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SOME COMMON CONDITIONS EXPLAINED

• PLANTAR FASCITIS

• ACHILLES TENDINOPATHY

• SPRAINED ANKLE

• ITB (ILIO TIBIAL BAND) SYNDROME

• SHIN SPLINTS / SHIN PAIN

• CALF STRAIN

• KNEE PAIN (PATELLO-FEMORAL SYNDROME)

• BUNIONS (HALLUX ABDUCTO VALGUS)

Plantar Fasciitis is an injury causing heel pain and pain along the arch of the foot the plantar fascia is a thick fibrous band of tissue in the bottom of the foot which runs from the heel to the base of the toes. When placed under too much stress, the plantar fascia stretches too far and frays, or tears, resulting in inflammation of the fascia and the surrounding tissues. The tears are soon covered with scar tissue, which is less flexible than the fascia and only aggravates the problem.

Symptoms

Typically symptoms are worst first thing in the morning or with activity after a period of rest and may include. Pain at the base of the heel., heel pain at the origin of the arch ligament when weight is put on the foot, pain at this point if standing on tip toes, tenderness and swelling under the heel, numbness along the outside of the sole of the foot.

Causes

Is caused by stress, tension and pulling on the plantar fascia due to muscular imbalance (typically inflexible calf muscles and weakness of the foot supporting muscles). Also, poor mechanical structure (either excessively flat or too high arched) of the foot placing more stress onto the plantar fascia can cause this injury. Over activity may also lead to plantar fasciitis.

Treatment

The treatment involves rest and icing to alleviate inflammation. Seek professional assistance from podiatrist for

• Strapping to control and prevent further straining to the fascial structure.
• Stretching, strengthening and massage to address muscular imbalance.
• Assessment & control of abnormalities in leg and foot structure.

Achilles Tendinopathy is a painful and often debilitating condition caused by over stressing the Achilles tendon. Achilles tendinopathy can refer either to inflammation around the tendon (Achilles tendinitis) due to a single incident or a series of very small tears (microtears) in the connective tissue in or around the Achilles tendon (Achilles tendinosis). The injury may occur at the point where the tendon attaches to the heel or at any point along the length of the tendon. Symptoms of Achilles tendinopathy may include pain and tenderness in the affected area, along with decreased strength and movement in the lower leg, swelling and redness. Achilles tendinopathy is caused by overuse and is most often seen in people who have engaged in a sudden increase in activity

The Achilles tendon is an extension of the two calf muscles; it runs down the back of the lower leg and attaches to the heel bone. The Achilles tendon connects the strong leg muscles to the foot and gives us the ability to rise up on our toes, facilitating walking and running. The Achilles tendon has a poor blood supply so it can be slow to heal.

Because the arch of the foot flattens over time, especially in athletes, someone may be problem-free for years and develop Achilles problems later in life. In these people, the muscles and tendon have little flexibility because of inactivity. It is especially important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually. Correct technique is also essential to minimise overload.

Achilles tendinosis weakens the tendon and may make the tendon more vulnerable to tear or rupture. The risk for rerupture increases if the condition is not treated. It can require weeks to months of rest and appropriate structural control for the tendon to slowly repair itself. If you look after this injury early enough you should make a good recovery. It is important you rehabilitate the tendon properly after it has recovered or the injury will return. If you ignore the early warning signs and do not look after this injury then it may become chronic which is very difficult to treat.

Treatment involves initial rest and inflammatory control. Seek professional podiatrist treatment for

• Strapping to support and unload the stressed area.
• Resolution of muscular inflexibility through massage and specific exercises.
• Ultrasound to improve blood flow and healing.
• Control of improper foot mechanics.

Spraining is stretching and tearing of ligaments. The most common mechanism of injury is when the foot lands awkwardly and rolls outwards – the “inversion” sprain ( Less common and typically much more debilitating is spraining due to the foot rolling inwards – the “eversion”sprain. Most commonly the anterior talo-fibular ligament will be sprained. In heavier sprains further ankle ligaments and tendons may be involved

Severity is rated in three degrees. First - being least severe and Third most severe. Ranging from minimal stretching and swelling with perhaps some tearing & no joint instability. Through to total rupture and complete instability.

Causes

A sudden change in direction, poor muscle control, poor proprioception and poor foot structure (excessively high or flat arches) are typically involved in ankle sprains.

Treatment

Reduce swelling with RICE immediately. Protect with strapping, bandage and or crutches if necessary.

• Professionally seek aid of podiatrist for
• Massage
• Immobilisation
• Stretching/strengthening
• Electro therapy
• Proprioceptive exercise

Finally ensure that any underlying structural fault of the foot is addressed by podiatrist to minimise reoccurrence.

The Illiotibial band (ITB) runs down the outside of the thigh, From its origin on the outside of the pelvis at the TFL muscle down to its insertion below the knee.

Cause and Symptoms

Tensioning of the tendon will cause to rub on the bone at the knee and this will eventually become inflamed and painful ( the TFL muscle may also be pulled tight over the outer hip bone causing pain and inflammation over the outer part of the hip) Tensioning may occur due to injury to soft tissue or, due to inappropriate leg rotation caused by collapsing foot structure overloading the ITB. When this happens running can become very painful. If you rest, the inflammation may settle down but if the causative factors are not identified correctly, when you start to run again the symptoms are likely to return. This occurs because the band is tight the tendon will once again become inflamed.

Treatment

Initialy implement R.I.C.E. to control acute factors. Stretch and massage of the Iliotibial band to alleviate contractile forces (Failure to stretch the Iliotibial band properly is highly likely to result in a recurrence of the injury when returning to training).

Gradual return to activity with a graded strengthening program

Seek professional podiatry treatment for Controlling of excessive leg rotation caused by poor foot function through prescription of foot orthoses to alleviate any mechanical strain and muscular rebalancing.

Shin splints (anterior, medial or lateral tibial/fibular stress syndrome) are an exercise related pain occurring along or just behind the inner edge of the shin ( Tibia).

Symptoms

Include tenderness over the inside of the shin with occasional swelling. Exacerbation of symptom occurs with bending of the toes or foot downwards. Pain is usually most severe at the start of activity, but may alleviate as the muscles “warm up”.

Causes

Overuse of specific muscles due to poor mechanical leg and foot function or due to training errors.

Treatment

Rest from weight bearing and impact creating activity is essential. Apply ice in the early stages to reduce inflammation. Seek professional podiatrist treatment for

• Control of poor foot mechanics to arrest excess internal tibial rotation and reduces stress on shin muscles.
• Deep tissue massage, stretching and strengthening

The calf muscles consist of the Gastrocnemius which is the big muscle at the back of the lower leg and the Soleus muscle which is a smaller muscle lower down in the leg and under the Gastrocnemius. Either of these two muscles can be strained (torn). Gastrocnemius-soleus strains are commonly seen in explosive sports such as court sports involving quick moves in all directions and often involve predisposition due to poor leg and foot structure.

Symptoms

Include sudden pain at the back of the leg with difficulty in contracting the muscle or standing on toes. Pain, swelling &/or bruising in the calf muscle may also occur. Most commonly injury will occur at the muscle-tendon junction.

Degree of injury can be graded from First through to Third. Ranging from minimal tear to complete rupture.

Treatment

Involves implementation of RICE for the acute phase. Followed by professional podiatric bracing, massage, rehabilitative stretching and strengthening exercises and control of any predisposing structural anomalies of the leg and foot.

Runner’s knee is an overuse injury common with running, jumping and court sports. The basic mechanism of the injury is the mal-tracking of the knee cap upon the knee joint.

Commonly lower limb biomechanical imbalance is the relationship between the foot and the knee. Excessive foot distortion, with flattening of the arch or rolling in of the heel results in internal rotation of the leg, which changes the angular alignment of the knee relative to the leg and foot. Injury occurs in two broad circumstances -- either when the patella is forced with excessive pressure against the underlying femur or when it tracks excessively on one side or other of the groove. In either case, this would cause irritation and abrasion of the cartilage of the patella, resulting in inflammation and pain.

Worthy of note is the fact that an excessively rigid or high arched foot can similarly cause poor tracking and excess jarring at the knee. Both mechanisms will cause compression to the various ligaments, tendons and menisci of the knees leading to conditions such as muscle strain, tendonitis, miniscal tearing, cartilage erosion and cruciate or collateral ligament damage.

Symptoms

Symptoms may include pain going up or down stairs, pain with prolonged sitting, pain deep in front of knee, giving way, swelling and clicking, pain with activity.

Management is based on an abundance of scientific research being led by physiotherapists. Stretching of tight structures, strengthening of weak structures and correction of abnormal biomechanics normally leads to successful recovery and return to sport. The use of tape to hold the patella in place is commonly used.

Treatment

The treatment involves implementation of RICE over the acute phase.

Professional treatment should then be seeked to determine the degree and type of injury .With the implementation of muscular strengthening and stretching of various muscle groups affecting the knee. Electro modalities may be implemented to aid and stimulate repair. Finally any structural or functional anomaly of the foot should be controlled to prevent any torsional stress and instability to the knee.

Bunions appear as a misaligned enlargement of the bone on the inside of the foot at the big toe. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow or high heeled. Bunion deformity goes through various stages with the initial being moderate malalignment of the toe through to complete distortion of the great toe , large irregular bone formation at the inside of the joint and contracture of the second toe ( at this stage bunions will be painful and debilitating). Poor foot biomechanics including flat feet can lead to bunions by causing accelerated mechanical arthritic change at the big toe joint.

Accommodating footwear and pressure relieving devices can be implemented to alleviate acute pain and inflammation associated with bunions.

However professional podiatric assessment and treatment of underlying structural anomalies of the foot need to be assessed and treated in order to prevent the further development of the bunion deformity.