you’re under a lot of stress.
And especially for women, there is a strong link between weak ligaments especially of the knee but even the foot and wrists too, but think about the ankle high area of ligaments there, strong link between women and estrogen issues, estrogen metabolism problems, high levels of estrogen in other words with weakening ligaments of the foot. So if your hormones are off, if you’re having PMS issues, if your estrogen-progesterone issue isn’t just as it should be, then that’s why women tend to be more susceptible to rolling their ankles, whether they’re landing wrong or landed just improperly at the time, or they’re running and roll an ankle. It has to do with hormones and it’s something to look into there.
So one of the easiest therapies that you can do right at home and it’s free to help rehabilitate your ankle and lower leg is walking around barefoot, just as I am right now. Basically just walking and standing barefoot will help to strengthen and rehabilitate the ligaments, tendons, and muscles of your lower leg. If you can do that comfortably or once you can do that comfortably then try to balance on just on one leg, or on one foot like I am right now. Basically nice and straight, strong as a tree trunk. There’s no wobble in my ankle. Wobble boards, however, are actually good for this, if you have a wobble board or a balance board where you can really try and catch up with the motion of the board and try to stabilize that. Those are great type of devices to use. But you can just use your own balance and just see the difference between your injured ankle or your non-injured ankle. Or even do this if they’re not injured, just to help strengthen your ankles.
And then once you can do this really easily, do it with your eyes closed. And you should be able to do it just as long and just as solid. Keep it just as solid as with your eyes closed as they are when they’re open as I am right now. Once you can do that then try and do a really slow calf raise up and down. Really controlled, so I’m not all over the place. I’m just going up, holding it, and slowly raising my calf. And I’m not bouncing or landing hard on my heel. You’ll feel it in your ligaments and the tendons around your ankle and your calf. And it’s a great way to not only help rehabilitate but also strengthen to prevent further injury from reoccurring.