There are a large number of sporting injuries or conditions that may occur in the foot and leg. Some of the more common problems are:
What is it?
This is where the tendon attached to the heel becomes inflamed. Today another term is often used, this is achilles tendonopathy this describes damage or breakdown and possible scarring of the tendon and can occur due to chronic irritation of the tendon, or can occur as a person ages and there may be pain but not necessarily inflammation present.
- Faulty biomechanics- foot pronation forces the heel bone into eversion, or to roll in, this bends the tendon so it cannot function efficiently, in addition anterior (forward tilt) of the heel bone causes compensatory shortening of the calf muscles.
- Low or negative heel shoes- this puts more strain on the tendon and may lead to damage and inflammation, for example football boots
- Tight calf muscles- put a constant strain on the tendon resulting in injury to the tendon tissue
- Sudden increase in running or walking- causing a tear in the tendon
- Home stretching and strengthening exercises however these must be used with the advice of your podiatrist or more damage my occur
- Ultra sound therapy, this helps reduce the pain and swelling and is thought to help prevent scarring of the tendon if used in the early stages
- Temporary heel raises in the shoe reduces strain on the tendon, allowing faster recovery
- Assisted stretching using cold spray and muscle release techniques
- Orthotics to address biomechanical problems, and realign the tendon to prevent further damage
These treatments are quite effective particularly if treatment is sought early on; mid Achilles tendon injuries are probably the hardest to treat and may take a number of treatment sessions to obtain full recovery.
What is it?
Plantar heel pain or pain on the anterior aspect of the heel (front) is very common. Generally there is an excessive pull of the plantar fascia. The plantar fascia is a fibrous tissue that helps hold up the arch and is involved in the windlass mechanism of the foot, when you walk or particularly if you go on tip toes it tightens and maintains your arch. This excessive pull on the fascia may tear at the heel attachment, in some cases there may be inflammation but not all! Other causes may be a stone bruise or bruising under the heel bone, and in some cases bursitis under the heel. Some people may have bony spurs on the heel these do not cause the pain however; it is the soft tissue damage at the insertion that is the problem.
- Acute injury or tearing of the plantar fascia, often during running or sports such as tennis
- Overloading due to excessive body weight
- A sudden increase in walking, barefoot walking, using stairs or ladders
- Faulty biomechanics usually due to the arch dropping and putting traction on the attachment to the heel
Treatments is individualised depending on symptoms and patient preferences.
Short term- to relieve symptoms
- Rest, express orthoses are good for this as they can be dispensed on the spot and ‘rest the arch’
- Specific home calf stretching exercises, in the clinic assisted stretches, trigger point work and muscle release techniques
- Rolling the foot over a tennis ball
- Ice in the very early stages, then later heat packs or contrast foot baths
- Foot mobilisation and massage,
- topical treatments such as Flexall cream
- Low dye taping
- Night splints usually in resistant cases
Long term- to improve foot function
- Address any biomechanical issues with either off the shelf devices or custom made orthoses
- Weight loss if this is a factor
- Changes in sports training
Plantar fasciitis responds well to treatment more so if help is sought early on. More chronic cases will take longer to respond. I find if the condition is in its early stages 3 treatments will suffice, with ongoing home exercises, heat packs etc. Chronic cases may require more treatment however most respond well.
What is it?
Knee pain can be due to acute trauma resulting in tearing of ligaments, tendons, or cartilage. However it can also be due to chronic overuse, or overloading of structures around the knee and this is commonly what we see in the clinic.
Often knee pain during walking or running and other sports is due to faulty biomechanics. There may be some form of muscle imbalance particularly of the quadricep muscles at the front of the knee; weak medial quads cause the patella to drift laterally causing pain under the patella. Other causes may involve running on hard surfaces or and pavements with a camber. Worn out running shoes may also be a factor.
Foot pronation in particular can contribute to knee pain. Medial knee pain occurs due to valgus stress on the knee joint resulting in irritation of the soft tissues in this area. Lateral pain can occur inside the knee joint itself due to compression on the lateral cartilage; this may be due to faulty alignment.
Some specific examples of knee pain;
Pes ansurinus bursitis
Pes anserinus bursitis is an inflammatory condition of the medial knee. Diagnosis of pes anserine bursitis should be considered when there is spontaneous pain inferomedially to the knee (inside of leg and just below the knee joint.) Tight hamstrings and or excessive internal rotation of the leg can cause irritation of the soft tissues on this side of the knee.
Ileo tibial band syndrome
This muscle helps stabilise the knee joint, and if tight, (often due to excessive foot pronation), causes pain on the lateral (outside) of the knee. It may also cause pain on the outside of the hip
Patello femoral Syndrome
Sub patella pain or chondromalacia can be a result of improper gliding of the patella due to internal leg rotation, the patella rubs on the wrong part of the knee joint. Squatting and walking upstairs may be particularly painful.
Osgood Schlatters disease – usually seen in teenagers, quite often during a growth spurt, so called growing pains. This condition involves inflammation of the growth plate of the tibia (lower leg bone), which is situated just below the kneecap.
- Acupuncture- I find this particularly useful in releasing tight muscles and for pain relief
- Stretching and strengthening exercises
- Realignment of the knee using foot orthoses, is very useful where excessive foot pronation is a key factor in the aetiology of the condition
Soft tissue injuries around the knee respond well to a combination of local treatment and addressing any biomechanical issues affecting the knee alignment.
Shin Splints (tibial stress syndrome)
What is it?
This is a fairly common injury in runners particularly females. There is pain on the front of the leg (lower 1/3) caused by inflammation of muscle, and its attachment to the tibia, there may be a small tear in the muscle. There are two types’ anterior shin splints (front of shin) and posterior shin splints (inside of shin). Shin splints cause a dull aching pain, and may be painful to the touch. It is usually more painful in the morning as tissues tighten overnight; it is particularly painful if you flex your foot up at the ankle.
Shin splints can progress and cause damage to the bone. Initially a stress reaction may occur, and if not treated properly this may develop into stress fractures of the tibia, an extremely painful condition. Stress fractures are treated by rest and time away from sporting activity.
What causes it?
Medial shin splints are often associated with foot pronation, while anterior shin splints may be associated with tight calf muscles.
- Over pronation of the foot
- Inadequate stretching
- Overuse and poor conditioning, running too much to soon
- Running surface such as hard roads or pavement with a camber causing increased foot pronation on one side
- Hills running
- Cut back on activity this is essential, and use alternative exercise such as swimming or walking in a pool, and bike riding which cause less stress on the leg muscles
- Icing will help with the pain
- Gentle stretching
- Walk on flat softer surfaces, don’t overstride
- Physical therapy, ultrasound, laser, acupuncture
- Foot orthoses to address biomechanical issues
- Check footwear for excessive wear, and match to foot type
Depending on the degree of damage shin splints can be effectively treated however training must be reduced to allow damaged tissue to heal, this may take up to 6 weeks.