Ankle and Foot Pain at Work

Ankle and Foot Pain at Work

It is incredible what the ankle and foot has to withstand in everyday life. The simple act of walking, each step the full body weight is loaded down through the joint as is slides and glides in the many tiny joints of the foot trying both to keep us upright, propelling us forwards and absorbing both forces from the ground and from the body. Multiple long thin tendons act as pulleys around the bony prominences of the foot co-ordinate with the attached muscle and are aided by the hundreds of small ligaments at each joint in the ankle, forefoot and toes to try and keep us stable, balanced and active. Phew!…. It’s incredible to think we are not all constantly in pain with the amount of workload going on at the foot every day!! 

However, should you start to notice pain or swelling at the foot or ankle and suffer limitation to daily activities consider letting your GP know and / or inform your line manager. They may be able to help and temporarily adjust your duties at work or hours and refer you on to the occupational health department for an assessment and support. 

While foot and ankle pain is rarely due to anything serious, you should attend A&E urgently if: 

• Pain is the result of a recent substantial trauma. 
• You are unable to move your foot due to pain and / or extreme weakness or have loss of feeling through lower leg/foot. 
• There is a new significant change in foot colour / redness or swelling. 

What causes Ankle and Foot pain?

Foot and ankle pain can occur following physical trauma such as a sporting injury, going over on your ankle or an accident at work each of which may result in bone trauma, a sprained ligament and / or a muscle or tendon injury. With the constant daily loading usually needed on the feet through standing and walking and the variety of shapes of people’s feet and limitations in footwear support, the majority of foot and ankle pains develop purely from gradual load and strain over time. 

Although pain can commence from these forces, the likelihood of developing persisting symptoms and the severity of symptoms often depends on a combination of other factors including;  

• Repeated or excessive stresses beyond your foot and ankle tissue thresholds – such as through increasing distance and frequency of sporting exercise, repeated poor manual handling techniques at home or work, poor work habits such as not rotating tasks where possible or not taking regular breaks from static loading positions, poor footwear.  
• Individual factors – being female, increasing age and pregnancy all increase the likelihood of developing pain.  
• Physical wellbeing factors – smoking, obesity and poor general fitness all increase the likelihood of developing pain and the length of time it takes to recover.  
• Psychological wellbeing factors – stress, depression and anxiety all increase the likelihood of developing pain and even increase the severity of pain and the length of time it takes to recover as does fear of movement, activity and work.  

A common source of foot pain is a condition often called ‘Plantar Fasciitis’. 

Plantar fasciopathy is a common work-relevant condition affecting the plantar fascia of the foot which is often seen within occupational health clinics. The plantar fascia is a thick band of connective tissue which runs from the heel on the sole of the foot, along to the toes. It is important in supporting and helping maintain the foot’s arch and create stability and in assisting us with the efficiency of propelling us forwards as we walk. 

Plantar fasciopathy often tends to be worse on the first steps in the morning or after a period of rest. The bottom of the heel may feel tender. It can also be worse when walking on harder surfaces, being barefoot or going up stairs. 

What causes plantar fasciopathy? 

Heel pain can occur in people of all ages but tends to be more common in middle age and affects females more than males. Pain usually presents if there has been an increase in volume or intensity of standing, walking or running, particularly in unsupportive footwear, causing the plantar fascia to become overloaded. Biomechanical and anatomical differences can affect heel pain, for example how your foot arch is shaped and your ankle range of movement. Some medical conditions can also be associated with heel pain, such as diabetes, while being overweight is also a risk factor due to the increased load through the plantar fascia. 

How can I help myself?

The majority of work-related foot and ankle pain cases can be self-managed or treated conservatively with physiotherapy treatment and advice, however, your attitude and the actions you take are the most important factors in preventing long-term problems. The most effective way to manage symptoms of foot and ankle pain are to;  

• Avoid overly prolonged static standing postures, keep mobile and active yet take breaks to sit for short periods were able or remember to lie down at home and elevate your legs. Low impact exercise such as yoga, Pilates and swimming or short walks can be a good starting point in maintaining strength, flexibility and fitness.  
• Try and keep the ankle and foot mobility by pointing the foot up and down and moving round in small circles on the bed a few times a day, as pain allows. 
• Talk to your GP or pharmacist about what pain relief may be right for you. If your pain is controlled, you will be able to maintain optimal movement.  
• Apply gentle heat (if not red and inflamed) to sooth or ice (wrapped in a damp towel) to have a numbing effect around the region, if desired, and try and elevate the leg to reduce any excessive swelling if present.  
• Try and maintain and wear quality, supportive footwear that is not loose and flimsy. Sometimes gradually adding a specialised arch support may help in some presentations like if your foot arches are flatter and foot rolls inwards significantly.  
• Report any symptoms you think may be work-related. Firstly, you may have a lawful duty to report your discomfort / injury. Secondly, by informing your employers they are then able to make any necessary adjustments to your workplace or working practices, either temporarily for yourself on an individual basis, or permanently for the team to improve overall workplace wellbeing. Also, in reporting it to your line manager, they may be able to refer you for physiotherapy support at work or externally.  
• If work can adapt your tasks and / or hours, if needed, then try and keep at work and keep active.  

How can physiotherapy help?

At Physiotherapy Matters, our physiotherapists can conduct a thorough assessment to confirm a diagnosis and work with you to help you manage your symptoms and return to normal activity by;  

• Helping you understand your condition.  
• Helping identify the factors that may have contributed to your symptoms and provide advice on how to minimise these, including manual handling or safe DSE use.  
• Developing symptom management strategies so you always feel in control.  
• Completing ergonomic workplace assessments to minimise any work-related risk.  
• Providing an individualised exercise program to improve mobility and strength to address symptoms but also to prevent future episodes, including work-hardening programmes.  
• Providing additional manual therapies that may help ease symptoms, such as:  
• Taping to provide postural support,  
• Soft tissue massage to reduce any muscular tension in the surrounding muscles, 
• Mobilisation of the lower and upper back to reduce stiffness, 
• Acupuncture to reduce pain