Ankle Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, many times voted best physiotherapists in Vancouver and in North Burnaby. And again, just recently, one of the top three physiotherapists in Vancouver, and we're going to talk about ankle pain today. How're you doing Wil?

Wil: I'm doing good. Thanks. Thanks. Thanks for that. Yeah, I'm doing really good. 

Mark: So ankle pain. What's the, I'm sure there's many different kinds and types. Let's talk about a specific one. What do you see the most of? 

Wil: Well, you know, I'm just thinking about like a few people that I've seen over the last few weeks that have come into the clinic. And one of the biggest things that they complain about is that in terms of ankle pain, is that they have trouble with squatting. Or doing like a lunge and basically having the ankle, like coming into a direction where it forces it into that motion. And so that's one of the biggest complaints with this type of a loss of mobility that I've been seeing with regards to ankle pain.

Mark: And is ankle pain then that's kind of in the front of the ankle. 

Wil: Yeah. So I'm thinking about these specific clients that I've been seeing, is that they actually have pain on the front outside part of the ankle, which is very consistent with like every time they squat. And they came into the clinic basically having those issues of not being able to do proper squats.

Mark: They're not feeling it when they're walking. They're not feeling it when they're running necessarily, but when they squat, when they kind of hyper flex the ankle joint, that's when they're feeling that pain. 

Wil: Yeah. Yeah, exactly. That's it. I mean, to a certain extent with these specific clients I had seen over the last few weeks, one was a runner, one was a rock climber and the other actually was an ultimate Frisbee player. So out of the three, the ultimate Frisbee player actually could feel it with a little bit more running But the interesting thing is that they can present in different ways.

So what I mean by that is that, you know you can either have a previous injury. So if you've sprained your ankle before, which you know, two out of the three of them did, it can cause a block in the range of the motion in the ankle, which was what was going on with two out of the three of them. 

Now, the other person, which was really interesting, they had no prior injury. But they were actually ramping up their training load and doing a lot of plyometric training. And so it's that repetitive nature. And so that imbalance of what was going on in the ankle that was causing the impingement. And the impingement for this person was located in a bit of a different area too.

So but what I see a lot more and what's more common is sort of that loss of mobility or what they call ankle impingement, which is basically located in the front outside part of the ankle when you try and do like a squat range of motion.  

Mark: So when you say impingement, it's like the something in the joint is kind of rubbing, there's not enough room in there somehow, is that what's going on? 

Wil: You can describe it more as a blocking sensation. So a blocking sensation when the ankle comes up, so like when you bring sort of the toes to the nose, range of motion, and sometimes you can get swelling, so there could be swelling in there. And so I'm describing the symptoms here a little bit. And there could be sort of this feeling that it's not stable. It's definitely some limited ankle motion. And like I was saying, the pain of the squatting is the big one. Sprinting, also climbing stairs or hill climbing and sometimes normal walking, like normal, just day-to-day walking can be affected if it gets bad enough.

Mark: So what's causing this? 

Wil: Yeah. So there's, I mean, first of all, this type of issue, there's a broad range of things that can come. So ankle, this type of ankle pain, related with the loss of mobility or ankle impingement. There can be many different issues that could be related to this. So it's such a broad spectrum, right?

I mean, when we look at the sort of extreme end of it, it could be something like a stress fracture. It could be like maybe a nerve trapping or ankle, or even higher up in the knee. It could even be something related to your back. Believe it or not. You know, when you have the pain, right. So that's why, you know, you need a proper physio assessment, let's say you could be doing a squat and be getting the pain, but you need a proper assessment to see, is it coming from the back or is it really the ankle? 

And then something more sinister. So I'm just talking about sort of the more like sinister stuff here again it could be something like a tumour, so you want to get all that stuff, like sort of checked out. And then it could be things like maybe it's like wear and tear, it could be like, if it's an old injury, like an old sprain, then something's just not moving well. And the joints aren't aligning properly. But then once again, it could be, if it's an old injury and it's been like this for awhile and it's been giving you problems ongoing, there might be a little bit of like that wear and tear with sort of like a little bit of calcium formation or osteophyte formation developing in your ankle joint, causing that block. 

Another issue that could be result of this ankle pain is maybe an overuse injury happening in one of the tendons. We don't know, so we'd have to assess it. But one of the most common things, like after someone that's had an ankle sprain, it's usually a blockage, but then there's these other things that you want to rule out.

Mark: So essentially there isn't going, because it's got such a wide range of possible causes. There's no typical course of treatment. You really need to dig into what is actually happening in the ankle in order to then go, okay, well, here's what we do now. 

Wil: Exactly. So we have to figure out what the actual limitation is and what's causing that. And then also, you know, if it's something that we think is possibly more you know, on the sinister end, then we would actually go more towards like referral to the doctor if that was the case. But we would obviously look at treating what we can treat and manage where we can manage based on our assessment and objective findings.

Mark: So if old the ankle sprains are, let's just make a crazy assumption, let's say old ankle sprains are what is causing the majority of the problems in most cases, what would be the typical course of treatment for that? 

Wil: Yeah. So then assuming that that's causing a shift in how the ankle is moving, we would want to restore that range of motion. And then after restoring that range of motion in the actual ankle joint, then we obviously on the assessment, you know, usually there's a bunch of other things going on. Like in terms of imbalances and in terms of stress issues and weaknesses that that would be presented. So quite typical, I mean, not all the time, but I would say nine out of ten times that you know, there's a lot of muscle imbalance. The calf muscles will be really tight. You gotta work that out because that will really pull on the ankle. Make things stiffer and put it out of sort of improper mobility or improper belt mechanics. So you wouldn't have an optimal type of movement pattern going on in there.

And then you would address all the issues that are related to balance and strength and all that stuff from not just the ankle, to the knee, but even right up to the hip and the core. Because all that can affect you know, this thing called the lower kinetic chain. So what that means is basically, you know everything is all connected.

So I know that's a big term, the lower kinetic chain, but what it is, is it's basically how when you think of chain, we think of like, you know the links of all these rings, you know, and how they all affect one another. And kinetic means movement. So how does the movement and how is the strength movement in the hip effect that in the ankle?

And so that's how that's all related. And so we want to affect everything. And obviously if someone comes in with presentation of pain and it has swelling, then we want to deal with that. So we want to take the swelling down. That's also really important to deal with. So we're looking at a bunch of different issues. Like if it's an acute thing we want to deal with that. And then take it through the the stages of healing when it calms down. Start looking at you know, the strengthening and we can even start to address the strengthening and a lot of the mobility things, even as the swelling is still starting to come down or even in the acute stage, as long as you're not reproducing a lot of bad pain in that area.

Mark: And so, of all the ways that you can hurt your ankle, this is one of the more common ones would you say? 

Wil: In terms of, well, in terms of spraining and then having, yeah, I would say like, it's one of those injuries that I would say that it bites you back if you don't take care of it. It's one of those injuries that can haunt you.

So you sprain your ankle. And especially if you're very athletic and you do a lot of sports involved with cutting and running jumping. So if you're a volleyball player, basketball player, and you do a lot in play and you sprain it, but you don't really rehab it properly, and it feels better, but you know, you may have this issue down the road.

 So you really need to look at rehabbing it. And so what that means is addressing those things that I just talked about, like all those deficits, because over time, you may not feel it, but there's sort of this like slow, gradual, imbalances starting to creep in. As it creeps in more and more then we get used to it until it becomes like symptomatic, then we think, oh, I don't know what happened. And then we think that this problem just suddenly appeared. Whereas an actuality you know, your old ankle sprain, especially if it was a particularly bad one where you healed from, but you didn't rehab from. So there's a big difference. 

So you heal from it, but you didn't rehab from it. You're not really addressing like all the other things that I talked about. Like, well, what about the strength and the balance? You may have addressed some of the general strength and balance and mobility issues. But if you're going back to doing a lot more running, or if you say just started to take up running or started up a new sport and you have this old ankle injury.

Then you want to start to look at doing some things to maybe assess. Okay, do I have an issue that I need to deal with? So this is also a concept of making sure that you prevent an injury before it starts. So this concept of prehab, which is preventing an injury from happening by rehabbing it and getting it stronger and really making sure that the movement area that you injured the past and also other adjacent or areas like above or below. So if it's your ankle, then your knee, and your hip and your back are all working together properly. 

Mark: If you have some ankle pain, get it diagnosed. Get into Insync Physio in Vancouver. You can call them at (604) 566-9716 to book your appointment. They also have a North Burnaby office, (604) 298-4878. Of course you can book online at

Both locations are available there. Get in there and get that ankle pain looked after. Get the prehab rehab all done. So you have your new sport or old sport, much more enjoyable for yourself. Thanks Wil. 

Wil: Yeah, no problem. You bet.