Lower Leg Pain Differentiation and Self Treatment
As the weather gets nicer, and we get out and start to be more active, the incidence of lower leg, foot and ankle pain start to increase. We will cover a few different sources how to identify them and self treatment to clear them up. There are a lot of different structures that start in your lower leg and go down into the foot and ankle as well as nerves and fascia that start up in your back and connect down into the foot and ankle. So pain in the lower leg doesn’t always mean the problem is where the pain is!
We will start with one of the more common issues: Posterior tibialis tendon dysfunction (PTTD), while it may be a mouthful, this is actually something that you can be experiencing in your lower leg and/or foot, usually due to a sudden increase in activity. Some signs and symptoms of PTTD are difficulty standing on your toes, walking on uneven surfaces, swelling in the arch of your foot or in your inner ankle, flattening of the arch of your foot, and/or notice the inner portion of the soles of your shoes are getting worn out; you may have early stages of PTTD.
Throughout this post, we’ll explain some of the tests that you can do to determine the cause of the pain. To save you some time, we’ll provide pictures and a link to a video for all the treatments.
A quick and easy way for you to further tease out if you have PTTD, is something called the navicular drop test. The test is quite simple, you should be barefoot and begin by sitting. Next, examine the arch of your foot, use a mirror if you must, there should be little to no weight going through your leg and foot at this point. Finally, stand up and examine the arch of your foot again. While it is normal for the arch to slightly flatten upon weightbearing, if there is an excessive collapse of your arch, that can further narrow down the hypothesis to PTTD being the cause of the pain in your foot.
Sitting Standing
Some other conditions that should be ruled out are sciatic nerve tension and achilles tendinopathy. In both cases, it is fairly easy to rule these in or out as the problem.
In the case of nerve tension, all you need is a chair to complete the test. Simply take a seat in the chair, sitting up tall, then kick one leg out so your knee is straight. Next, take note if this reproduces symptoms in the area where you typically have pain. If there is pain in the region, bend your ankle so your toes are pointing up towards your face while still keeping your knee straight. If this increases the pain in the region then there is likely tension throughout the nerves in this region.
The last item to rule out is achilles tendinopathy. This pain tends to be fairly localized and specific to the area that is injured. The achilles tendon is the thick, dense tissue that connects the calf muscle to the back of the heel. If there is a type of tendon dysfunction, you may feel several nodules of dense tissue that are tender to touch, if these nodules move as you point your ankle towards or away from you, you may have achilles tendinopathy, this is referred to as the “Arc sign” test. You may also have tenderness through the calf muscles if you massage them, finally, the first several steps in the morning might be elicit pain in the region
Finally, we’ll go into some treatments and exercises to address the stated issues!
We’ll start with the topic of this blog, PTTD. If you’ve recently been experiencing pain in your leg and foot, you could start with managing the pain during activity by purchasing arch support for your injured side to offload the muscle that is damaged. This is just to use initially; it should not be thought of as a long-term solution to the problem.
Video compilation of all exercises in this post
The first exercise we will ask you to do is the clamshell to strengthen your hip musculature.
Complete several sets of 15 reps of this exercise, while it should be a challenge at the end of the set, we are not looking for you to achieve muscular failure at the end of the set. Repeat this exercise for both legs.
The next exercise is going to be directly working the posterior tibialis muscle. For this exercise you are going to need a long resistance band for resisted inversion.
This may cause minor pain, that is okay, if the pain greatly increases as you perform more reps, then we would ask you to attempt the exercise without resistance. Again, for this exercise, perform several sets of 15 reps.
Finally, the last movement we would ask you to perform is a stretch for the posterior tibialis muscle. Maintain a moderately stretched position for 30-60 seconds for several sets each day.
Next, let’s address the problem from a sciatic and/or tibial nerve perspective. To start, you will want to free up any tissue tension that is causing a decrease in nerve mobility. A good item to use for this would be a tennis ball, or a foam roller if you have that.
Now that the region is freed up throughout the nerve distribution, we can move the nerve around to help mobilize it! This is called a sciatic nerve glide.
You should feel a moderate amount of tension through the back of your leg while doing so. If there is severe amount of tension/pain when doing so, back off a bit and do not straighten out your knee as much.
Last, but not least, we will quickly discuss a treatment plan for achilles tendinopathy. You will initially want to rest and avoid activities that put strain on your achilles, such as running or jumping. For the first week or so, try applying ice to the area for 15-20 minutes, 2-3 times a day to help reduce swelling, make sure that you are using a layer of cloth between the ice and your skin to avoid damaging your skin. Begin with simple calf stretching, you can use the bottom step at a staircase to do so.
Moving on to exercises, one we can start with is called eccentric heel drops.
You can gradually increase to lowering only with your affected foot as your strength builds. Aim for a few sets of 10-15 reps per day, but decrease the amount of repetitions if you experience sharp pain. During this early phase, the goal is to gently stimulate the tendon without pushing through pain, so listen to your body and avoid overdoing it.
None of the tests provided are able to provide you with a guaranteed diagnosis, especially without the help of a licensed physical therapist. If you find that you are continuing to have pain after several weeks of trying these exercises, give us a call to schedule an evaluation. Sometimes these conditions need a little outside help from a skilled Physical Therapist to get you back on track! We’ll dive deeper into some other areas and tests to provide you with more personalized treatments based on your specific findings and goals.