foot and heel pain

At your knee and ankle, as with all your other joints, the bones do not actually meet or touch. They are suspended in a tension and compression matrix of soft tissue such as ligament, tendon and fascia. For your knee or ankle to work properly, and pain free, the push and pull of this soft tissue matrix must be stable and occurring in synchronisation with the movements of the other joints in your feet, legs and back. Pain in these joints often persists for years, increasing with time, or reoccurs after treatment. This is because the underlying poor movement pattern that is placing stress on the soft tissue tension/compression matrix of your joint still exists. This must be restored before your body can successfully heal.

"Knee pain and weak legs had been causing me discomfort for a long time and was affecting my work. Ian Sadler made me aware of the underlying issues with my Biomechanics, prescribed tailored made orthoses and recommended stretching and strengthening exercises. The result has been great; my work is no longer affected because the condition has gone, my overall health has improved, and I finally feel back to my old self"

Sam Leggett
Session Drummer

Sam Leggett

Ankle pain

Ankle Sprain

Your ankle is a very important joint, transmitting movement and weight between your foot and the rest of your body. The ankle joint complex is made up of four joints held together by a complex system of ligaments. An inversion injury (ankle sprain) is the most common type of ankle injury (nearly 85%) and usually involves over-stretching and damage to one or more of the ligaments on the outside of your ankle. It can go as far as fracturing the bone, or rupturing one of the ligaments or muscle tendons around your ankle. Your Biomechanics can predispose you to ankle injury making you more likely to ‘roll’ your ankle over.

Acute ankle sprain

This involves a single incident and damage to ligaments only. This will often resolve within a few weeks of Rest, Ice, Compression and Elevation (R.I.C.E.). However, the ligament's position sense will be impaired for several months, making further sprains and nerve damage more likely, and leading to chronic ankle instability. You should seek professional assessment and rehabilitation even for a simple sprain.

Chronic ankle instability

Signs include: continually spraining your ankle, a feeling of instability at your ankle, ‘egg shaped’ swelling at your ankle by the end of each day, or continually ‘going over on your ankle’ but have no symptoms. The most likely cause of this is that you have poor Biomechanics predisposing you to ankle injury, or if full rehabilitation has not been achieved after a previous sprain. Biomechanics assessment and rehabilitation are essential for this condition to prevent further injury to your ankle, feet and knees.

For your body to recover successfully from ankle sprain, the balance of soft tissue matrix must be restored via the assessment of your biomechanics, an appropriate exercise program, and in some cases orthotic therapy.

Sinus tarsi syndrome

The sinus tarsi is a small tunnel which sits between the two bones underneath the ankle joint. As the foot moves during walking or running, the gap in this tunnel increases and decreases in size. Chronic ankle instability, or poor ankle biomechanics can cause this tunnel to become too mobile and damage the soft tissue structures that hold it together. Your underlying poor biomechanics must be resolved and external support will be required to stabilize the joint while it heals.

See the experience of a patient suffering with an Achilles tendon rupture.

For more information about how you get injured and how to recover from injury see the science bit.

Knee Pain

The knee joint is made up of your femur (thigh bone) and tibia (shin bone) with your patella (kneecap) sitting at the front, gliding up and down in a groove in the femur. Your knee is a remarkable joint: it must support your body weight at any degree of flexion, whilst transmitting the power generated by your back, hip and thigh muscles to your leg. It is able to achieve this due to its complex soft tissue structure controlling the push, pull and twist generated by your feet and hips.

The knee joint is prone to two general types of injury:

Acute trauma

Coming from an impact or a sudden twist, this will require rest and almost certainly care from a Physiotherapist or Osteopath to provide recovery. However, if you continue to have repeated acute twists, your biomechanics may be leaving you prone to this type of injury.

Chronic wear and tear pains

Anterior knee pain and Patellofemoral pain

These are both used as ‘umbrella’ terms for pain at the front of your knee. They are generally given to a condition where your patella runs slightly out of its groove in the femur. This causes wear on the adjoining surfaces, and damage to the cartilage of the patella and femur. It may also cause the tendon attaching your patella to your tibia to be pulled in the wrong direction at the wrong time, causing it to be damaged.

These conditions are caused over time by small variations in the movements of your knee. Your tibia is rolled in and out by the movements of your foot and ankle, your femur by the movements of your hip. The soft tissue tension / compression matrix of your knee controls, absorbs and transmits these movements up and down your leg. If, for example, your foot is rolling your tibia too far in, or keeping it rolled in too long due to excessive pronation, your tibia will be twisting in while the femur is being pulled out by your hip. This will change the tension / compression dynamic at your knee and damage your knee over time. For sports people, much smaller variations can lead to this type of problem. Depending on your biomechanics this type of poor synchronisation can lead to other conditions such as:

Osteoarthritis of the Knee

This is when the uneven movement of your knee joint has caused part of soft tissue matrix protecting your bone surfaces to wear down. Essentially, damage is occurring to part of your bone or cartilage more quickly than your body can repair it. This most commonly occurs if your patella runs poorly in the groove of your femur, or at your meniscus (a "C" shaped "shock absorber" which lies between your femur and your tibia). You have a meniscus on the inner (medial) side of your knee and one on the outer (lateral) side of your knee. Injuries to either the medial meniscus or the lateral meniscus are common, and are often referred to as a "torn cartilage". This can give feelings of ‘grinding’, ‘locking’ or ‘catching’ depending on the injury. This puts extra stress on the protective articular cartilage covering your bone surfaces, leading to increased and uneven wear at your joint.

For your knee to successfully heal, the underlying and uneven stress going through it must be eliminated. Your poor biomechanics must be assessed and realigned. This will most likely include exercises and orthotic support. The earlier you seek help for your knee pain, the more likely it is that long term damage from wear and tear can be averted, stopping reliance on painkillers, anti-inflammatories and ultimately undergoing knee replacement. Even after having your knee joint replaced, the underlying poor biomechanics from your feet and hip may still exist, putting stress on your replacement joint and wearing that out more quickly, too.

See the experience of one patient suffering with arthritic knees and progressively flattening feet.

For more information about how you get injured and how to recover from injury see the science bit.