Ankle and Foot pain
Did you know your two ankles and feet contain 25% of the bones found in your entire skeleton? Given that they are critical to our mobility and we spend so much time on them it is important to keep them happy and maintain them properly.
Chances are good that someone in your family has twisted, tweaked or sprained an ankle at some point. Most of us know to place an ice bag on the joint, elevate it, and keep the weight off as long as possible until it “heals”. (See post on ice application for more). After the pain and swelling go away we think all is well. Unfortunately often an inheritance of adhered ligaments and tendons survives the ordeal to be resurrected as foot or knee pain in the future. We have encountered many clients over the years who sprained an ankle in their past and neglected to report it on their health history. Unless a scar is left behind we tend to forget such incidents since we survived them and have moved on. However, many times the ghosts of ankle sprains past come back to haunt us as knee, hip or even shoulder pain.
An ingenious feat of engineering, the 26 bones of each ankle and foot are responsible for supporting the entire weight of your body while giving you the flexibility to walk on all types of surfaces. There are 7 tarsal bones; 5 metatarsal bones; and 14 phalanges in the toes. We do not count two small round sesamoid bones found on the bottom of the big toe although they are important in proper movement of the big toe.
You were born barefoot, and that remains the most natural way to walk. Humans have chosen to dress their feet in all manner of foot wear, some of which do harm to the natural contours and gait mechanisms designed into the foot structure. Add on to that the occasional ankle sprain or toe stubbing and you may end up with a walking pattern that is quite different from the one you were born with due to compensations made for the pain associated with the injuries. Scar tissue has a habit of gluing tissues together and decreasing the range of motion of the tissues and joints. Trigger points develop in the muscles when they are overused or used in movements they were not designed for.
Ask most people to move their ankle joint and they will point the toes down (plantarflexion), point the toes up toward the knee (dorsiflexion) and make a circular movement with foot (circumduction). The actual ankle joint is classified as a hinge joint, a type of synovial joint. The only true major actions at the ankle are dorsi and plantar flexion. The circumduction movement happens in the other tarsal bones making up the “subtalar” joint. The ankle is made up of the ends of the two long leg bones (tibia and fibula) and the talus bone of the tarsal area (Fig A). The ends of the tibia and fibula forma square shaped “hole” into which the peg-shaped talus bone fits. It is a structurally strong and secure arrangement given that almost the entire weight of the body is passing through the joint on its way to the foot. The bones of the ankle joint are held together by numerous ligaments. The main ligaments bind the fibula and tibia to the talus and calcaneous (heel bone). They are found on the inside and outside of the ankle. When the ankle rolled, twisted or otherwise moved forcibly these ligaments can be stretched or torn. Inversion sprains are most common and occur when one rolls the ankle to the outside edge of the foot. The ligaments connecting the fibula to the talus and calcaneous are most affected. When the ankle is rolled to the inside edge of the foot (less common) the deltoid ligament connecting the tibia to the calcaneous and talus bones is most affected. Keep in mind that there are also muscle tendons passing over the ligaments as they cross the ankle joint. It is common for adhesions and scar tissue to bind these tendons and ligaments together when the ankle is sprained and immobilized. Separating these structures to restore full mobility is a benefit and goal of massage to the ankle joint after a sprain has healed.
The tarsal bones of the foot are designed to form 3 arches (medial longitudinal, lateral longitudinal and transverse) which together with the metatarsals and phalanges support the weight of the entire body. The joints or articulations between the various tarsal bones are classified as gliding joints in that their joint surfaces tend to be flat and slide or glide in relationship to one another. The bones are held together by ligaments and the movements are rather limited.
Muscles from the back of the leg (calf area) attach to various of the tarsal bones as is the case with the tibialis posterior in the deep posterior compartment of the lower leg. The tendon of the peroneus longus muscle passed under the cuboid bone and attaches to the medial cuneiform along with the tibialis anterior from the front of the leg. The position and movement of several of the tarsal bones can be affected by tendons passing under or around them. This is why massage of the lower leg muscles is important when working with foot and ankle discomfort.
Flat feet or fallen arches are a result of poor medial arch structure and support. A thick band of connective tissue, the plantar fascia, connects the heel bone (calcaneus) to the metatarsal bones of the toes and can result in foot pain, immobility of the arches of the foot. Heel spurs can develop from tension forces being exerted on the front of the heel bone. Inflammation of this fascia is called plantarfasciitis.
Metatarsals and phalanges
The five metatarsal bones join with the tarsal bones at the proximal end (closer to the ankle) and do not move much at these joints. At the distal end where they join with the phalanges of the toes there is more movement available. The metatarsal bones are part of the medial and lateral longitudinal arches of the foot helping to distribute the weight of the body when standing, walking and running. Sometimes the first metatarsal bone of the big toe can become misaligned and contribute to bunion formation. Another misalignment of the metatarsals occurs when one or more is positioned lower than those adjacent. This can be termed a “dropped” metatarsal. Often a thickened callous will form on the bottom of the foot under the affected metatarsal. It can be painful to put pressure on it. One of the contributing causes is footwear where the toe box is too narrow forcing the metatarsals and phalanges of the toes to become crowded. Spiral Synergy addresses dropped metatarsal bones by exaggerating the position of the bones and applying a compression force in the direction of the tarsal bones. This technique is demonstrated on the Spiral Synergy instructional DVD for the leg.
“Hammer toes” and “claw toes” are misalignments in the foot involving the phalanges of the lateral four toes (all but the big toe). The middle phalange and distal phalange are often involved and any of the 3 bones in each toe can be affected. Poorly fitting footwear can be a contributing cause. Muscle tension in the deeper muscles in the back of the leg (calf area) are involved along with small muscles deep in the bottom of the foot. Massage of these muscles and the fascia that surrounds them can help relieve the pain and discomfort associated with the condition.
Pain in the metatarsal area can also come from trigger point activity in the muscles of the calf and front of the leg. There are also muscles on the top and bottom of the foot that cause referred pain into the metatarsal area.
Massage therapy can loosen up scar tissue and the associated gluing of tissues, release trigger points and restore mobility. The muscles of the leg, which arise from the bones below the knee (tibia and fibula), are responsible for the many movements available at the ankle, the tarsal joints, the arches of the feet and the toes. When these muscles become tight they can cause pain and restrict the movement available in the foot and ankle. Pay particular attention to the tibialis anterior muscle lying adjacent to the shin bone on the outside. It can refer pain into the big toe. On the back of the leg the prominent calf muscles are the gastrocnemius and soleus which combine to form the achilles tendon attaching to the heel. While it is important to keep these muscles loose and stretched out the three muscles lying underneath these two muscles operate the toes and support the arches of the foot. They are frequently overlooked due to their deep location in the back of the leg. Bend the knee to slacken the superficial calf muscles so you can press deeper and feel the tension in those deep leg muscles.
While there is only one muscle on the top of the foot, it can cause pain symptoms on the top of the metatarsal area. The bottom of the foot has several layers of muscle which serve to move the big toe and the other four toes. Start with the most superficial layer and as the muscles relax press progressively deeper to reach the deepest muscles. They can cause foot and toe pain and contribute to the boney
There are a variety of instructional massage DVDs availble on this website
These natural plant derivatives can be applied to the area of discomfort directly or diluted in vegetable oil and massaged in. Some oils are good for relaxing muscular tension (basil, marjoram, idaho balsam fir, wintergreen, peppermint) and others are well suited for supporting boney structures such as joints (cypress, wintergreen, balsam fir, spruce, juniper, cedarwood). There are some Young Living essential oil blends prepared to address soreness and pain such as Aroma Siez, Deep Relief, Relieve It, Panaway and Stress Away. Learn more about essential oils by watching a recorded presentation on this website.
In Reflexology theory foot pain and tension is often associated with imbalance in organs and body areas that correspond to the reflex areas you are pressing on. If you are experiencing discomfort in a specific area of the foot or ankle you can refer to Reflexology charts to discover the body system associated with the area. Then you can apply reflexology techniques to help restore balance.
This gentle, painless approach to releasing foot pain and discomfort relies upon moving the various ankle and foot bones around to feel for the direction that creates the most comfort and alleviates the pain. Once these positions are found compressive or slight pulling forces are applied to stimulate nerve receptors in the muscles and joints which communicate with the brain and result in brain signals to restore normal tension levels to the structures. These techniques are demonstrated in instructional DVDs available on this site.