Reviewing National Physical Therapy Month: Knee, Ankle, And Foot

This October, we're celebrating National Physical Therapy Month once again. The national campaign, which has been held annually since 1981, is meant to increase public awareness about physical therapy and to highlight the various ways in which the lives of current and prospective patients can improve from treatment. We fully support these efforts and we're doing our part by reviewing the wide range of conditions that physical therapists can effectively manage in each region of the body.

In this post, we're focusing on the knee, ankle, and foot by looking at some of the most common issues that can develop in these areas.

Knee

The knee is one of the largest and most complex joints in the body. It's also incredibly vulnerable to injury, as knee pain ranks behind just back pain as the second most common condition involving the muscles and bones. Knee pain is the leading cause of disability in adults aged 65 years and older—with knee osteoarthritis being responsible in most of these cases—while various tears are more likely to occur in active individuals. Here's a look at some of the most common conditions that physical therapists treat:

• Knee osteoarthritis: an extremely common disorder in which the cartilage on the ends of bones in the knee gradually wears away, which reduces its ability to absorb shock and increases the chances that bones will contact one another; usually leads to pain, stiffness, and swelling that makes it difficult to walk and move the knees normally
• ACL tear: the anterior cruciate ligament (ACL), which helps stabilize the upper leg bone to the knee, can be damaged or torn when an athlete suddenly cuts or changes direction; ACL tears are most often seen in football, basketball, and soccer, and will sideline athletes for extended periods of time
• Meniscus tear: tears of the meniscus, a tough piece of cartilage that absorbs shock and stabilizes the knee, typically occur from twisting or turning too quickly on a bent knee, often when the foot is planted on the ground; degenerative meniscus tears may also occur in older adults; symptoms include pain, swelling, and difficulty extending the knee
• Patellofemoral pain syndrome: sometimes referred to as 'runner's knee,' this overuse injury results from repetitive movement of the kneecap against the thighbone, which can damage the tissue under the patella; as the name suggests, runner's knee is most common in runners and other athletes

Ankle and foot

The feet and ankles have the tall task of withstanding the weight of the entire body, and as a result, injuries are also quite prevalent in this region. Foot and ankle issues are particularly common in active individuals who engage in lots of running and/or jumping activities. Below are some of the most common ankle and foot conditions that physical therapists frequently treat:

• Ankle sprain: ankle sprains are the most common sports–related injury in both children and adults; this injury typically occurs when an individual twists their ankle or lands awkwardly, which can push ligaments beyond their limits; pain, swelling, tenderness, and difficulty bearing weight are all signs of ankle sprain
• Plantar fasciitis: this condition results from inflammation of the plantar fascia, a thick band of tissue that connects the heel to the toes; when this tissue is overstrained from repeated activity—like running—it becomes inflamed, which leads to a stabbing pain near the heel that's most noticeable upon waking up; plantar fasciitis is the most common cause of heel pain
• Achilles tendinitis: another overuse injury related to inflammation of the Achilles tendon, which connects the calf muscle to the back of the heel; it's most common in runners who do lots of speed training, uphill running, or who rapidly increase their training intensity or duration, and it leads to heel pain that usually comes on gradually as a mild ache in the back of the leg or above the heel
• Turf toe: this is a sprain of the ligaments surrounding the big toe when it's bent back too far (hyperextended), which is common in football players; it can occur from a sudden, forceful movement or repeated hyperextensions over time, and leads to pain, swelling, and limited movement of the big toe

Evidence supports the role of physical therapy for lower extremity conditions

Physical therapists regularly see these and many other painful conditions that involve the knees, feet, and ankles. As with other regions of the body, they utilize a variety of tools and techniques in tailor–made treatment programs that are based on the type of injury and the patient's unique abilities, needs, and goals. Most programs will include specific strengthening and stretching exercises, pain–relieving modalities, manual (hands–on) therapy techniques, sport–specific exercises for athletes, education, and guidance on how to modify activities to avoid further damage.

Research has shown that physical therapy can significantly improve patient outcomes and help them avoid surgery in certain cases. One study found that manual therapy led to clear improvements in physical function and reduced pain in patients with plantar fasciitis, while a robust review of studies found that physical therapy led to outcomes similar to surgery for various types of tendinitis, including Achilles and patellar tendinitis. Other research has shown that physical therapy leads to similar improvements in physical function when compared to surgery for patients with meniscus tears, and that physical therapy is also more cost–effective than surgery for these tears.

In our final post, we'll look at how physical therapy can also help manage other miscellaneous conditions throughout the body.