Active Seniors

How long do injuries take to heal? Part 1 – ankle and foot

Some discomfort during and after exercise is normal and usually signals that the body is increasing it’s tolerance and tissue strength. However when this pain is sharp, severely affects your ability to move the area, and stays longer than 2-3 days after it first occurred it can be a sign of an injury to the area. This will be a multi series article covering the common injuries to the body, how long they take to recover from and some simple steps to make that recovery as smooth as possible.

Before we dive into the specific injuries, it is very important to understand that the recovery process is almost never linear. While the pain will settle and your function will return, most people still experience some “bad” moments/ days along the way. This is most often due to the tissue improving it’s tolerance but still not quite being back to normal, meaning it cannot yet withstand what would be seemingly normal loads. It can also occur when other stressors that affect recovery are present such as poor sleep, substances such as alcohol, poor food choices and of course stress itself. When these temporary lapses in recovery occur, it is important to keep your overall progress in mind. You may be having a more painful day than the previous day, but you are still most likely much better than where you were in the weeks before.

In this article we will start with the foot and the ankle area. One of the biggest challenges with injuries in this area is the difficulty in finding the right level of load to assist in recovery but to ensure that the body is not overloaded. All of the injuries to these areas (aside from fractures) require a certain amount of load to promote healing. As we load our feet and ankles all the time to stand and walk, it is easy to forget that these activities create some level of stress and need to be balanced out with specific rehabilitation based loading.

One of the common areas that is affected in this area is the plantar fascia. Injury to this area is characterised by heel and/or arch pain that is worse first thing in the morning or after periods of sitting. The plantar fascia is tissue that runs from the heel to the base of the toes and supports the arch of your foot as well as helping with the dispersion of force when we are walking. Injury to the plantar fascia is usually a build up of repetitive stress over time causing micro-tears and resulting irritation. It can settle on its own, however the typical time that symptoms last (without treatment) can be up to 18 months. Management involves specific exercises for the foot, managing the mobility of the tissues around the foot and ankle and sometimes other lifestyle changes such as weight loss.

Another common injury in this area is an ankle sprain. Ankle sprains are usually called inversion sprains as it almost always involves the body rolling over the outside of the ankle due to the anatomy of the joints. Pain is usually felt on the outside of the ankle and foot area and there is almost always some level of swelling around the outside of the ankle. Where there is ligament damage there can also be bruising in these areas as well. In some instances there can also be a small break in the bone on the outside of the leg.

Ankle sprains are graded according to their severity. A grade 1 sprain is a minor strain to the ligaments that usually resolves in between 1-4 weeks. A grade 2 sprain involves partial tearing of the supporting ligaments that can take up to 12 weeks to resolve. A grade 3 sprain is a complete tear of the supporting ligaments that can take between 3-6 months to resolve. Grade 2 and 3 sprains can cause problems in the future with poor stability and balance in the ankle, as the ligaments are one of the primary restraints to certain ankle movements and when they are damaged they often stretch beyond their existing length. Early movement of the ankle (where practical) and balance exercises are important in the management of ankle sprains. Balance exercises should aim to train the ankles to withstand forces from different directions.

Finally, a common area that can get injured is the Achilles tendon. The Achilles tendon is a large spring like structure that makes walking and running efficient by storing and releasing energy. It connects to the calf muscles at the back of the leg and runs underneath the heel, causing the ankle to point and propelling the body forward when walking. The Achilles tendon is usually subject to repetitive stress and the tendon itself can become irritated when the tension in the tendon exceeds its capabilities and recovery time is inadequate.

Repetitive overuse, causing injury to the Achilles tendon causes irritation in 2 areas. The most common place is in the middle of the tendon, around 4-5cm above the heel. Appropriate management of this type of irritation involves using exercises such as calf raises, to build the resilience of the tendon. It is also important to modify any aggravating factors and to ensure recovery after loading is appropriate. This type of irritation can take up to 12 weeks to settle down.

The other area of the Achilles tendon that can be irritated is at the insertion to the heel. Pain will be localised to the back of the heel itself, and this type of injury takes much longer to settle and is a little bit more involved in the early stages of rehabilitation. In these early days, calf raises are still a part of management but never letting the heel drop lower than ground height. In addition, exercises such as lunges and squats usually need to be modified and stretching the ankle will usually irritate the condition further. Unlike the mid portion, irritation to the insertion can take between 6-12 months to settle.

In the next article we will look further up the chain to the knee and hip.

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