This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Achilles Rupture
The 2 main calf muscles that allow you to rise up onto your toes and jump are the gastrocnemius and soleus. The tendons of these 2 muscles combine to form the Achilles tendon which attaches to the back of the heel. This tendon can tear or rupture. This can happen if too much stress is put on the calf muscles or too much of a pull is put on tendon by foot being bent backwards too much. If there is a deep cut to the back of the leg this can also injure the Achilles tendon. Symptoms include immediate pain and a feel of having been kicked in the back of the leg. You may not be able to put weight on the leg or if you can you will not be able to walk properly and rise up onto your toes/walk on your toes. Your physiotherapist will be able to perform special tests to diagnose if this has happened. If suspected immediate attention by a specialist foot and ankle surgeon that we can recommend to you is required. If not seen straight away you are unlikely to recover as well. The consultant will decide whether to repair your tendon surgically or conservatively by wearing a supportive specialized boot.
Physiotherapy is extremely important following this injury to ensure the best rehabilitation is carried out. We have devised information leaflets and protocols of what to expect during your rehabilitation – please refer to post surgery physiotherapy.
Achilles tendinopathy
This is pain in the Achilles tendon as described above which may start suddenly or gradually. The pain can be in the middle of the tendon, at the top of the tendon where it inserts into the calf or at the bottom where it attaches to the back of the heel. It normally occurs with an activity that involves walking or running and becomes worse as you continue. There can be a swelling where the pain is.
Physiotherapy can be very effective for this condition. Treatments that can help are soft tissue therapy, working on tight or weak muscles that may be contributing, advising on footwear and insoles and correcting any issues with your walking or running style. A very effective rehabilitation programme has been developed by Alfredson et al (1998) which they can take you through. If physiotherapy is not effective we can recommend a top foot and ankle consultant to review you. There is a new treatment called electroshockwave therapy which has been found to be effective for this condition and your consultant will be able to provide this or alternatively we can recommend where to have electroshockwave therapy done.
Posterior impingement
Pain can occur in the back of the heel due to impingement and normally happens when you rise fully onto your toes and repeat this action. There can be a formation of bone within the ankle or the presence of a bony structure called an 'os trigonum' which can cause the impingement.
Physiotherapy can perform special tests to determine if this is the cause of your pain. Treatments that can help include mobilizing other joints in the foot and ankle, correcting your sporting technique and advising on how to reduce any inflammation. If physiotherapy is not effective we can recommend a top London foot and ankle consultant to review you.
Accessory soleus muscle
This small mass of soft tissue being present between the end of the tibia (leg bone) and Achilles tendon is very rare. It causes pain in the Achilles when exercising with swelling. If this is suspected by your physiotherapist they will recommend a review with a top London foot and ankle consultant.
Other ankle fractures
Fractures of other parts of the ankle will tend to cause pain throughout the ankle and a lot of swelling. If you have injured your ankle and have a lot of swelling and pain and standing on the leg is difficult without pain, we advise you seek urgent medical attention to confirm if you have sustained a fracture to the ankle. We can recommend top London foot and ankle consultants to you. If you do have a fracture it is likely you will have to have the ankle joint fixed in a cast or boot for a period of time. Physiotherapy is important during this time to maintain strength in the rest of the leg. Following removal of the cast or boot physiotherapy is vital to regain full movement, strength and stability around the ankle and help you return to activities you were doing before the fracture.
Osteoarthritis and Rheumatoid Arthritis
Osteoarthritis can occur in any joint in the body and is a the process of 'wear and tear' where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. Affected joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.
We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment that includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function.
Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmmes, massage, taping, acupuncture and mobility programmes.
We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:
- Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
- Wheelchair assessments
- splinting
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants to help you.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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