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Foot and Toes Injuries

 

Severs Disease

What is it?

  • In adolescents bones are still maturing.
  • The points where tendons attach onto the bone often become inflamed.
  • Severs Disease is one such case of this and refers to where the Achilles tendon attaches onto the heel (calcaneum) It is common in young athletes involved in running and jumping sports.
  • It is particularly common in Boys at the age of 10.

 

What do I look for?

  • Pain at the back of the heel around the Achilles attachment.
  • Tightness in the calf region.
  • Pain with running, walking, heel raises or calf stretches.
  • Pain lasting for a period of time after activity.

 

 What causes it?

  • Sudden growth spurt
  • Tight calf muscles
  • Poor foot posture/ incorrect footwear
  • Lower limb muscle imbalances.
  • Increasing physical activity

 

It is important to have this problem addressed as early as possible.  The aim is always to keep the child involved in sport and activity, as complete rest will not usually help, and can lead to children staying inactive.

The problem will eventually resolve itself, but if not correctly addressed, can cause excess pain, and a dislike of physical activity.

 

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan. Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

 

Selecting The Right Shoe

During activity it is important to make sure you not only have a good shoe, but you have the right shoe for your feet.

-Your shoe choice is dependent upon: 

-How your foot absorbs shock.

-How you walk and Run.

-Your body weight

-Training surfaces

As you walk or run, your foot naturally absorbs and transfers shock.

PRONATION describes the movement of your foot in absorbing this shock.                 

UNDER Pronated feet are less common and tend to have more stress related injuries, less ‘natural’ cushioning.

OVER Pronated feet are more common and can transfer the shock and stress to other structures leading to damage.

Sometimes we need to support a foot to alter the shape and the amount of pronation. The Rearfoot and Midfoot are two of the different areas of the feet that require support.

In selecting any Shoe, it is important to select one that supports your particular foot shape.

Different Brands of shoes have different levels and areas of support. Most major Sports Shoe Manufacturers make a variety of models within their range, to allow for various foot types, and various biomechanical styles.

By examining a Sports Shoe, you can often see different amount and types of support in different areas of the shoe.

Different Shoes have different densities, and amounts, of foam to provide support and padding. This can be provided at a number of different areas of the shoe including the arch, heel and ball of the foot.

This huge variation between, and even within brands makes it very hard to pick the right type of shoe to suit the shape of your foot.

Only a very small number of shops that sell shoes have trained people onsite who can recommend the right sort of shoe for your foot.

 

Plantar Fasciitis

What is it?

The Plantar Fascia is a thick broad band of connective tissue on the bottom of your foot attaching from your heel to the base of your toes that helps to maintain the arch of your foot. Plantar Fasciitis is simply inflammation of the plantar fascia.

 

What do I look for?

  • Pain on the bottom of the heel or foot with the first few steps in the morning
  • Pain when walking or running, often starting with a dull ache and progressing to a sharper constant pain and then may dull down once warmed up
  • Pain may radiate from the heel into the toe region.

 

What causes it?

  • Poor foot posture, tight calf muscles
  • Lack of correct footwear support
  • It is common in people/ athletes who use repetitive, maximal ankle and foot range of movement.
  • Sudden weight gain or beginning of a new training regime

 

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.

 

Heel Pain

Heel pain is one of the most common foot injuries assessed, diagnosed and treated by a Podiatrists, Physiotherapists and Sports Medicine Doctors.

Heel pain most commonly occurs in middle aged Men and Women, but can also occur in children (usually between 8 and 13 years old) as they become more active in sporting activities.

The most common cause of heel pain is poor biomechanics. This uneven loading of the soft tissue in the heel and the bone, can lead to stress that causes pain.  Heel pain can also result from an acute injury, such as direct trauma from landing on a stone, running in footwear with inadequate support, or running on hard surfaces.

The heel bone, or Calcaneus, can also develop a heel spur on it.  This can be a deep painful site in the centre of the heel, though around 10% of the population may have heel spurs with no symptoms linked with its presence.

The Calcaneal spur is a result of the traction, or pulling of soft tissue that attaches at the front edge of the heel bone, causing the bone to lay down more bone in the form of a spur.

There is a band of tissue that runs from the heel to the toes, it is very strong piece of soft tissue, and is called the Plantar Fascia.  This is commonly linked with pain occurring in the heel, and when it gets inflamed due to strain, this causes pain (PLANTAR FASCIITIS).

Pronation of the foot (flattening of the arch during weight bearing), causes load on the Plantar Fascia.  Non supportive footwear or poor foot function will lead to load on the Plantar Fascia.

There are many other causes of heel pain including referred pain, local nerve irritation, bursitis, stress fractures, etc.

Early diagnosis and appropriate treatment is the best approach with resolving the heel pain quickly.  Strapping of the foot can be very worthwhile in resting the soft tissue, or injured heel.

Other treatment modalities that can be used include: Icing, anti-inflammatory medication, shockwave therapy, massage, stretches, appropriate training warm ups, footwear changes, and/or orthoses.

 

Flat Feet 

“Flat Feet” is a commonly used term to describe someone’s foot type.

However it is often incorrectly used to describe a foot that “over-pronates” or “rolls in” excessively.

We will often be encouraged to look at our footprint after a shower to decide if we have pronating feet or not.  This is not strictly correct.  Many people have very “flat feet” and they function without any pain in this position, as it is considered their neutral or ideal foot posture.

When we walk we contact the ground on the outside of our heel, or the lateral back corner of our foot.  To absorb shock the foot then pronates at a controlled rate, this movement is the “flattening” of the arch towards the big toe.  If this rate of pronation is too great, or there is too much flattening of the arch, then this becomes excessive pronation and becomes a problem for the foot and lower limb.

Once the foot is in full contact with the ground it must then convert into a rigid lever to push off the ground forward.  This is called propulsion, and the foot therefore converts from a shock absorber to a strong lever to keep the gait, or walking cycle occurring.

So if the foot goes through too much pronation after heel strike the soft tissue must do so much more work to achieve the conversion of the foot to a rigid lever, and can therefore create a great load on soft tissue associated with your biomechanics.

So a flat foot may be an indication of someone who is maximally pronated, or in fact could be someone who is in their ideal foot posture location.

If you question whether you have “flat feet” or maximally pronated, contact a LifeCare Podiatrist.

Do Heel Spurs Heal?

One of the easiest physical diagnosis to make is Plantar Fasciitis or heel spurs. But unfortunately treatment of this common problem is not nearly as easy.

When you hear; “when I get out of bed the first ten steps are agony” and the client points to the inside of their heel: you probably have Plantar Fasciitis.

PLANTAR FASCIITIS is of course the chronic inflammatory response to repeated trauma to the attachment of the plantar fascia to the medial calcaneum.

The problem is very common, and can affect women in their middle age, young sportsmen, and everyone in between.

Tenderness on the point of insertion, and the presence of the heel spur on x-ray go further to confirm this diagnosis.

The causes of Plantar fasciitis can be wide and varied. Tight calf muscles can significantly affect this problem, as can wearing high heel shoes. Pronated or flat feet puts excessive stress onto this attachment and the problem will continue until this is corrected.

However, fixing this problem is the hard bit. The response to trauma over a long period of time makes correcting this problem very difficult.

Anti inflammatories and cortisone injections can give significant improvement. But they may only clear the symptoms not the cause, and benefits can be short lived.

Properly designed orthotics can give significant long term relief, however this does not always give immediate results.

Our expert Physiotherapists can significantly help this problem both in the short and long term.

Strapping is often an extremely useful method of decreasing the stress onto the attachment of the plantar fascia, giving the tissue a chance to heal. Local treatments such as electrotherapy can significantly reduce the inflammation. A full bio-mechanical assessment can highlight the main causes and how to correct them.

So next time patient mentions heel pain, don’t just treat the symptoms help fix the cause. Contact us.

 

Cuboid Syndrome

INTRODUCTION

The mid foot region is a complex structure comprising of the small tarsal bones and numerous supporting ligaments and tendons. One of these joints which commonly becomes problematic is the cuboid and its other articulations – this is known as “cuboid syndrome”.

 SYMPTOMS

 Commonly “cuboid syndrome” is felt as a sharp consistent pain over the outer aspect of the foot. The pain tends to be worse with walking on the outer aspect of the foot or during the “toe off” phase of the walking/running cycle.

CAUSE

The cause of cuboid syndrome is varied but commonly it can be linked to poor foot biomechanics, especially over-pronation “flat arched feet” and sometimes subsequent to a severe ankle sprain. In the first instance the primary cause is due to the repeated pulling on the cuboid by the fibularis longus muscle which is located on the outer aspect of the lower leg.

TREATMENT

Immediately after injury, treatment of cuboid syndrome involves reducing inflammation. This requires using the RICER regimen, and referral to an appropriate Sports Doctor and Physiotherapist.

WHAT TO DO

Treatment to maximise full rehabilitation following the onset of cuboid pain should involve:-

-Physiotherapy aimed at correcting any biomechanical problems.

-Physiotherapy to reduce joint inflammation and improve joint mobility. This will promote healing, full recovery and safe return to activity.

-Podiatry may also be needed to assess the problem to promote full recovery and return to sport or normal activities. If you feel you may have this problem don’t wait to get better, contact us.