The foot and ankle help us to absorb the forces that result when our feet hit the ground (ground reaction forces). The foot and ankle also provides the brain with tons of sensory feedback about the environment around us. If you have ever experienced pain in this area you know getting around can be much more difficult. There are many types of injuries that can occur in this region of the body, some injuries are more traumatic such a sprain, while other injuries can gradually develop into a debilitating pain for no apparent reason, like plantar fasciitis. In all cases, it is important that you have your pain assessed by a trusted physiotherapist or chiropractor. The earlier you that you seek treatment the faster you will gain pain relief and the less likely you are to develop compensation strategies creating further problems up the kinetic chain like into your knee, hip and even your spine.

What Makes the Foot and Ankle Unique?

The foot and ankle are made up of multiple joints that work together but also function independently. The foot is built this way to adapt to the grounds surface as well as allowing it to act as a lever for force and energy.

The foot is divided up into four regions of joints

  • The ankle joint:

    The large joint at the top of the foot responsible for connecting the foot with the lower leg and contributes to extension (lifting the foot) and flexion (pointing of the foot).
  • The subtalar joint or the hindfoot:

    It sits below the ankle joint in the heel and helps the foot to move inwards and outwards.
  • The mid tarsal region or midfoot:

    It is the top of the foot where the largest arch is. Here there are five bones that interact to allow your foot to scoop and splay.
  • The forefoot:

    It consists of the long bones of the foot and toes commonly known as the ball of the foot.

There are numerous ligaments, smaller muscles and long tendons coming down from muscles in the lower leg that help to control movements in the ankle, foot and toes. There is a large connective tissue band called the plantar fascia that expands the bottom of the foot. All these bones and soft tissues are closely interconnected to each other and all work together to allow your foot to function with proper mechanics.

What are the Causes of Foot and Ankle Pain?

Ankle Sprains

This is the most common foot/ankle injury we treat at Sunup Physiotherapy. When the ankle rolls inward or outward and is taken past its normal range of motion the ligaments can be stretched beyond their capacity. These can also result in strains of the muscles, or even fractures to bones.

Ankle Fractures

There are multiple ways to fracture the foot. Most commonly, a fracture will occur with a traumatic event, like a severe sprain or fall. There is also a risk of developing a stress fracture from repetitive loading in a dysfunctional manner. In some cases, you may be placed in an ankle boot and be instructed to avoid weight bearing for a period of time until the bone starts to heal. In other cases, the fracture may call for a surgical intervention as there can a crack in the bone that has shifted or even bone fragments that need to be repaired with pins, screws and plates. Your orthopedic specialist will request an X-ray if they think you may have a fracture and will use the X-ray results together with their expertise to make a decision regarding surgery. If you have traumatically injured your foot or ankle and are unable to put weight through the injured ankle (i.e. stand up and put pressure), it is very important that you be seen by a doctor as they may require an X-ray to evaluate the bones of your foot.


This is a term used to describe inflammation of the sesamoid bones at the base of the big toe. These bones about the size of a kernel of corn and are floating bones imbedded under the big toe (one on either side) within the tendons. Their purpose is to improve the force transmission through the tendon during the “push off” phase of gait when the toe is extended. If the tendon and bones are being subjected to repetitive forces, they can become warn, swollen and irritated making it painful to push off the big toe.

Tarsal Tunnel Syndrome

The tarsal tunnel is the name of a pathway on the inside of ankle area above the inner ankle bone where tendons and the tibial nerve travel. It is protected and contained by a strong connective tissue band called the flexor reticulum. The tibial nerve divides in the tarsal tunnel to provide sensation and innervation to different parts of the foot. In the case of tarsal tunnel syndrome, the tibial nerve becomes irritated in this space due to compression or friction. Pain develops and sensation disruption on the sole of the foot can occur.

Achilles Tendonitis

This tendon is the largest in the body and connects the muscles of our calf to the heel bone. The calf muscles are very active muscles that are firing whenever we are standing, walking or performing activities in weight bearing. This tendon can become irritated or inflamed with excessive loading, tight calve muscles, stiffness in the heel bone and/or improper load transfer through the lower extremity. It is important to build strength and adjust to new activities gradually to allow the Achilles tendon (as well as other joints and soft tissues) to adapt to the new loads and become resilient. If you build up too quickly, injuries can occur. Please click here to read more about Achilles Tendonitis.

Plantar Fasciitis

The plantar fascia is a strong connective tissue band that spans the bottom of the foot. It plays an important role in the “push off” phase of gait by tightening all the structures along the arch of the foot to form a rigid lever (an energy efficient way to propel forward). If you have been overloading the plantar fascia by walking excessively with new footwear, along uneven ground or walking bare foot more, than you may experience a situation where the fascia becomes injured and inflamed. Plantar fasciitis can be quite painful on the bottom of the heel and can be particularly sore with the initial steps in the morning or after resting. The pain is present when standing or walking especially during the push off phase of gait.

Flat Foot Deformity

Clinically there are many causes for flat feet. Some common causes include weakness of the muscles in the foot and up the kinetic chain, past injury, ligament sprains, poor footwear and/or inactivity to name a few. Whatever the reason it is important that you work of your strength and in some cases, have a pair of custom made orthotics to better align your foot and improve shock absorption and weight transfer through the lower body.

Morton’s Neuroma

This condition occurs when there is an entrapment of the nerve at the bottom of the foot that runs in the web space between the 2nd and 3rd toes. It can cause burning, tingling and a numbness pain over this area and ball of the foot. It is made worse with the toe off (push off) phase of walking. It can be made worse with barefoot walking, when the balls of the feet are flattened and when there is stiffness in the big toe joints.

Shin Splints

This is the common term used to describe an overuse syndrome that involves the tibialis posterior and/or the tibialis anterior muscles which insert onto the shin bone. It is a cause for pain and inflammation at the site of the attachment of these tendons onto the shin bone. These muscles control the foot and ankle and are active with walking, running and jumping. It is a condition often seen in runners as the repetitive force absorption through the foot creates pain. Stiffness in the mid foot, poor mechanics, flat feet, tight or weak caves can all contribute to the onset of this painful condition.

Peroneal Tendinopathy or Tibialis Posterior tendinopathy

These two muscles groups are located along the sides calf and tendons loop around either side of the ankle to control movement and produce force. Both tendons play a role in supporting the arches of the foot and work together to balance the forces. When there is a movement dysfunction one tendon will typically become overworked as the other weakens. This will result in irritation of one or both of the tendons located most commonly where they loop around the sides of the ankle. Strengthening and balancing these muscles are an important part of the recovery.


The metatarsals are the long bones in the forefoot. The term “algia” originates from the Greek word for pain. Therefore, this condition presents as pain on the bottom of the forefoot (along the “ball of foot”). It comes from inflammation and irritation of the joints and soft tissue structures of the area. This can be due to weakness, poor mechanics, improper footwear or repetitive dysfunctional load transfer.

How can Physiotherapy, Chiropractic, and a Massage Therapy Help your Foot and Ankle Pain?

A team of healthcare professionals can personalize and direct your treatments to address your specific injury and help you recover faster. Treatments at Sunup Physiotherapy with a Physiotherapist or Chiropractor can include controlling pain with therapeutic modalities, shockwave therapy, acupuncture or dry needling, manual/hands on therapy to improve joint stiffness in additional to strength, flexibility and motor control through individualized therapeutic exercises. Soft tissue release is also important and may require massage therapy treatment to reduce muscles tone and relax the nervous system. If your ankle injury is severe or appears to not be improving your physiotherapist or chiropractor will suggest you get consulted by a physician who can refer out for imaging if deemed necessary.

How Long Does it Take to Recover from Foot and Ankle Pain?

Depending on the cause, severity and what tissue is damaged, recovery can take a few weeks up to months. It is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your exercise program and follow their advice. Keep in mind that your physiotherapist and/or chiropractor treats these types of conditions regularly and will help you recover as quickly as possible.

What are the Best Exercises to Help with your Foot and Ankle Pain?

A well-rounded program should include range of motion, strengthening, flexibility and balance. These exercises should be individualized to your particular needs and goals. If you are returning to a particular sport the final exercise program will be catered to movements and forces that are needed to perform the specific activity.

Some of the most common exercises are listed below. These will help you get started. However, these exercises should be performed only if they feel comfortable and should be modified and/or stopped if pain increases during and/or after. Always listen to your body and consult with your physician or trusted allied health professional for more individualized guidance.

When focusing on motor retraining, please preform the exercises paying close attention to form, in a slow and controlled fashion. Try to aim for 3 sets of 10 reps.

  • Resistance band strengthening exercises

    Using a resistance band tied in a loop around either side of your midfoot, turn foot in and out against the resistance. Move at tempo that is slow and controlled about one sec in and out. Make sure to not rotate the leg and you are focusing on achieving the movement through your ankle.
  • Calf raises

    On both or just the injured foot (as long as this is pain free) raise up onto the ball of the foot. Perform this exercise slow and controlled. The tempo should be one second up and one second down. Watch that you do not use momentum and that you keep foot/ankle in proper alignment.
  • Single leg balancing

    Standing barefoot on the injured foot for a period of up to 1 min. You should find that you have a lot more movements in the foot, knee and hip when you start this exercise but as your balance improves this happens less and less. You can challenge your balance further by adding an unstable surface under your foot like a pillow. Or try closing your eyes. ONLY perform this if you feel safe to do so and it is pain free.
  • Calf stretches

How to Treat Foot and Ankle Pain at Home?

  • If you have a recent, acute injury of your ankle, you may first want to try a contrast bath. This will help to control the swelling and bruising. To prepare you will need two buckets, one with ice cold water and the other with warm water. Place your foot in warm water for 4 min followed by 1 min into the ice cold water. You can repeat this 3 times. Always end with cold. This will help you control swelling. If there is minimal swelling but the tissue is warm and painful, then ice might be the best choice. Apply ice with mild compression to the tissue for 10 min upto 4-5 times a day.
  • Protect your foot and ankle. There is tissue that has been damaged and you do not want to continue to add strain to this area. There are numerous bracing options that we sell in clinic that can help you protect and support the area as it heals. You also need to make changes to your footwear they are conducive to healing and provide the support you need. We also recommend limiting or completely removing aggravating activities and pace yourself accordingly. Please keep in mind that you will not need to apply these cautious strategies indefinitely. As the tissue heals, it becomes imperative to gradually introduce new and progressive stresses to stimulate bone and soft tissue recovery.
  • Try the above-mentioned exercise program as tolerated.

If your foot or ankle pain persists or if you are unable to move naturally once the pain subsides, a visit to your trusted Physiotherapist and/or Chiropractor is highly encouraged. If you are looking for expert care in the North Edmonton, be sure to contact us. We would be happy to help!

Physiotherapy Treatment for Ankle Sprains

A sprained ankle is one of the most common ankle injuries that we help treat at Sunup Physiotherapy. If you have rolled your ankle you understand just how debilitating an injury like this can be, making walking and everyday activities much more difficult. It is important to know that once you have sprained an ankle your likelihood of re-injury is exponentially higher. If you think you have sprained your ankle, taking some immediate steps to rehabilitate your ankle will help you recover faster and prevent a future sprain.

What is an Ankle Sprain?

An ankle becomes sprained when the ligaments (supportive joint tissues) becomes stretched beyond their natural range and the forces then become absorbed by the secondary restraining structures such as the muscles, joint capsule and joint surfaces. This can occur by rolling your ankle inwards, outwards, or jamming it with an upward pressure. This results in damage to the ligamentous tissues and symptoms of pain, swelling, bruising and walking with a limp can present. Once these symptoms resolve they can be followed with the feeling of instability, stiffness in certain movements and decreased balance and agility.

In more significant forceful events there can be fractures of the bones, and this would be indicated if the pain is so intense after injury you are unable to weight bear for at least three steps on the injured foot/ankle. If you cannot weight bear without an intense pain after an ankle injury it is important that you get X-ray imaging immediately to determine if the bone has been fractured.

In a typical ankle sprain, meaning no fracture, the damage that occurs to the ligament and supportive tissue to the ankle causes the ankle tissues to become inflamed and the joint less stable. Once the initial inflammation process is under control it will be important to strengthen and retrain the muscles around the ankle to improve the stability of the joint and prevent future re-injury.

How can a Physiotherapist or Chiropractor help with an Ankle Sprain?

Your trusted health care professional will perform a thorough assessment to determine the extent of the tissue damage and the possible cause. More often than not you may have rolled your ankle from weakness or imbalance up the kinetic chain, meaning your knees, hips or core.

They will work with you to set goals that include management of the acute swelling and pain, resolve the proper range of motion with hands on manual therapy treatment, increasing strength and proprioception with exercises and getting you back to your activity.

They may recommend a brace for the initial recovery period, apply therapeutic modalities such as shockwave therapy, ultrasound, or acupuncture, perform hands on treatment and use specialized equipment such as a wobble board to retrain your ankle’s ability to respond to unstable surfaces. Most of all they will provide you with guidance and re assurance of how best to proceed and help you achieve a speedy recovery.

If your injury is not healing in the expected timeline our physiotherapist or chiropractor will refer you to family doctor for further assessment and investigation.

What are the Best Exercises to Help you Recover from an Ankle Sprain?

In the first few days following an ankle sprain you will want to do range of motion and gentle strengthening exercises in all directions and in a pain free range.

  • Range Of Motion Exercises
  • Calf Stretches
  • Strengthening Exercises
  • Calf Raises And Foot Strengthening
  • Bosu Squats
  • Airplane

What Should be Avoided when you have Sprained your Ankle?

If you have recently sprained your ankle, it is important in the first few days to try to walk as normally as possible but in short durations/intervals. You might by limping and that is normal but for the most part try to keep your stride with your heel contacting first and rolling off your big toe as normal as possible. Do not immediately jump to crutches or a walking boot unless a doctor or other health care professional has recommended it to you. If after the injury you feel this is necessary you will want to consult with a doctor for imaging.

Prevent the swelling from continuing and getting worse. To do this make sure you elevate your foot at rest. Avoid or decrease activities that cause the pain or swelling to increase. Try ice to see if this can help.

Make sure your wear supportive shoes, do not wear flip flops, high heels or unsupported flat sole shoes.

How can you Treat your Ankle Sprain at Home?



Use a brace and supportive shoes, such as running shoes.


Rest, ice, Compress, Elevate your ankle every 2 hours of your awake time with ice ON/OFF for 10min intervals using ankle pump exercise. When you are at work or rest continue to elevate your ankle, for as long as the swelling is around.

Start rehabilitative exercises early

See above and progress them as you improve.

Avoid aggravation

If you heel quickly on your own but return to sport and notice pain, stiffness and or swelling from the activity it is indication that your tissue is not ready for that stress. In this case an assessment with a trusted physiotherapist or chiropractor is indicated. It most likely needs some hands on manual therapy to improve the mechanics and may only take a few treatments to resolve. Shockwave therapy can also be used to breakdown scar tissue formation and mobility improvement.

Balance exercises

Don’t forget to work on your ability to balance. It may seem unnecessary but improved balance is a huge factor in re-injury prevention. Practice standing on one leg and even try this challenge on an unstable surface such as the subway, a bosu ball or a couch cushion.

How Long Does it Take to Recover from an Ankle Injury?

The timeline for recovery will vary depending on your injury severity and the tissues involved. In some cases, in a low-grade sprain you can heel in a few weeks and may not even feel the need to seek treatment, however you have to remember you are more pre-disposed to a re-occurrence. In most cases, seeking the care of a trusted health professional will help you understand your injury severity and help guide you on the quickest road to recovery. On average with a commitment to exercises and treatment, it should take 2-3 months to get back to the activities you enjoy.

In some more severe cases, the injury can take as long as 6 months to fully recover. This is typical in cases where the boney surfaces of the ankle get bruised or injured. In very rare cases a surgery may be elected to repair the tissue and regain stability. In these very severe cases, family physician will be following you closely and will make appropriate referrals for care.

If you have sprained your ankle, book an appointment with one of our highly skilled physiotherapists and/or chiropractors, contact us today.

A surgical consult for an ankle can occur for different reasons. The most common and urgent cause being an ankle fracture (break in a bony integrity). Other reasons you may consult with an ankle surgeon include but are not limited to; chronic instability, chronic tendon dysfunction and arthritis.

What Can Cause an Ankle Fracture?

Ankle fractures can be caused by excessive force that the anatomical structures including soft tissues and bone are not able to absorb. This can occur from a forceful twisting, turning, rolling or impact to the ankle. Stress fractures can also happen over time due to repetitive force or an underlying bone health issue.

What Type of Ankle Fractures Are There?

The most common type of ankle fracture is a unimalleolar fracture which occurs at the lateral malleolus, the bony bump on the outside of the ankle. A bimalleolar fracture is the second most common and occurs at both the lateral malleolus and the medial malleolus, the bony bump on the inside of the ankle. A trimalleolar fracture involves all three sides of the ankle: the outside and inside structures mentioned and the posterior rim of the tibia at the back of the ankle.

How Can Physiotherapy, Chiropractic and/or Massage Therapy Help Treat Ankle Fractures?

Patients with ankle fractures are usually given a non-weight bearing status by their doctor for 4-6 weeks, meaning they will need to use crutches with a cast as they are not permitted to put weight through that foot when standing or walking. During this time, the patient can see their physiotherapist to help them optimally adjust their gait aid and to learn exercises they can be doing to manage pain, swelling, and maintain strength to nearby joints while casted. Around the 6-week mark, if imaging demonstrates the bone(s) are healing well, your doctor will give you clearance to begin hands on treatment in the form of physiotherapy, chiropractic and/or massage therapy. It is important to start treatment right away for optimal recovery. As a result of immobilization in a cast, the ankle will become stiff, weak and the muscles around the joint will be tight. The goal of therapy is to improve pain, range of motion, strength, and return to desired activities.

What Should be Avoided with an Ankle Injury?

Patients should follow the instructions from their doctor regarding their weight bearing status and any other special instructions they may have been given. This may include avoiding to put all or some of their weight through their affected ankle early in the rehabilitation process. Your Physiotherapist and or Chiropractor will make sure to fully explain your doctor’s instructions before commencing treatment. When you first start to use your ankle again after the cast you may experience pain, swelling and some uncomfortable sensations. This is most likely normal but it is always important to bring them to the attention of your health care professional.

How Long Does It Take to Recover from Ankle Injuries?

Some ankle fractures can heal without surgery using a cast or a splint, however, more serious fractures will require surgical intervention with the insertion of hardware (pins, screws or plates) to ensure optimal alignment of the ankle bones. Generally, bones heal by 6 weeks and you can start introducing stress, but other injured soft tissues, such as ligament damage, may prolong the healing process.

It usually takes another 2-3 months to restore full range-of-motion, strength and function in the ankle. In some severe cases it can take up to six months to a year to maximize range of motion, strength and function. In these cases, full range and function may not be achieved due to uncontrollable factors and you may be at higher risk to develop arthritis.

The prognosis for the injury is better if the patient receives rehabilitation early and does not have hardware inserted into the joint space.

What Are Some Safe Home Exercises for a Post-Immobilized Ankle?

Most importantly, it is always best to follow physiotherapist and/or chiropractors’ instructions post operatively as every ankle fracture and or surgery is different.

  • First, you can begin range-of-motion and mobility exercises. These can include things such as ankle circles and movement of the ankle in specific directions. Another exercise you can typically start right away is calf stretching. You can perform a calf stretch by using the belt to pull the ball of your foot towards your shin, holding to a point that a comfortable pulling sensation is felt on the back of the calf. This is held for 30 seconds and repeated three times 2-3 x/day.
  • Next it is important you get comfortable with weight bearing through that leg and ankle. This can start by standing near a counter for support while shifting weight slowly from the unaffected side to the affected side to a point before there is discomfort and repeating daily.
  • When it comes time to remove the cast and you are cleared for weight bearing, exercises and hands on therapy should start right away. It is important to consult with your health care professional so they can develop an individualized exercise program which will include strengthening and balance training. Finally, as range of motion and strength have been maximized, speed and agility exercises such as running, jumping and cutting will be introduced

If you are suffering from an ankle fracture and are seeking treatment, our highly skilled physiotherapists would be happy to help,  contact us today!

Are you experiencing pain under your big toe? Are you having trouble walking or running because of it? Are you a runner or dancer? Do you often wear high heels? You might have sesamoiditis.

What is Sesamoiditis?

Sesamoid bones are bones that are embedded in tendons. The largest and most commonly known sesamoid bone in the body is the kneecap, or patella. Two other tiny seasamoid bones (approximately the size of a pea) are found underneath the big toe. They act as pulleys to improve the force transmission through the tendon and help the big toe “push off” during walking and running. When the force is too great or too repetitive this area can become irritated and inflamed causing pain, weakness and ultimately difficulty walking, running, dancing and more.

What Causes Sesamoiditis?

You have 26 bones in each of your feet. Together that’s 52 bones, or one-quarter of all the bones in your body! Feet are complex but are impeccably designed to bear weight and to carry you around where you need to go. Due to this complexity, there is a lot of opportunity for dysfunction, which ultimately can lead to pain such as sesamoiditis. The sesamoid bones can become irritated with activities that involve repetitive forces to the forefoot such as dancing or running. Also, if foot mechanics are altered (you over-supinate or you wear high heels often) this can also transmit excessive force through the sesamoid bones causing inflammation. If you think you might have sesamoiditis it’s important to seek help from a physiotherapist, chiropractor, or physician as soon as possible.

What are the Symptoms of Sesamoiditis?

Individuals with sesamoiditis often complain of a gradual onset of dull, longstanding pain beneath the big toe joint. This pain typically comes and goes. It worsens in shoes with higher heels or during certain activities where more force is being transmitted through the big toe such as walking quickly, running, jumping or ballet to name a few.

What are the Best Exercises to Help with Sesamoiditis?

For optimal results it is always best to get a custom exercise and rehabilitation program to treat your sesamoiditis from a qualified physiotherapist, chiropractor, or sports medicine doctor. In general the following exercises are recommended to help treat or prevent sesamoiditis.

  • Foot Strengthening
  • Foot Mobilization
  • Calf Stretching
  • Big Toe Curls

How Long Does it Take to Recover from Sesamoiditis?

If you have sesamoiditis it can take 2-3 weeks for complete healing to occur with proper care. If you have a more serious injury like a sesamoid fracture, it will take 6-8 weeks with no weight bearing for the injury to fully heal. Sesemoiditis can bother people for months if left untreated so it’s important to start treatment with a physiotherapist or chiropractor to help improve recovery time.

What Should I Avoid Doing if I Have Sesamoiditis?

If you have sesamoiditis you should avoid doing any activity that causes pain for the first few weeks. It is important to remember that this sesamoiditis is caused by inflammation due to irritation of the tendons around the sesamoid bone and rest is the primary treatment. Dancing, running, and other high impact activities are sure to irritate the sesamoid and should be avoided. Often with seamoiditis even walking can cause irritation so shoes with proper support are very important. Similarly, wearing high heels, or shoes that don’t offer good foot support and place extra pressure on the area should also be avoided if you have sesamoiditis.

What Can I Do to Prevent Sesamoiditis?

To help prevent sesamoiditis it is important to wear shoes that fit properly and support the arches are you feet. This also means replacing old shoes, especially work out shoes that are worn out. Another good way to prevent sesamoiditis is to stretch after activity and warm up well before exercising, this is especially important with high impact exercise like running.

How can a Physiotherapist or Chiropractor Help with the Treatment of Sesamoiditis?

The first step to recovery is a comprehensive assessment by a physiotherapist or chiropractor. The pain and inflammation might be below the big toe but the root of the problem may be elsewhere in the body. Once the root problem is established, the first step in treatment is usually rest from the aggravating activity. Shockwave therapy, ultrasound, laser, taping, hands on therapy, and ice may be used in different combinations to relieve symptoms. Exercises will also play a large part in the rehabilitation process. Orthotics or other shoe inserts can be helpful in off-loading the painful area.

If you think you might have sesamoiditis or a related condition, then contact us today to book an appointment with one of our highly skilled physiotherapists or chiropractors. Our team of physiotherapists, chiropractors and massage therapists are here to help get you on the road to recovery and back to the activities you love.

Tarsal Tunnel Syndrome

Summer weather brings more walking, running, flip-flop wearing, and foot pain! Recently a number of patients have presented to our north Edmonton clinic complaining of plantar fasciitis. But interestingly enough, a few of these patients didn’t actually have plantar fasciitis but rather were diagnosed with tarsal tunnel syndrome. It is important to recognize that pain at the bottom of the foot does not always mean the plantar fascia is to blame. You may be suffering from Tarsal Tunnel Syndrome! So don’t rule it out until a qualified professional such as a physiotherapist, chiropractor, or physician conducts a detailed assessment and tells you otherwise.

What is Tarsal Tunnel Syndrome?

The tibial nerve begins behind the knee and runs down into the foot behind the medial malleolus, or bump on the inside of the ankle. As it passes behind this bony bump, it is tethered down by a band of tissue called the “flexor retinaculum” along with some other tendons and blood vessels. The passageway under the flexor retinaculum is called the “tarsal tunnel” and usually the tibial nerve branches into the medial plantar nerve and lateral plantar nerve, within the tunnel which innervates and give sensation to the bottom of the foot.

Tarsal tunnel syndrome results from an irritation of the tibial nerve within that tunnel. Any irritation caused by compression or friction of a nerve can result in inflammation and in more chronic situations nerves can actually become shorter and tighter and can even become scarred down in places. This means that instead of sliding easily through the tunnel and the tissues during every day foot movements, the tibial nerve gets pulled on and rubbed against which causes more inflammation and may lead to more scarring.

What are the Symptoms of Tarsal Tunnel Syndrome?

Symptoms of tarsal tunnel syndrome vary widely depending on both the patient and the severity of nerve compression and/or irritation. Typically, paresthesia in the territory of the distal branches of the tibial nerve occurs, causing tingling, shooting pain, burning, or aching along the tibial nerve and into the plantar nerves. If only one of the plantar or calcaneal nerves are affected, the dysfunction can be called distal tarsal tunnel syndrome.

Prolonged walking or standing can exacerbate the symptoms, and sometimes pressure over the nerve and tarsal tunnel can be painful. Tarsal tunnel syndrome can be both idiopathic or post-traumatic.

How can Physiotherapy or Chiropractic Treatment Help Tarsal Tunnel Syndrome?

Physical therapy and chiropractic treatment for tarsal tunnel syndrome will depends on why the nerve is being compressed. Your health care professional will complete a thorough assessment to determine the root cause of your particular symptoms. A proper assessment would dictate what faulty foot position or weakness is causing the nerve irritation, and through shockwave therapy, manual therapy, and exercise the therapist would work on correcting the underlying cause of the problem. Treatment may also focus on reducing swelling, inflammation and pain using therapeutic modalities, education and release. Your physiotherapist may also suggest foot inserts or in more extreme cases orthotics to help support your foot and resolve the symptoms more quickly.

What are the Best Exercises to do for Tarsal Tunnel Syndrome?

These are just a couple general exercises that may help with Tarsal Tunnel Syndrome. If you experience more pain or do not notice any improvement within a few days, we recommend seeking care from a trusted physio or chiro who will provide you with an individualized exercise program.

  • Tibial Nerve Flossing
  • Tibialis Posterior Strengthening
  • Calf Stretching
  • Big Toe Curls

How to Treat Tarsal Tunnel Syndrome at Home?


You may first want to try a contrast bath. This will help to control the inflammation and swelling. To prepare you will need two buckets, one with ice cold water and the other with warm water. Place your foot in warm water for 5 min followed by 2 min into the ice cold water. You can repeat this 3 times. Always end with warm. Follow this procedure 3 times a day.

Wear supportive shoes

Wear running shoes, insoles that support your arch or orthotics if you have them.

Perform Rehab Exercises

Please refer to exercises section above.

What to Avoid if you have Tarsal Tunnel Syndrome?

If you are suffering from Tarsal Tunnel Syndrome, you should avoid the following:

  • Walking or standing for prolonged periods in bare feet especially on hard flooring.
  • Ignoring the pain and not seeking treatment when it is not going away.
  • Wearing tight fitting shoes or tying your laces to tightly.
  • Wearing unsupportive flip flops, flats, dress shoes or high heels.

If you have pain on the bottom of your foot, contact us today to book in with one of our experienced physiotherapists who will help you determine the root cause of the pain and help you treat it so that it goes away for good!

Physiotherapy for Achilles Tendinitis 

What is the Achilles Tendon?

A tendon is the part of the muscle that connects it to the bone. It is denser with connective tissue and is no longer contractile tissue. The Achilles tendon is the largest tendon in the body and it connects the calf muscles to the heel bone. Your calf muscles and Achilles tendon are highly involved in helping you stand upright, walk, jump and run.

What are the Symptoms of Achilles Tendonosis?

Common symptoms of Achilles tendonitis include pain and stiffness along the Achilles tendon. The symptoms may be most noticeable after prolonged positions and/or first thing in the morning when you take your first few steps. You may also notice that the symptoms decrease as you move around. If you are exercising vigorously then you may experience more pain and you will especially notice increased discomfort the morning after. You may also notice swelling and thickening around the Achilles tendon.

What causes Achilles Tendinosis or Achilles Tendinitis?

If there is excessive strain, repetitive stress or failed load transfer through the lower leg, then the Achilles tendon can become inflamed- termed tendinitis (active inflammation). The fibres that make up the Achilles tendon start to break down and degenerate which can lead to an inflammatory process that causes swelling and pain. As your body responds to the trauma to the tendon, scar tissue is produced which leads to thickening of the tendon. The tendonitis most commonly occurs through the middle of the tendon (non-insertional tendonitis) or where it attaches on to the bone (insertional tendonitis). Often, this issue is precipitated when you progress the amount or intensity of an activity too quickly without giving your body (muscles and tendons) a chance to adjust and adapt. Tissue injury follows.

How can a Physiotherapist or Chiropractor help with Achilles Tendinosis?

Physiotherapy and chiropractic treatments are very successful for the resolution of Achilles tendinopathy. Your physiotherapist or chiropractor will conduct a thorough assessment of your lower extremity and back to determine what the underlying causes are.

Typically, patients that present with Achilles tendinosis have tight calves and joint restrictions in the ankle and foot bones. Your physiotherapist or chiropractor will release your tight muscles and mobilize your stiff joints here and even maybe up the chain into your back. Your therapist might also use acupuncture to reduce your pain and promote healing of the tendon or dry needling to release tight muscles. Extracorporeal shockwave therapy is another adjunct treatment that your physiotherapist or chiropractor can incorporate into your treatment plan. Shockwave therapy research has shown superior results in breaking down scar tissue and accelerate healing of the Achilles tendon.

In addition to the above, your physiotherapist or chiropractor will also guide you through exercises that will strengthen your tendon and correct any muscle imbalances that exist. They may not just have you perform exercises for your ankle but also your knee, hip and core weakness which may have contributed to the development of Achilles Tendinitis.

If you are not progressing as expected your physiotherapist or chiropractor may refer to for massage therapy or a consultation with a physician. These other options will help aid in your recovery and ensure that all appropriate measures are being taken.

What are the best exercises to help with Achilles Tendinosis?

Eccentric calf strengthening exercises have been supported by research to improve the strength and integrity of your Achilles tendon. Eccentric loading, simply means the phase of an exercises where the muscle is working as it is lengthening, such as the lowering phase in a calf raise.

  • Eccentric Gastrocnemius Loading
  • Eccentric Soleous Loading
  • Isometric Calf Strengthening (For Pain Relief)
  • Calf Stretching

What should I avoid doing if I have Achilles Tendinosis?

  • Power movements- jumping, hopping, sprinting, running
  • Pushing through pain, continuing with aggravating activities
  • Deep static stretching before activity

What can I do to prevent Achilles Tendinosis?

  • Doing an active dynamic warm up before an activity
  • Stretching of lower extremities in the hours following an activity
  • Strength training the calves 2-3x/week
  • Wearing supportive shoes or prescribed orthotics
  • Always start new activities slowly and gradually, allowing your muscles, joints and tendons to adapt to the new load
  • Train with proper sporting technique, avoid faulty patterns

How long does it take to recover from Achilles Tendinosis?

If you are able to manage your symptoms early with activity modification and rehab exercises you are likely to recover in a 6-8 week timeline. If your Achilles has been painful for longer than 6 weeks, your tendon has thickened, it will take longer, even up to a few months.

Our physiotherapists and chiropractors have a lot of experience treating this Achilles tendonitis (tendinosis) successfully. Contact us today for more information or to book an appointment with one of our highly trained physiotherapists or chiropractors today.

What’s in common with Kevin Durant, David Beckham, Brad Pitt, Dame Judy Dench, George Clooney, Boris Becker, Kobe Bryant, and Dwayne Johnson? The answer is they all tore their Achilles!

The Achilles tendon is the strongest tendon in the body. Also called the heel cord, it runs from the calf muscles towards the back of the heel bone, and facilitates walking and running movements by lifting the heel off the ground. During running and jumping movements, it can bear loads 6-12x the body weight (up to 2000 lbs.), yet it is one of the most common tendons to rupture. A complete rupture is a significant injury often resulting in lost time at work, and restricted participation in sports up to a year following the injury. The overwhelming majority of people recover well and are able to return to some level of physical activity, however calf weakness and other biomechanical changes can persist in the long term.

Causes of an Achilles Rupture?

Unfortunately there is no known cause. However, it is most likely related to a reduced load capacity of the ankle/foot complex as a result of previous lower body injury, or sudden changes in load (e.g.: playing tennis only 2-3x in a year). Typically it is an injury of middle aged men who are participating in recreational sports. Women are less likely to suffer an Achilles tendon ruptures. It often happens during a quick forced hyper-dorsiflexion movement (sudden extreme calf stretch), but it can occur during an odd jump off the curb, as well.

Signs and Symptoms of an Achilles Rupture?

Symptoms can significantly differ if it is a full rupture vs partial tear.

Partial tear signs and symptoms

  • sudden pain around the Achilles tendon
  • potential swelling
  • limited strength, range of motion and function

Full tear signs and symptoms

  • audible pop
  • sudden pain in lower calf area
  • often described as getting kicked in the calf
  • unable to walk and/or put weight on it
  • increased dorsiflexion at rest in prone position
  • in rare cases, people can walk on a ruptured achilles for days/weeks before getting medical attention (this walk is a severe limp without any meaningful ankle movement)

Surgery or No Surgery for an Achilles Rupture?

There is a two-decade-old debate about surgery vs non surgery, however, 1 year after the injury, the difference in outcomes are negligible. There is a 7-10 day window of opportunity following a full rupture when it is best to get a surgery. It should be a joint decision between the patient and the surgeon looking at age, general health status, access to rehabilitation, previous injuries etc. It can be an overwhelming decision to make in a short time, however it typically does not influence functional outcomes in the long term.

How can Physiotherapy Help with Treatment of an Achilles Rupture?

  • Physiotherapy has a crucial role in recovery
  • Having a physiotherapist who is experienced treating this condition is extremely important because they have the ability to advocate for the patient, as well as progress the load accordingly.
  • An initial consultation within the first few weeks is recommended to optimize rehab and start non weight bearing exercises.
  • In-person rehabilitation starts around the 8 week mark, depending on the surgeon/protocol used. Total rehabilitation time is between 6-12 months. Physiotherapy primarily focuses on restoration of calf strength and function. In addition, optimal joint mobility, proper muscle length, balance, proprioception and global strengthening also takes place.
  • In addition to load management; manual therapy, physical modalities, dry needling, and taping can also be used to aid recovery.
  • Shockwave therapy can minimize pain, improves scar tissue, speed up healing, and improves mobility quickly.

If you believe you have an Achilles rupture, please get immediate medical assistance and contact us when you are ready to start your rehabilitation.

Physiotherapy Treatment for
Plantar Fasciitis

What is Plantar Fasciitis?

Plantar Fasciitis is a painful condition that is caused by inflammation of the connective tissue that spans the bottom of your foot from your heel bone to the balls of your feet. This thick band of connective tissue, the plantar fascia, helps to support the arch of the foot. It also helps to propel you forward as it winds up the tendons of the sole of the foot on the push off part of the gait cycle. The plantar fascia is maximally stretched when your foot is on the ground and bearing your full body weight such as when you are transferring weight from one leg to another while walking.

What causes Plantar Fasciitis?

If the plantar fascia is overloaded or strained repetitively it can create micro tears which in turn will cause an inflammatory reaction and lead to pain.

Causes include:

  • Over pronation of the foot or high arches
  • Tightness in the calf muscles
  • Weakness of the ankle and foot stabilizing muscles
  • Prolonged weight bearing on hard surfaces
  • Overuse and repetitive impact sports on hard surfaces
  • High body mass index or weight gain

What are the symptoms of Plantar Fasciitis?

The pain from this inflammatory response is the main symptom of Plantar Fasciitis and most often appears along the bottom of the heel on the sole of the foot but can also travel through the arch. One common symptom is to have pain with the first few steps after a non-weight bearing period such as your first steps when you get up in the morning. This discomfort is then relieved with movement “walking it off” as the tissue warms up and pushes the cellular inflammatory by-products out of the way.

How can a Physiotherapy or Chiropractic treatment for Plantar Fasciitis help?

Plantar fasciitis can be treated very easily and effectively using conservative measures including extracorporeal shockwave therapy, hands on techniques, prescriptive exercises, therapeutic taping and footwear modification.

On your initial visit at Rebalance, your physiotherapist or chiropractor will assess the movement in your lower extremity to determine the root cause of your Plantar Fasciitis. Once the underlying cause is determined they will develop a treatment plan that will get you back on your feet as quickly as possible.

What are the best exercises to help with Plantar Fasciitis?

  • Foot Strengthening
  • Calf Stretching
  • Plantar Fascia Stretching
  • Water Bottle/Ball Rolling

What should I avoid doing if I have Plantar Fasciitis?

If you have Plantar Fasciitis, you should avoid the following:

  • Wearing unsupported footwear
  • Walking prolonged periods when in pain
  • Quick increase in sport or activity duration or intensity
  • Running or walking on hard surfaces like concrete
  • Running or walking barefoot on a beach
  • Prolonged standing
  • Heavy lifting, squatting or increasing load through the lower body

How long does it take to recover from Plantar Fasciitis?

Typically, if you seek out treatment right at the onset of symptoms, treatment success will be quicker, approximately 6-8 weeks. Clinically shockwave therapy on our patients has demonstrated fast resolution of symptoms compared to some other treatment methods. When combined with the right exercise program, symptoms can resolve in 4-6 sessions.

However, if Plantar Fasciitis symptoms are recurrent or have been lingering for some time, the condition can be more stubborn to treat. There are many factors that make this condition more difficult such as insufficient rest, inability to limit weight bearing, not following the recommendations and exercises provided by your physiotherapist in addition to contribution from the back and nerve. In some cases, it can take many months to achieve full resolution of symptoms.

If you think you may have Plantar Fasciitis it is important you get assessed and treated to prevent the injury from becoming chronic. To book an appointment with one of our physiotherapists or chiropractors in north Edmonton, contact us today!

Forefoot Pain (aka Metatarsalgia)

The word metatarsalgia comes from metatarsal (long bones in feet) + algia (pain in Greek). It is a general term used for pain in the plantar (bottom of foot) forefoot area. Symptoms may occur in one or both feet and commonly affects the bones as well as the joints at the ball of the feet.

Symptoms of Metatarsalgia

Symptoms of metatarsalgia include all or some of the following:

  • Sharp, burning or aching pain in the ball of your foot, frequently occurring in one or more of the five metatarsal bones.
  • Sensation of having a pebble in your shoes
  • Symptoms that worsen as you spend more time in standing, running or walking, especially while barefoot, and eases with rest
  • Occasional burning, tingling or numb sensation in your toes
  • Often localized symptoms under the first metatarsal bone (big toe bone)
  • Another frequent site is pain between the first and second metatarsal bone

Causes and Risk Factors of Metatarsalgia

The common factor is excessive pressure transmitted through the affected area. One or more of the following causes can play a role in developing metatarsalgia:

  • Intense training/repetitive loading of forefoot
  • High impact activities where the athlete spends excessive time on balls of foot (i.e. runners, dancers, football players)
  • Wearing high heels puts increased pressure on ball of foot
  • Improper footwear especially shoes with a narrow toe box
  • Excess weight as extra pounds mean more pressure through the foot as you move
  • Certain foot shapes i.e. high arches, bunions, long second toes, hammer toes, excessive calluses may increase the risk of developing metatarsalgia
  • Connective tissue and tendons change over time and may increase the risk of developing metatarsalgia
  • Surgical procedures around the foot can cause a build-up of fibrous scar tissue causing joint stiffness in the area and limiting range of motion

How do I know I have Metatarsalgia?: Diagnosis

The diagnosis is made by a subjective history and detailed physical examination by an experienced physical therapist. Successful treatment must identify the underlying causes of metatarsalgia. Your therapist will gain a detailed understanding of the characteristics of your pain, your lifestyle, hobbies, occupation and previous history of musculoskeletal conditions in order to guide them to the root cause. The best physiotherapists will utilize this information along with your physical exam findings to develop an individualized treatment plan for your pain.

Differential Diagnoses: What Are Some Other Things That Could Be Confused for Metatarsalgia?

  • Rheumatoid arthritis or gout often presents itself as inflammation of the forefoot joints. Careful client history should reveal if any further tests are indicated to rule out rheumatoid arthritis.
  • Morton’s neuroma is a fibrous thickening of nerves that run along the metatarsal bones.
  • Fluid build up due to circulatory or metabolic dysfunction can put pressure on the structures of the forefoot
  • Stress fractures of the metatarsal bones may develop due to repetitive loading
  • Entrapments along the nerves originating from the low back area may also refer pain in this area.


If needed, imaging such as an X ray or CT scan can be performed to rule out stress fracture and/or joint degeneration. A blood test may determine if foot pain is being caused by a systemic inflammatory condition like rheumatoid arthritis or gout.

Treatment for Metatarsalgia

Acute self-management includes the use of ice, rest, and reducing aggravating activities.

Physiotherapy Management:

If your self-management techniques do not provide results, we recommend seeking the expert care of a trusted physiotherapist. They will conduct an assessment and the best physios will provide an individualized, tailored program for you. This is sure to get you back on your feet (without pain) quickly. Your treatment will likely include one or all of the following techniques:

  • Exercise therapy including stretching certain foot and ankle muscles, strengthening foot intrinsic muscles and self-mobilizations exercises targeted at the joints of the foot and ankle.
  • Manual therapy in order to improve tissue mobility, range of motion and decrease pain
  • Education regarding proper footwear and training load management
  • If indicated prescription of orthotics or metatarsal pads
  • If indicated modalities like acupuncture, dry needling, IMS, cupping or taping
  • Shockwave therapy can minimize pain, improves scar tissue, speed up healing, and improves mobility quickly

Your physiotherapist may refer you to a Foot Doctor (Podiatrist) if your treatment is not responding as expected.

If you think you have metatarsalgia and you are looking for an excellent physiotherapist in north Edmonton, contact us today. We’d be happy to help as our physiotherapists and chiropractors have a great deal of experience dealing with metatarsalgia and other foot and ankle conditions.

Tibialis Posterior Tendinopathy:
Will I be able to run again?

Many runners are training for upcoming races, with some even travelling to different cities and countries to participate in running events from 5-10Km runs to half-marathons, full marathons, ultramarathons, obstacle races or triathlons. A common condition that we deal with in this population of new and veteran runners is pain on the inside of the ankle and shin ‘Tibialis Posterior Tendinopathy’.

What is Tibialis Posterior Tendinopathy?

The tibialis posterior muscle is the muscle located in the back inside of your lower leg and calf that is connected to the foot by a tendon that loops down behind the medial malleolus (inner ankle bone) and inserts in the bottom of your foot. This muscle is responsible for helping point your foot, supporting and stabilizing the foot’s arch and helps with pushing off during running. Tendinopathy occurs when there is microtrauma, inflammation, degeneration or lengthening of the tendon due to over use or improper use of the muscle.

What are the Symptoms of Tibialis Posterior Tendinopathy?

  • Pain on the inside of the shin and inner ankle bone
  • Swelling on the inside of the shin and inner ankle bone
  • Pain during walking and running, especially during the push off portion of the gait cycle
  • Tenderness/pain when firmly touching the muscle and tendon
  • Pain during single leg heel raises

What Causes Tibialis Posterior Tendonopathy?

  • Repetitive and prolonged activities putting strain on the Tibialis Posterior (Running)
  • Changes in foot wear
  • Changes in training schedule – Increasing training too quickly or without enough rest time
  • Poor biomechanics in the foot – excessive pronation (Flat footed)
  • Muscle imbalances in the lower extremity including hip, pelvis and core
  • Improper rehabilitation following a previous lower extremity injury

What can a Physiotherapist or Chiropractor do to Treat Tibialis Posterior Tendinopathy?

Visiting a Physiotherapist or Chiropractor will help determine the source of your pain in order to treat you and get you back to running sooner. Your therapist will investigate what factors led to the excess strain being placed on the Tibialis Posterior in the first place. Your rehabilitation will address those specific factors and root cause of your injury to avoid re-injury in the future.

Initially activity modification and rest is important. Soft tissue massage, taping, and modalities such as acupuncture, Shockwave Therapy, Ultrasound and Laser can help settle down the inflammation and help to reduce the pain. Stretching, balance, and strengthening exercises are initiated once symptoms settle. Gradual introduction of strengthening exercises that mechanically load the tendon are important for the tendon to heal and be able to withstand future stress. For example the progression of exercise may look like this:

  • the early stages strengthening starts with isometric exercises
  • then light concentric activation
  • then eccentric strengthening
  • then harder concentric exercises
  • finally, plyometric or sport/activity specific exercises are introduced and progressed

How do I know if I have Tibialis Posterior Tendinopathy?

Sometimes the following conditions can appear to be a Tibialis Posterior Tendinopathy but are different issues that require very different rehabilitation

  • Compartment Syndrome
  • Stress Fracture
  • Referral from the lumbar spine
  • Deep Vein Thrombosis
  • Periostitis

The bottom line is that there are many issues that can appear similar to tibialis posterior tendinopathy so it is important to be properly diagnosed by an experienced health care professional. A physiotherapist and/or chiropractor will be able to determine if you have tibialis posterior tendinopathy and treat you with a proper rehabilitation plan so you can recover quickly.

What are the Best Exercises to Help with Tibialis Posterior Tendinopathy?

  • Ankle Inversion With A Resistance Band
  • Calf Raises
  • Foot Intrinsic Muscle Strengthening
  • Tibialis Posterior Stretching
  • Towel Scrunching

How Can I Treat Tibialis Posterior Tendonopathy at Home?


Immediately after an aggravating activity, the area may feel warm, swollen and painful. If so, it is likely that you have inflammation around the tendons and we recommend applying ice to the area for 10 min. This should be helpful and may need to be repeated 3 times a day in the earlier stages.

Modify activity and cross train

In the early healing stage you are going to have to modify and stop if possible the aggravating activities that provoke your symptoms. This will allow your tissue to heal without being re-aggravated. Once the symptoms settle, you can start a gradual return to your activity. For the time being you may want to do another activity ie. Instead of running try biking or swimming. Both of these activities keep your cardiovascular endurance in check but do not involve as much pressure or force through your Tibialis Posterior tendon.

Do rehab focused exercises

Please see exercises above. As long as the exercises are not painful to complete and do not lead to more pain after you complete them. Often times, an individualized exercise regimen is required and your trusted physiotherapist will able to help with that. It is best to start the rehab exercises as early as possible and progress as you are able.

Use Kinesiotaping

You can apply this stretchy tape under the arch and up along the path of the tendon on to the medial calf. You will want to apply approximately 50% stretch in the tape through the mid portion for best results. Your physiotherapist will be able to apply the tape for you and show you the correct application technique.

What Should be Avoided if I have Tibialis Posterior Tendinopathy?

Avoid pushing through the pain and continuing to participate with the aggravating activities. You may feel better once you have warmed up the tendon but it is still not recommend that you push through as you are likely putting additional stress on the tendon which will make the tendon more vulnerable to further damage. In some cases, tendon damage is irreversible and the damaged cells within the tendon will never heal. So tread cautiously, listen to your body and take this seriously.

Unsupported shoes and/or high heels should also be avoided if you are suffering from tibialis posterior tendinopathy. This type of footwear will place more demand on the tendon and delay heeling.

Lastly, you should most certainly avoid movements or activities that require power through the lower extremity such as sprinting or jumping. These movements will place too much load on the injured and compromised tendon and will not only lead to further tissue damage but may also put you at risk of tendon rupture.

How Long Does It Take to Recover From Tibialis Posterior Tendinopathy?

Normal recovery time for this injury is 6-8 weeks, however this is dependent on variables like the duration of symptoms and how much cellular damage has occurred in the tendon. If the tendinopathy is more chronic (meaning that you have been dealing with it for more than 6 weeks before seeking treatment) it may take up to 4-6months to heal and get you back to your activity. If this issue has been ongoing and you have experienced several flare ups, you may have permanent cellular damage in the tendon and although you may improve significantly with treatment, you may never reach 100% recovery status.

If you have an issue with your tibialis posterior tendon or any issue in your ankle region, don’t wait to see our trusted physiotherapist or chiropractor. Get assessed and seek treatment as soon as possible for the best results and to ensure a speedy recovery!

If you are in north Edmonton and are looking for the best, look no further. Our physiotherapists and chiropractors are the best in the city and have experience with a wide range of orthopedic conditions including this one. Contact us today.