Foot and ankle pain: Sprain or one of the numerous ankle tendinopathies?

It's easily done. You're minding your own business, you're walking along, you're out with friends, you're increasing your training for the next big race and suddenly you have foot and ankle pain. You must've sprained it, right? A sprained ankle is a very common ankle injury. The word sprain relates to the trauma ligaments have gone through in your ankle. The most common is an ankle inversion injury. Whereby the sufferer has gone over on their ankle, by falling down the stairs, or falling off a kerb or tripping in their stilettos on a Friday evening. However it has occurred, there is what we call a mechanism of injury. In other words, the sufferer has done something they can recall that has led to this pain. But not all foot and ankle pains have this mechanism of injury. Some have a gradual onset and get worse. We call this an insidious onset. Where the sufferer cannot recall anything they've done to cause their pain.

The foot and ankle, despite a small area of the body has more bones, ligaments and muscles than I care to count. It is becoming more and more apparent that the insidious injuries can be tendon related, more specifically tendinopathy related. Below I'd like to draw your attention to other foot and ankle tendinopathies that you may not have heard of. I have blogged before about the pathomechanics of tendinopathies, please feel to read that. I won't recap that here.

Tendinopathies usually occur because the sufferer is doing something to cause the pain but doesn't know what that something is. The most obvious tendinopathy in the ankle is the Achilles Tendinopathy whereby the sufferer, typically runners, have increased their running distance too fast / far too soon. The tendon can't take the load the sufferer is placing through it and causes pain.

Flexor Hallucis Longus tendinopathy

The muscle that bends your big toe

Typically suffered by ballet dancers but also those who need to repeatedly push off from their big toe, ie: runners. It is a tendon strain by effectively being on tip toes for too long. Sufferers tend to struggle to flex or extend (bend / straighten) their big toe.

Tibialis Anterior tendinopathy

The main muscle that lifts your ankle upwards

This is also a common over use injury, typically in distance runners and football players. Sufferers tend to struggle dorsiflexing (bending upwards) their ankle. Sufferers tend to be toe runners and is closely related to Flexor Hallucis Longus tendinopathy.

Tibialis Posterior tendinopathy

One of the muscles that points your ankle downwards

This is the tendinopathy most likely to be misdiagnosed as an ankle sprain, due to the area of localised pain and sometimes having a mechanism of injury.

Peroneal tendinopathy

The main muscle on the outside of your shin that lifts your ankle outwards

This the tendinopathy most likely to be misdiagnosed as an ankle sprain too! Sufferers tend to struggle to lift their foot up and out to the outside (dorsiflexion and eversion).

Tendinopathies are common. They happen to most people. Left untreated, they can lead to disrepair and in extreme cases, a rupture. Just be aware that your ankle problem may not be a sprain. If you suspect any of the above for yourselves or someone close to you, then contact your local, knowledgeable, friendly physiotherapist