Treatment for Ankle Sprain – San Francisco Podiatrist Union Square CA
Dr. Bill Metaxas discusses the symptoms, causes and treatments for Sprain Ankle.

http://www.footankleinstitutesf.com

SPRAINS
Injuries to the outside of the ankle associated with rolling of the foot are known as ankle sprains.
The ankle ligaments provide stability to the ankle by helping to hold the ankle bone within the ankle joint. The ankle ligaments usually involved in an ankle sprain are also known as the lateral collateral ligaments of the ankle. The lateral collateral ligaments of the ankle are comprised of the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament.
The lateral ligaments provide stability to the ankle throughout the gait cycle as the foot bends up and down. Therefore total lateral stability of the ankle is provided by these three ligaments.
The most anterior (front) and most frequently injured of these ligaments is the anterior talofibular ligament. This ligament is intracapsular, or blended and contiguous with the lining of the anterior lateral aspect of the ankle capsule (joint). It can be seen as a fibrous thickening of the lining of the joint and courses from the front of the fibula to the front of the lateral surface of the talus.
The main function of the anterior talofibular ligament is the prevention of axial or rotational instability of the ankle. During gait as the heel is coming down, the foot is held in a dorsiflexed (up) position. Essentially the foot is pivoting on the edge of the heel only. Any irregularity in the ground, or laterally directed force, will cause the foot to twist in or out depending on the orientation of the force. Similarly, when we push off, the foot is in a plantar flexed (down) position. As the foot is plantar flexed, the position of the foot increases the long axis of the leg and increases the torque on the ankle region. Any ground irregularity or laterally directed force will cause the foot to twist in or out depending of the orientation of the force.
Classification of Injury
Rolling in of the foot (inversion), with the sole of the foot towards the opposite leg, is defined as a lateral ankle sprain. There are several classifications of this injury. A simple definition of injury breaks the injury down in terms of physiologic injury: sprain, strain or rupture which define the extent of stretching and A second classification of injury of the lateral collateral ligaments of the ankle is known as Grades 1, 2, or 3. This classification describes the functional loss of the ankle and the resultant grade or level of injury.
The end result of injury of one or more of the lateral collateral ligaments of the ankle is ankle instability. This instability can show up initially as a result of the severity of the injury or later as a result of chronic ankle instability.
During the moment of injury, due to the instability caused by the injury, movement and twisting of the Talus (ankle bone) in the ankle joint resulting in bone to bone compaction and twisting of other ligaments, tendons and nerves may occur. Injuries beyond the level of the ligaments themselves can occur and will occur depending of the level of injury. MRI, CT scans, bone scans and electro-diagnostic testing may be recommended to evaluate for these secondary injuries.
Chronic Ankle instability occurs much later than then original injury. Once the lateral collateral ankle ligaments are injured, they no longer provide the ability to stop ankle twisting and to hold the Talus within the ankle joint. As you walk or run with an unstable ankle, the talus can twist within the joint and partially come out of the joint. This movement is unnatural and abnormal and redirects force to the outside of the joint. With an increase in joint load to the outside, the foot will roll to the inside producing further tearing of the ligament and further injury.
Treatment
Conservative treatment for this condition depends on the necessity to stabilize the foot to restore the anatomical position of the ankle ligaments. The often noted RICE formula (rest, ice, compression elevation) is the standard initial treatment. Any treatment provided is to allow the ligaments to heal in the correct position and at the correct length. Depending on which ligaments are injured and to what degree the ligaments are injured, your doctor can provide you with the best ankle brace to stabilize your ankle.
Supplemental treatment for secondary injuries incurred at the time of injury will be diagnoses and treated at the same time as the treatment for the ankle ligaments.
Surgical Treatment
Surgical treatment of the ankle ligaments or associated injury conditions are performed when instability develops later or the injury is severe enough initially that stabilization must be done to allow for proper healing.

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Heel Pain – Podiatrist Torrance, Redondo Beach, Palos Verdes, CA

Dr. Robert Anavian discusses the symptoms, causes and treatments for Heel Pain.

http://www.anavianfootcare.com

Heel pain, Heel Spurs and Plantar Fasciitis

A common foot complaint is pain in the bottom of the heel. This is often referred to as heel spurs or plantar fasciitis. It commonly is painful the first few steps in the morning or after rest. It tends to get worse the longer one stands during the day. It is caused by subtle changes in foot structure that occurs over time. These changes result in the gradual flattening of the arch. As this occurs a thick ligament (the plantar fascia) that is attached to the bottom of the heel and fans out into the ball of the foot is stretched excessively. This ligament acts as a shock absorber while walking. As the foot flattens it stretches. If it stretches too much it gets inflamed and causes pain. Over time the pull of the ligament creates a spur on the heel bone. It is important to realize that it is not the spur that causes the pain and therefore the spur does not need to be removed in most cases. This condition may also cause generalized arch pain called plantar fasciitis. This is an inflammation of the plantar fascial ligament.
A common factor that contributes to this condition is tightness of the calf muscles. Women who wear high heels and people who walk for exercise will often develop this problem because of the tightness that results in the calf muscle as a result of these activities. A non-supportive shoe also contributes to this problem. Weight gain is another factor in developing heel pain.
Home Treatments
Stretching
Calf muscle stretching is very useful. The typical runners stretch by leaning into a wall is helpful. An alternative method of stretching is to stand approximately two feet from a wall. Facing the wall turn your feet inward so you are pigeon toed. Lean forward into the wall keeping your heels on the floor and the knees extended. Also keep your back straight and do not bend at the hips. Hold the stretch for 10 seconds and do the stretch ten times in a row. Do the stretching three times each day. Always stretch the calf muscles following any form of exercise.
Over the Counter Arch Supports
Wear a supportive sport or walking shoe. This can be supplemented with a good over the counter arch support.
Oral Anti-inflammatory Medications
Medications like Advil, Tylenol, or Aleve may be of some benefit. Always read the medications directions and warnings before use.
Professional Care
If the heel pain persists your foot doctor may suggest a cortisone injection, taping the foot to support the arch, night splints to stretch the calf muscles at night while you are sleeping or functional foot orthotics. On occasion surgery may be required to cure this condition. Orthotics should be tried before surgery and should be used following the surgical procedure (See surgical treatment of plantar heel pain).

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