Category Archives: Uncategorized

Stress Fracture

Summary

• Stress Fractures occur when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces that often lead to microscopic cracks in the bone.

How did I get this?

• Generally, it is repetitive stress (i.e. running, marching, sport etc.) although some bone diseases can pre-dispose to thin bones which therefore fracture more easily. In people with osteoporosis (thinning of the bone) there is an increased risk of stress fracture.

What can I do about it?

• Rest the area and stop sporting activity.
• Wear good fitting shoes with adequate support and cushioning.
• Avoid high heels.
• You can try a protective pad.
• See a podiatrist.

What help can I get for this?

• Podiatrist may advise appropriate shoes, consider prescribing orthotics, consider immobilisation, and advise on surgery.

When will it get better?

• In the majority of cases, conservative care allows the bone to heal and normal activity can then be resumed. Surgery is sometimes necessary to stabilise the fracture site which allows longer time to resume activity.

Sever’s Disease

Summary

• It is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 to 14 years old, because the heel bone is not fully developed until at least age 14. When there is too much repetitive stress on the growth plate, inflammation can develop. Symptoms include pain in the back or bottom of the heel, limping, walking on toes, and difficulty running or jumping.

How did I get this?

• Overuse and stress on the heel bone through participation in sports is a major cause. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer/football, running, or basketball are especially vulnerable.

What can I do about it?

• Rest.
• Ice pack application.
• Calf and hamstring stretches.
• See a podiatrist.

What help can I get for this?

• Podiatrist will confirm the diagnosis and advise appropriate shoes, exercises, and orthotics.

When will it get better?

• Use of orthotics and supportive footwear usually provide relief within a few weeks.
• The condition is self-limiting. Once the growth plate has closed the condition will resolve.

Retrocalcaneal bursitis

Summary

• Retrocalcaneal bursitis is a condition characterized by tissue damage and inflammation of the retrocalcaneal bursa (a small fluid filled sac located at the back of the heel) causing pain in the heel region. Risk factors include poor foot biomechanics (particularly flat feet), inappropriate footwear (e.g. excessively tight fitting shoes), muscle weakness (particularly the calf, quadriceps and gluteals), muscle tightness (particularly the calf), joint stiffness (particularly the ankle or foot), bony anomalies of the heel bone, inappropriate or excessive training or activity, inadequate recovery periods from sport or activity, inadequate warm up, inadequate rehabilitation following a previous Achilles injury, change in training conditions or surfaces, inappropriate running technique, inadequate fitness, poor pelvic and core stability, poor proprioception or balance, and being overweight.

How did I get this?

• Compressive forces and friction may be placed on the retrocalcaneal bursa during certain ankle movements or by wearing excessively tight shoes. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur.

What can I do about it?

• Rest.
• Massaging the calf muscles.
• Stretching.
• Ice packs.
• Seek podiatry consultation.

What help can I get for this?

• Podiatrist may prescribe padding or strapping, appropriate footwear/modification, exercises, or orthotics
• Orthopaedic surgeon for surgical removal of bone spur (if present), removing the thickened inflamed retrocalcaneal bursa, and debriding the Achilles tendon.

When will it get better?

• This condition usually gets better in several weeks with the proper treatment.

Posterior tibial tendon dysfunction

Summary

• Posterior tibial tendon dysfunction (PTTD) is an injury involving overstretching or rupturing of the posterior tibial tendon, leading to tendon inflammation, weakness, foot deformity and arthritis. The posterior tibial tendon extends from the deep layer of muscle at the back of your leg. It runs along the inside of your ankle and down the inside of your foot to underneath your arch. This tendon, along with some strong stabilising ligaments, is one of the major supporting structures of the foot. In PTTD, the tendon’s ability to perform that job is impaired, often resulting in a collapsed arch or ‘flat foot’. PTTD is the most common type of flat foot developed during adulthood, and is also known as adult-acquired flat foot.
• Symptoms include pain and swelling on the inside of your ankle which grows worse with increasing activity, tenderness over the midfoot especially during activity, weakness or an inability to stand on your toes, a collapsed arch and development of a flat foot, and gradually developing pain on the outer side of your ankle.

How did I get this?

• Often occurs in women over 50 years of age and may be due to an inherent abnormality of the tendon. But there are several other risk factors which include obesity, diabetes, hypertension, previous surgery or trauma, inflammatory diseases, and arthritis. The tendon may also become inflamed if excessive force is placed on the foot, such as when running on a banked track or road.

What can I do about it?

• Rest.
• Short term nonsteroidal anti-inflammatory drugs such as ibuprofen.

What help can I get for this?

• Podiatrist may advise immobilization of the foot for six to eight weeks with a removable boot to prevent overuse.
• Podiatrist may prescribe shoe inserts such as a heel wedge or arch support.
• Podiatrist may recommend that you use a custom-made orthotic or support.
• Foot and ankle surgeon for surgical management such as tendon repair or ankle joint fusion if conservative treatments don’t work.
• A program of exercises and therapy to help rehabilitate the tendon and muscle following immobilization.

When will it get better?

• The success of nonoperative treatment first requires the assessment of the flexibility of the flatfoot deformity. It is common for a patient to take 4-6 months to achieve much of their recovery and 12-18 months before they reach their point of maximal improvement after surgery.

Posterior Heel Spur

Summary

• The Achilles tendon inserts into the back of the heel bone. If there is excessive pull at the attachment, the area can become painful. In some instances a bone spur can form at the back of the heel. There is pain directly over the bone at the back of the heel.

How did I get this?

• Overuse particularly in sport. However, bone spurs can take many years to form without being painful.

What can I do about it?

• Rest.
• Ice.
• Heel raises can help.
• An Achilles heel protector can be of benefit.
• See a podiatrist.

What help can I get for this?

• Podiatrist may advise appropriate shoes, stretching, heel raise , and possible guided injection for symptoms control.
• Orthopaedic surgeon for surgical removal of bone spur.

When will it get better?

• This can be a very difficult condition to treat and can take several months to settle. Whilst the treatment options can be of benefit, they will not reduce any bone spur. With surgery, it often involves a long recovery (6-12 months).

Plantar Fibroma

Summary

• A benign small nodule that grows on the bottom of the foot. This feels firm to the touch. This mass can remain the same size or get larger over time, or additional fibromas may develop. People who have a plantar fibroma may or may not have pain.

How did I get this?

• The cause is unknown but thought to have a genetic component.

What can I do about it?

• Wear appropriate comfortable footwear.

What help can I get for this?

• Podiatrist for shoe padding or orthotic devices to relieve the pain by distributing the patient’s weight away from the fibroma.
• Foot and ankle surgeon for surgical treatment to remove the fibroma if the patient continues to experience pain following non-surgical approaches.

When will it get better?

• Return to unrestricted activity and shoe wear is in the one- to two-month range after surgery if measures are strictly followed.
  

Plantar Fasciitis

Summary

• An overuse injury that affects the sole of the foot. Symptoms include severe pain in the heel after the first few steps out of bed in the morning, or when standing up after sitting for long periods of time. Pain subsides while walking, but returns after spending long periods of time on your feet.

How did I get this?

• Low arched foot, abnormal strain caused by long hours on the feet, unsupportive shoes, and obesity are factors in developing this condition. Other causes include an underlying inflammatory condition, bone disease, infection, stress fracture, and nerve entrapment.

What can I do about it?

• Rest.
• Ice application and massage with a golf ball.
• Calf Stretches.
• Wear supportive footwear.
• Avoid going barefoot.
• Short term anti-inflammatory medications (ibuprofen) decrease inflammation and relieve the pain.

What help can I get for this?

• Podiatrist may prescribe padding and strapping to soften the impact of walking, support the foot and reduce strain on the fascia. This may be followed by orthotic devices to correct underlying structural abnormalities. Dry needling, foot mobilisation and extracorporeal shockwave therapy have been found to be effective.
• Podiatrist may prescribe a night splint to maintain an extended stretch of the plantar fascia while sleeping, reducing the morning pain experienced by some patients.
• Your Doctor may advise injection therapy to help reduce the inflammation and relieve pain.
• If after several months of non-surgical treatment you continue to have heel pain, surgery may be considered.

When will it get better?

• No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Peroneal Tendon Injury/Overuse

Summary

• The peroneal tendons are two tendons that lie immediately behind the outside bone of the ankle. These two tendons are responsible for moving the foot outwards. They balance the ankle and the back of the foot and prevent the foot from turning inwards repetitively. These tendons can be injured due to overuse or acute injury. There is pain behind the ankle, swelling over the peroneal tendons, and tenderness of the tendons.

How did I get this?

• It usually occurs because these tendons are subject to excessive repetitive forces during standing, walking, and running. History of ankle injury (e.g. blow to the ankle or ankle sprain) which can displace the peroneal tendons. Certain foot shapes such as a higher arched foot predispose to the development of injury as well.

What can I do about it?

• Rest is key, often helped by supportive footwear such as a hiking boot or jogger.
• Applying ice to the area can help to reduce swelling and help to control pain.
• Short term use of anti-inflammatories and can reduce the swelling around the tendon.
• Seek podiatry consultation.

What help can I get for this?

• Podiatrist for footwear modification, strapping, bracing, orthotics or other measures to reduce stress on the tendons and allow for rest and inflammation to subside.
• Orthopaedic surgeon for possible surgical repair if there are large tendon tears.

When will it get better?

• Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Recovery after surgery involves several weeks of restricted weight-bearing and immobilization, depending on the type of surgery performed. Following immobilization, therapy can begin. Total time for recovery is usually 6-12 weeks, depending on the extent of surgery.
  

OsTrigonum Syndrome

Summary

• Ostrigonum syndrome refers to pain in the back of the ankle. The Ostrigonum is an extra (accessory) bone that sometimes develops behind the ankle. The presence of an Ostrigonum in one or both feet is congenital (present at birth). It becomes evident during adolescence. Pain in the back of the ankle is the first indicator of Ostrigonum syndrome. The area in front of the Achilles tendon is sore to touch and the bony prominence may even be palpable. The diagnosis can usually be confirmed by x-ray views of the ankle from the side.

How did I get this?

• Ostrigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players and other athletes.

What can I do about it?

• Rest to stay off the injured foot to let the inflammation subside.
• Applying a bag of ice covered with a thin towel to the affected area decreases inflammation process.
• Short term nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
• Seek podiatry consultation.

What help can I get for this?

• Podiatrist may consider immobilization using a walking boot or splint to restrict ankle motion to allow healing.
• Your doctor may prescribe cortisone injection into the area to reduce the inflammation and pain.
• Foot and ankle surgeon for possible removal of Ostrigonum.

When will it get better?

• Most patients’ symptoms improve quickly with non-surgical treatment. However, in some patients, surgery may be required to relieve the symptoms. There is usually persistent swelling and discomfort after the surgery so limiting activities is required until these symptoms settle.

Nerve entrapment / Neuroma

Summary

• Thickening of the tissue that surrounds the nerve leading to the toes. Burning pain in the ball of the foot that may goes into the toes which generally intensifies with activity or wearing shoes. There may also be numbness or an unpleasant feeling in the toes.

How did I get this?

• Anything that causes compression or irritation of the nerve can lead to the development of a neuroma (e.g. wearing high heeled or tight shoes). Foot deformities are risk factors. Injury and trauma to the feet can also lead to this condition.

What can I do about it?

• Placing an icepack on the affected area helps reduce swelling.
• Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
• Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
• Padding techniques provide support lessening the pressure on the nerve and decreasing the compression when walking.

What help can I get for this?

• Podiatry consultation for treatments that include footwear advice, padding, orthotics, and may advise guided injections for alleviating the pain.
• Surgery may be considered if not responded adequately to non-surgical treatments.

When will it get better?

• Appropriate treatment can provide swift relief, but you will still need to consider long-term measures to help keep your symptoms from returning.